Ischaemic Heart Disease Flashcards
What is the main cause of IHD
Atherosclerosis
What is Atherosclerosis
Accumulation of lipids, smooth muscle cells and macrophages in intima of medium and large vessels
Describe the progression of Atherosclerotic plaque
Endothelial Injury Fatty Streak Intermediate lesion Plaque -> Rupture Erosion
What causes plaque rupture
Plaque grows and recedes to maintain Balance shifts towards inflammation Cap wall weakens and thins Cap ruptures and forms thrombus Occlusion can occur
What are the types of IHD
Heart Attack
Gangrene
Stroke
What are the modifiable risk factors for IHD
Smoking
Alcohol
Obesity
Diabetes Mellitus
What are the non modifiable risk factors for IHD
Family History
Age
Afro Caribbean
Male
Describe the presentation of Angina
Central CRUSHING chest pain
Radiates to the neck jaw and arms
What is stable angina
Angina relieved by rest and GTN, Caused by exercise
What is unstable angina
Angina with no relief and no extrinsic cause (Severe ischemia)
What is Prinzemetal Angina also known as
Coronary Artery Vasospasm
-Cocaine use w/ ST elevation
How do you treat IHD
Aspirin/Clopidogrel
Statins
Antihypertensives
How do you treat Angina
GTN (Stable) isosorbide mononitrate
BB-CCB
AAA (Aspirin, Atorvastatin, ACEi)
Why can exercise cause angina
Patients with atherosclerosis will have low microvascular resistance to increase their blood flow
When exercising they need their microvascular resistance to go lower to get more blood flow but it can’t leading to insufficient oxygen supply
What is the GOLD standard investigation for IHD
CT coronary Angiography
What would you exclude when investigating IHD
Anaemia (Full blood count)
Diabtetes (HbA1c)
What investigations would you do for IHD
1.ECG
1.CT CORONARY
ANGIOGRAPHY
2.Echocardiography
2.Exercise tolerance
3.Invasive Angiogram
What cause atherosclerotic Inflammation
Endothelial damage
Chemoattractants migrate leukocytes to wall
Cytokine IL1,1L6 released = Inflammation
What are preventative factors for Stable Angina
Smoking Cessation Glycaemic control HTN Hyperlipidaemia Weight Loss Alcohol intake
What revascularisation methods can be considered in Stable Angina
CABG
PCI (Cheap)
Why would you choose CABG over PCI
Over 65
Diabetic
3 vessel disease
left main stem stenosis
What percentage of stenosis is required for systematic atherosclerosis
70-80%
What is the QRISK score
Predicts CVD risk for 10 years in healthy patients
What QRISK score indicates start of lipid lowering therapy
10+
