Ischaemic Heart Disease

Question 1

what is ischaemic heart disease

Answer 1

narrowing of arteries- same as coronary heart disease

Question 2

can IHD cause sudden death

Answer 2

yes but not common

Question 3

what percentage of IHD deaths common

Answer 3

50% (rare as not many deaths from IHD)

Question 4

what does a family history of CHD put diagnosed patients at greater risk of

Answer 4

ventricular fibrillation

Question 5

what types of plaque causes transient ischemia

Answer 5

unstable plaque

Question 6

what causes an acute MI

Answer 6

and acute occusion

Question 7

what does a chronic closure of an artery cause

Answer 7

scar formation

Question 8

how does scar formation affect the electrical conductivity of the heart

Answer 8

can cause ventricle fibrillation as potentially allows re-entrance circuit (as signals circle the scar)

Question 9

when can a clot cause VF

Answer 9

when affecting electrically sensitive area of the heart

Question 10

how does disordered cardiac muscle fibres affect treatment of fibrillation and cardiomyopathy

Answer 10

harder to treat

defibrillation less effective

Question 11

what is cardiogenic shock

Answer 11

Inadequate systemic perfusion as a result of cardiac dysfunction

Question 12

what circulatory effects does an MI cause

Answer 12

build up of pressure in heart and lungs- oedema and systemic inflammation response

Question 13

what is the key thing to treat in an MI

Answer 13

ischaemia

Question 14

how is angina diagnosed

Answer 14

visceral, dull, pain from myocardial hypoxia
gestures (tight fist over/holding chest)

characteristic patterns of
provocation, relief (rest), timing (1-2 mins)

risk factors

Question 15

describe the pain of angina

Answer 15

Pressing, squeezing, heaviness, a weight,

Radiating to arm(s), back, neck, jaw, teeth

Question 16

what can provoke angina

Answer 16

Exertion, stress, cold wind, after meals

Question 17

what other than rest can relieve angina

Answer 17

GTN spray

Question 18

what are the differential diagnosis of chest pain

Answer 18

GI tract (reflux, prptic ulcer, oesophageal spasm, biliary colic)

musculoskeletal (injury, nerve root pain)

pericarditis

pleuritic pain

Question 19

what causes of chest pain are emergencies

Answer 19

MI- severe, ongoing despite morphine

Pulmonary Embolus- breathlessness, dull

dissection of aorta- tearing, excruciating

Question 20

what is associated with autonomic upset

Answer 20

sweating, SOB, fear, impending doom

Question 21

does angina always accompany CHD

Answer 21

no

Question 22

what is exercise testing

Answer 22

BP and ECG recorded during exercise

Question 23

what is perfusion imaging

Answer 23

is a non-invasive imaging test that shows how well blood flows through (perfuses) your heart muscle

Question 24

what are the pros and cons of perfusion imaging

Answer 24

pros
non invasive more precise than ETT

cons
radiation, false pos and negs

Question 25

what is a CT angiography

Answer 25

injecting contrast to get 3d reconstruction of coronary circulation

Question 26

what are the cons of CT angiography

Answer 26

less precise than angiography, costly

Question 27

what is ETT

Answer 27

exercise tolerance test

Question 28

what is angiography

Answer 28

sheath inserted into artery from wrist/groin to coronary ostium x ray contrat agent injected to outline coronaries video fluoroscopy recorded in multiple views

Question 29

what are the pros and cons of angiography

Answer 29

best imaging cons risk of death/stroke (low) radiation contrast; renal dysfunction, rash, nausea

Question 30

how do you reduce the risks of CHD (death/disability)

Answer 30

drugs, lifestyle, revascularisation

Question 31

what drugs are used to treat CHD

Answer 31

aspirin- antiplatelets beta blockers- slow heart rate, reduce o2 demand statin- reduces cholesterol ACE inhibitor- reduces blood pressure

Question 32

what is coronary revascularisation

Answer 32

restoring blood flow to the heart e.g. coronary artery bypass

Question 33

how is the heart accessed in a coronary artery by pass

Answer 33

median sternotomy

Question 34

what vessels are used in a coronary artery bypass

Answer 34

Long saphenous vein | Internal Mammary artery

Question 35

what is cardioplegia

Answer 35

temporary cessation of cardiac activity

Question 36

what are the complications of coronary artery bypass

Answer 36

death, stroke, MI, atrial fibrillation, infection, cognitive impairement, sternal malunion, renal failure

Question 37

define and describe PCI

Answer 37

Percutaneous coronary intervention (angioplasty with stent) non-surgical procedure that uses a catheter to place a small structure called a stent to open up blood vessels in the heart that have been narrowed by plaque buildup

Question 38

what are the complications of PCI

Answer 38

death, stroke, MI, renal failure, bleeding, vascular complications; stent thrombosis or restenosis

Question 39

what is restenosis

Answer 39

the recurrence of narrowing of a vessel

Question 40

describe the PCI technique

Answer 40

``` vascular access anti platelet drugs, anticoagulation catheter to ostium (opening)of coronary guidewire down vessel balloons threaded over wire stents implanted ballon, catheter and wires removed ```

Question 41

what makes a patient suitable for revascularisation

Answer 41

multi vessel disease left main disease diabetes co-morbidities

Question 42

what are the pros of radial artery access

Answer 42

dual supply to hand, superficial, compressible, no adjacent nerve/vein

Question 43

what are the cons of radial artery access

Answer 43

smaller, prone to spasm, occlusion

Question 44

what is haematoma

Answer 44

solid swelling of clotted blood within the tissues

Question 45

how is a STEMI revascularised

Answer 45

PCI

Question 46

what is acute coronary syndrome and how is it revascularised

Answer 46

any group of clinical symptoms compatible with acute myocardial ischemia and includes unstable angina (UA), non—ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI). angiography with a view to revascularisation