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Cardio > Ischaemic Heart Disease > Flashcards

Ischaemic Heart Disease Flashcards

1
Q

What is the main cause of IHD

A

Atherosclerosis

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2
Q

What is Atherosclerosis

A

Accumulation of lipids, smooth muscle cells and macrophages in intima of medium and large vessels

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3
Q

Describe the progression of Atherosclerotic plaque

A 
Endothelial Injury
Fatty Streak
Intermediate lesion
Plaque -> Rupture
Erosion
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4
Q

What causes plaque rupture

A 
Plaque grows and recedes to maintain
Balance shifts towards inflammation
Cap wall weakens and thins
Cap ruptures and forms thrombus
Occlusion can occur
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5
Q

What are the types of IHD

A

Heart Attack
Gangrene
Stroke

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6
Q

What are the modifiable risk factors for IHD

A

Smoking
Alcohol
Obesity
Diabetes Mellitus

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7
Q

What are the non modifiable risk factors for IHD

A

Family History
Age
Afro Caribbean
Male

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8
Q

Describe the presentation of Angina

A

Central CRUSHING chest pain

Radiates to the neck jaw and arms

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9
Q

What is stable angina

A

Angina relieved by rest and GTN, Caused by exercise

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10
Q

What is unstable angina

A

Angina with no relief and no extrinsic cause (Severe ischemia)

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11
Q

What is Prinzemetal Angina also known as

A

Coronary Artery Vasospasm

-Cocaine use w/ ST elevation

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12
Q

How do you treat IHD

A

Aspirin/Clopidogrel
Statins
Antihypertensives

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13
Q

How do you treat Angina

A

GTN (Stable) isosorbide mononitrate
BB-CCB
AAA (Aspirin, Atorvastatin, ACEi)

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14
Q

Why can exercise cause angina

A

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

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15
Q

What is the GOLD standard investigation for IHD

A

CT coronary Angiography

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16
Q

What would you exclude when investigating IHD

A

Anaemia (Full blood count)

Diabtetes (HbA1c)

17
Q

What investigations would you do for IHD

A

1.ECG
1.CT CORONARY
ANGIOGRAPHY
2.Echocardiography
2.Exercise tolerance
3.Invasive Angiogram

18
Q

What cause atherosclerotic Inflammation

A

Endothelial damage
Chemoattractants migrate leukocytes to wall
Cytokine IL1,1L6 released = Inflammation

19
Q

What are preventative factors for Stable Angina

A 
Smoking Cessation
Glycaemic control
HTN
Hyperlipidaemia
Weight Loss
Alcohol intake
20
Q

What revascularisation methods can be considered in Stable Angina

A

CABG

PCI (Cheap)

21
Q

Why would you choose CABG over PCI

A

Over 65
Diabetic
3 vessel disease
left main stem stenosis

22
Q

What percentage of stenosis is required for systematic atherosclerosis

23
Q

What is the QRISK score

A

Predicts CVD risk for 10 years in healthy patients

24
Q

What QRISK score indicates start of lipid lowering therapy

25
Q

What is the GRACE score

A

Predicts death from MI upto 3 years in ACS

26
Q

If a patient presents with a fist to the chest, what sign is this

A

Levine sign

27
Q

When is Decubitus angina induced

A

When lying flat

28
Q

What is the first line investigation for angina

29
Q

How is ANGINA treated

A 
GTN spray
Lifestyle modifications
1 = CCB / BB
2= CCB and BB
3= CCB, BB AND Ivabradine
30
Q

When is CCB CI

A

Herat fail

31
Q

When is BB CI

32
Q

What CCB should be given for Angina

A

Non rate limiting (cause bradycardia)

-Amlodipine

33
Q

What other drugs can be given to anginal patients

A

ACE-i
Aspirin
Statins
AntiHTN

34
Q

At what point would you consider PCI and CABG

A

Referral or useless drugs

35
Q

What is a PCI

A

Coronary artery balloon stent

36
Q

What is CABG

A

LAD bypass graft

Cardio (26 decks)

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