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HLB > Ischaemic Heart Disease > Flashcards

Ischaemic Heart Disease Flashcards

1
Q

Ischaemic Heart Disease

A

a group of clinical syndromes usually due to atherosclerosis of the coronary arteries: angina, MI, heart failure

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2
Q

Less common ischaemic heart diseases:

A
  • arrhythmias
  • mitral valve dysfunction
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3
Q

Angina symptoms and exacerbating figures:

A
  • exertional
  • settles within 2-10min
  • tight/dull/squeezing/heavy
  • poorly localised, L>R, commonly across the chest
  • radiation to arms L>R and throat/teeth
  • sometimes can be worse on inspiration but very few
  • worse: in the cold, after a large meal
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4
Q

Demand Ischaemia:
- is (2)
- causes
- when

A
  • stable angina
  • fixed obstruction
  • inadequate blood flow when demand increases:
    - exertion
    - other demands for blood (post-meal)
    - tachyarrhthmia (increases metabolic demand,
    chest pain)
  • will present as chest pain (angina)
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5
Q

Incidence of coronary artery disease by age

A

over 70s increased risk

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6
Q

Cardiac Pain:

A
  • referred pain = pain of visceral origin, perceived in
    somatic regions innervated from the spinal segments
    as the heart
  • carried via cardiac sympathetic afferent nerves:
    - to spinothalamic tract
    - to the thalamus
    - to the cerebral cortex
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7
Q

Cardiac pain referred to which areas?

A
  • T1-T5 (chest pain)
  • C5-C6 (shoulder)
  • tends to SPARE C7-C8 (distal arm)
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8
Q

Cardiac referred pain diagram

A

insert

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9
Q

Myocardial Infarction: symptom of chest pain: key features:

A
  • severe and persistent
  • tight/dull/squeezing, heavy
  • poorly localised, L>R, commonly across chest
  • radiation to arms L>R and throat/teeth
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10
Q

Myocardial Infarction associated symptoms:

A
  • malaise
  • nausea
  • breathlessness
  • sweating
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11
Q

Myocardial Infarction is acute or chronic

A

acute

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12
Q

Supply Ischaemia:
- is (2)
- caused by
- results in

A
  • acute coronary artery occlusion (full occlusion)
  • inadequate blood flow even to cover basal
    requirements
  • atheromatous plaque that has ruptured, exposing
    collagen and proteins, activating clotting cascade,
    thrombus formation, looming occlusion
  • results in an acute MI
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13
Q

Ischaemic Cascade:

A

insert diagram

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14
Q

Heart Failure:
- causes and symptoms

A
  • Due to low cardiac output:
    - fatigue
  • Due to fluid retention:
    - leg swelling
    - breathlessness (cough)
    - orthopnoea
    - Paroxysmal nocturnal dyspnea (waking in the
    night gasping for breath)
  • 50-70% cases due to IHD:
    - previous MIs
    - chronic ischaemia
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15
Q

Paroxysmal nocturnal dyspnea indicates

A

LV systolic dysfunction

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16
Q

Silent Ischaemia:

A
  • first sign of IHD may be sudden death:
    - acute occlusion of non-obstructive plaques or
    - obstructive disease with silent ischaemia
  • strong evidence of benefit from preventive
    medication/therapies and lifestyle changes
17
Q

Silent Ischaemia: Screening?:

A
  • no ideal screening test
  • Exercise ECG: low sensitivity and specificity, labour
    intensive
  • Cardiac CT: expensive, radiation risk
18
Q

Principles of Management for all IHD patients:

A
  • lifestyle changes
  • risk factor management
  • anti-thrombotic therapy

may work:

  • medication for symptoms
  • revascularisation for chronic, severe disease
  • acute reperfusion Rx for STE-MI
  • rehabilitation
19
Q

Principles of Management for IHD: Lifestyle changes:

A
  • stop smoking
  • optimise weight: MBI 18.5-25 kg/m^2
  • low saturated fat diet
  • regular aerobic exercises
20
Q

Principles of Management for IHD: Risk Factor Management: State the three risk factors:

A
  • hypertension
  • hyperlipidaemia
  • diabetes
  • become younger and more female
21
Q

Principles of Management for IHD: Risk Factor Management: Hypertension:

A
  • lose weight
  • reduce salt intake
  • drugs (ACE inhibitors = Ramipril)
22
Q

Principles of Management for IHD: Risk Factor Management: Hyperlipidaemia:

A
  • diet: reduce saturated fat intake
  • Drugs: (statins = atorvastatin)
23
Q

Principles of Management for IHD: Risk Factor Management: Diabetes:

A
  • optimise glycaemic control: reduce intake of refined
    sugars
  • drugs (metformin, insulin)
24
Q

Anti-platelet drugs:

A
  • cyclo-oxygenase: aspirin
  • ADP receptor anatagonist: Clopidogrel
  • GP 2b/3a antagonists: Abciximab, Tirofiban,
    eptifibatide
25
Q

Anti-platelet drugs diagram

A

insert

26
Q

Acute MI anticoagulants:

A
  • heparin derivatives
  • intravenous heparin
  • low molecular weight heparin
  • fondaparinux
27
Q

Anti-anginals:

A
  • beta blockers (beta 1 selective (bisoprolol))
  • calcium channel antagonists (cause vasodilation)
    (amlodipine, diltiazem)
    -
28
Q

Anti-anginals:

A
  • beta blockers (beta 1 selective (bisoprolol))
  • calcium channel antagonists (cause vasodilation)
    (amlodipine, diltiazem)
  • Nitrates (GTN, isosorbide)
29
Q

Medical Rx - Anti-anginals: beta-blockers:

A
  • block cardiac beta-1 receptors: reduce the force of
    contraction, reduce heart rate response to exercise
  • biosprolol (beta 1 selective)
30
Q

Medical Rx - Antianginals: Calcium Channel Blockers:

A
  • calcium channel antagonists
  • reduce calcium entry to myocyte and vsacular smooth
    muscle
  • reduce force of heart contraction
  • dilate arteries: coronary arteries, lowers BP (reduced
    afterload)
  • amlodipine, diltiazem
31
Q

Medical Rx - anti-anginal drugs: Nitrates:

A
  • nitrates mimic actions of nitric oxide (EDRF)
  • dilate coronary arteries
  • dilate veins > arteries, reducing venous return
    (preload)
  • short-acting: GTN spray
  • Long acting: Isosorbide mononitrate
32
Q

Left anterior descending artery:%:

A

45%

33
Q

Circumflex artery: %:

A

20-30%

34
Q

Left mainstem and Proximal Left anterior descending:

A

high risk

35
Q

Revascularisation: Coronary Artery Bypass Grafting:

A
  • open heart surgery via sternotomy
  • uses conduits to bypass coronary stenoses: internal
    mammary arteries, radial arteries, saphenous veins
  • heart stopped
  • bypass machine
  • 1 week in hospital
  • 2-4 months recovery
36
Q

Revascularisation: PCI:

A
  • percutaneous coronary intervention
  • stenting, angioplasty
  • percutaneous procedure:
    - catheter to the coronary artery
    - wire through the narrowing
    - dilated with a balloon
    - stent deployed
  • local anaesthetic
  • rapid recovery
  • home same day
  • back to normal in 1 week
37
Q

Acute MI: minutes = myocardium:

A
  • necrosis detectable after 15min, but
  • not uniform within an ischaemic territory: sub-
    endocardial myocardium is more sensitive, collateral
    blood vessels provide partial protection
  • myocardium can be salvaged upto 12 hours after
    coronary occlusion
38
Q

Acute reperfusion Rx for ST-elevation MI- thrombolysis vs primary PCI:

A

Typical STEMI mortality rates:
Pre-intervention 10-15%
Thrombolysis/aspirin 6-8%
Balloon only PCI 2-3%
Balloon + stenting PCI <1%

39
Q

Why is it harder to use a saphenous vein in a CABG?

A

harder to make a vein behave as an artery
7% occlusion chance

HLB (49 decks)

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