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YR3: CARDIAC LO's > Ischaemic Heart Disease > Flashcards

Ischaemic Heart Disease Flashcards

1
Q

Define IHD

A

decreased blood supply to heart muscle resulting in chest pain (angina pectoris).
May present as stable angina or acute coronary syndrome.

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2
Q

How can ACS be subdivided?

A

Unstable angina: rest pain due to ischaemia, without cardiac injury
NSTEMI: ST depression, subendocardial injury
STEMI: ST elevation with transmural infarction

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3
Q

Define Myocardial Infarction

A

cardiac muscle necrosis resulting from ischaemia

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4
Q

Describe the epidemiology of ischaemic heart disease

A

COMMON
5/1000 PA
Prevalence: > 2 %
M > F

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5
Q

Describe the aetiology of Angina Pectoris

A

Myocardial O2 demand exceeds supply
Often due to atherosclerosis
Rarer causes: coronary artery spasm (e.g. cocaine), arteritis + emboli

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6
Q

List 9 risk factors for IHD

A 
Male
Age
FHx
Diabetes mellitus 
HTN 
Hyperlipidaemia  
Smoking
Diet + exercise
Alcohol
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7
Q

Describe the pain that characterise ACS

A

Acute-onset chest pain
Central, heavy, tight, crushing
Radiates to the arms, neck, jaw or epigastrium
Occurs at rest
More severe + frequent pain than previously occurring stable angina

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8
Q

What are 3 associated symptoms of ACS?

A

Breathlessness
Sweating
Nausea + vomiting

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9
Q

What may occur in elderly or diabetic patients with ACS?

A

Silent infarcts

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10
Q

Describe the presenting symptoms of stable angina

A

Constricting discomfort in the chest, neck, shoulders, jaw + arms on exertion
Relieved by GTN/ rest within 5 minutes

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11
Q

What are 8 signs of ACS?

A 
May be NO CLINICAL SIGNS 
Pale  
Sweating  
Restless 
Low-grade pyrexia  
Check both radial pulses to rule out aortic dissection 
Arrhythmias/ New heart murmurs  
Disturbances of BP  
Signs of complications (e.g. acute HF, cardiogenic shock)
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12
Q

What are the appropriate bloods to take for suspected ACS?

A 
FBC
U+E's (electrolyte imbalance)
Glucose
Lipid profile
Amylase  (pancreatitis could mimic MI) 
CRP
TFT's
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13
Q

Which cardiac enzymes rise in ACS and when?

A

CK-MB (within 6 hours)

Troponin I + T (3-6 hours after infarction, peak at 12-24 hours, remain raised for up to 14 days)

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14
Q

Describe ECG findings for unstable angina and NSTEMI

A

ST depression or T wave inversion

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15
Q

Describe ECG findings for STEMI

A

Hyperacute tall T waves
ST elevation (> 1 mm in limb leads, > 2 mm in chest leads)
New-onset LBBB
Later: T wave inversion, Pathological Q waves

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16
Q

What may a CXR in ACS show?

A

Complications of ischaemia eg, pulmonary oedema
Cardiomegaly
Enlarged mediastinum

17
Q

What is the medical management strategy of stable angina?

A

Symptomatic (GTN)
Anti-anginals (BBs/CCBs)
Risk factor reduction (statins, aspirin, ACEi)

18
Q

Describe the conservative management of stable angina

A

Stop smoking
Lose weight
Exercise

19
Q

How do you treat patients with stable angina when pharmaceutical methods are ineffective?

A

Percutaneous coronary intervention

Coronary Artery Bypass Graft

20
Q

Describe the acute management of ACS

A 
MONABASH
Morphine 2.5-5mg IV
Oxygen  
Nitrates  
Antiplatelets (300mg Aspirin + 300mg Clopidogrel)  
Beta-blockers  
ACE inhibitors  
Statins  
Heparin 5000 units
21
Q

Detail the treatment of unstable Angina and NSTEMI

A

Immediate
300mg Aspirin + other anti-platelets (e.g. clopidogrel, Ticagrelor)
Either:
· Fondaparinux (NOAC): if low bleeding risk + no coronary angiography planned in <24hrs
· LMWH: if coronary angiogram planned

Risk stratification – GRACE score:
High risk: Glp2b/3a inhibitors + coronary angiography (<72hrs)
Low risk: conservative RF control

22
Q

Detail the treatment of STEMI depending on time since onset of symptoms

A

<12 hours: PCI (if <120 mins), thrombolysis if >120 minutes + rescue PCI
>12 hours: coronary angiography + PCI if indicated

23
Q

What medical therapy is used to address STEMI?

A

GP IIb/IIIa receptor antagonist e.g. Abciximab (pre-catheterisation)
Anticoagulant e.g. Heparin until PCI/ 48hrs post fibrinolytic
Dual anti platelet therapy: Aspirin + clopidogrel (or ticagrelor) for >,12 months

24
Q

What are the complications of ACS?

A 
DARTH VADER
Death
Arrhythmias
Rupture
Tamponade
Heart failure
Valve disease
Aneurysm
Dressler's Syndrome
Embolism
Re-infarction
25
Q

List 3 early complications of ACS which are not in DARTH VADER

A

Heart Block
Cardiogenic shock
Pericarditis

26
Q

What is used to calculate risk of mortality in patients with unstable angina or NSTEMI?

A 
TIMI Score (Thrombolysis in myocardial infarction)
High scores associated with high risk of cardiac events within 30 days of MI
27
Q

How do leads localise site of MI?

A

Inferior: II, III, aVF
Anterior: V1-V4
Lateral: I, aVL, V5/6
Posterior: Tall R wave + ST depression in V1-3

28
Q

Which leads have maximal ST elevation in anterior MI?

A

SAL
Septal (V1-2)
Apical (V3-4)
Lateral (V5-6)

29
Q

Describe the mortality of ACS

A

50% deaths occur within 2 hours onset of symptoms

30
Q

What indicates a worse prognosis in ACS?

A

Elderly
LV failure
ST changes

YR3: CARDIAC LO's (33 decks)

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