Ischaemic Heart Disease Flashcards
What are common causes of chest pain?
Skin (shingles) MSK Vascular Respiratory GI Cardiac
What are MSK causes of chest pain?
Costochondritis
Rib fractures
What are vascualr causes of chest pain?
Aortic dissection
WHat are GI causes of chest pain?
GORD (burning sesnation worsened why laying down)
Peptic Ulcer disease (high abdo confused for chest)
What are respiratory causes of chest pain?
Pleurisy (imflammation of the plura)
-from pneumonia/ embolism
Have general unwellness/ breathlessness
What are the two types if chest pain?
Cardiac
Pleuritic
What is cardiac chest pain?
Dull/ heavy Poorly localised Central Worsened with exercise Get referred pain
From visceral afferent nerves
What is pleuritic chest pain?
Sharp
Well localised
Non central
Worsened by movements
Via somatic afferent nerves
What is pericarditis?
Inflamation of the pericardium
How does pericarditis present?
Sharp pain behind stermun
Aggrivated by breathing
Pericardial rub heart murmour
Widespread ST elevations across all leads
What is acute coronary syndrome?
Spectrum of myocardial ischaemia/ infarctions
What are the conditions classed as acute coronary syndromes?
Unstable angina
NSTEMI
STEMI
What is the difference bewteen a NSTEMI and STEMI?
ST elevation in STEMI
In STEMI complete occlusion of coronary artery whrere as in NSTEMI only partial
What invetigations would you do for an MI?
History (type of chest pain, autonomic symptoms)
Identify risk factors
Troponin blood test (elevated in MI)
ECG (ST segment abnormalities)
Echocardiogram (can see if area of heart walls damaged ect)
How can you distinguish NSTEMI from unstable angina?
Troponin blood tests
NSTEMI levels will be raised
-this is due to cardiac myocyte death
How does stable angina occour?
Atherosclerosis- stable occlusion of vessels
Have a stable atherosclerotic plaque (normally still able to get enough O2 delivery)
How do Actute coronary syndromes develop?
Stable occlusion
Plaque rupture and platelet aggrigation
Thrombus formation
Sudden increased occlusion
Degree of increased occlusion determines type of syndrome
What is the difference between stable and unstable angina?
Stable angina is relieved by rest (exercise related)
Unstable angina is present at rest (risk of leading to MI)
How is (stable) angina managed?
GTN spray during episodes- causes venodilation (restore o2 balance to ischeamic heart)
B-blockers- reduce mycocardium o2 demand
Antiplatelet therpaies (eg Asprin)- reduce risk of platelet aggregation
Other treatments to reduce CV risk factors
How is Unstable angina treated?
Simular to stable
Heparin (blood thinner reduce change of platelet formation)
Treatments to reduce CV risk factors
How is a NSTEMI treated?
1) Antiplatelet and antithrombotic drugs (Asprin/ Enoxaparin)
2) Anti-ischaemics (B-blockers/ GTN)
3) Secondary prevention (reducing risk factors eg, statins and ACE inhibitors)
In what circumstances does an NSTEMI need an urgent PCI?
If pateint has ongoing CP with dynamic ECG changes
If they develop arrythmias (eg VTs) suggests heart unstable
How to manage a STEMI?
URGENT
1) Asprin (reduce platelet aggregation)
2) Morphine (and antisickness for pain)
3) GTN spray (reduces some symptoms)
4) O2 if have low sats
5) Transfer to cath labs for PCI
What is a PCI?
Percutaneous coronary intervention
Catherter inserted to peripheral artery + directed to site of occlusion
Balloon inflated (this compressed thrombus and plaque)
Artery made patient
Stent inserted (restores normal blood flow in longer term)
