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2a Cardio > Ischaemic Heart Disease > Flashcards

Ischaemic Heart Disease Flashcards

1
Q

What is another name for Ischaemic Heart Disease?

A

Coronary heart disease (CHD) or
Coronary artery disease

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2
Q

What is Ischaemic Heart disease?

A

Heart’s blood supply is blocked or interrupted due to atherosclerosis in the coronary arteries

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3
Q

What are the main symptoms of ischaemic heart disease?

A

Angina
SOB
Pain in neck, shoulders, jaw or arms
Feeling faint
Nausea

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4
Q

What is stable angina (3 parts)?

A

1) Central crushing chest pain radiating to neck and jaw

2) Brought on with exertion

3) Relieved with 5 mins rest or GTN spray

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5
Q

What does stable angina progress to?

A

Unstable angina
Then NSTEMI (partial infarction)
then STEMI (transmural infarction)

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6
Q

What is unstable angina (3 parts)?

A

1) Central crushing chest pain radiating to neck or jaw

2) Pain at rest

3) Pain not relieved with inactivity or GTN spray

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7
Q

What is Prinzmetal’s?

A

Type of angina due to coronary vasospasm rather than atherogenesis in coronary arteries.

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8
Q

Which group of people is Prinzmetal’s angina seen in?

A

Cocaine users particularly

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9
Q

What is an ECG finding in Prinzmetal’s angina?

A

ST elevation

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10
Q

What would it mean for an angina to be decubitus?

A

Induced by lying flat

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11
Q

How is a venous thrombosis diagnosed?

A

D-dimer (sensitive but not specific, is a fibrin degradation product and may be elevated due to infection, malignancy or trauma)

Imaging like duplex ultrasonography or Venous Doppler ultrasound

May take PT, aPTT and TT

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12
Q

What does an atherosclerotic plaque consist of?

A

Lipid
Necrotic core
Connective tissue
Fibrous cap

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13
Q

What are some risk factors for IHD?

A

Age
Smoking
Male
Family history
DMT2
Cocaine use
Hyperlipidaemia
Hypertension
Kidney disease
Obesity
Physical inactivity
Stress

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14
Q

Name some environmental factors which exacerbate IHD

A

Cold weather
Heavy meals
Emotional stress

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15
Q

Name some types of angina

A

Prinzmetal’s angina
Microvascular angina
Crescendo angina
Unstable angina

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16
Q

For describing pain, what does OPQRST stand for?

A

Onset
Position (site)
Quality (nature/character)
Relationship (with exertion, posture, meals, breathing and with other symptoms),
Radiation
Relieving or aggravating factors
Severity
Timing
Treatment

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17
Q

Name a calcium channel blocker

A

Amlodipine

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18
Q

Beta blockers reduce heart rate, ___ ventricular c_____, CO and oxygen demand

A

left ventricular contractility

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19
Q

Side effects of beta blockers

A

Tiredness, nightmares, bradycardia, erectile dysfunction, cold hands and feet

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20
Q

When would you not prescribe a beta-blocker?

A

Patients with asthma

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21
Q

How do nitrates help?

A

Venodilators meaning reduced venous return and reduced preload and afterload

22
Q

How does aspirin help?

A

COX inhibitor, decreased prostaglandin synthesis including thromboxane, decreased platelet aggregation, antipyretic, anti-inflammatory, analgesic

23
Q

What is a complication of aspirin

A

Gastric ulceration

24
Q

Statins inhibit which enzyme?

A

HMG CoA Reducatase

25
Q

What is PCI?

A

Percutaneous coronary intervention
same as coronary angioplasty
same as stenting

26
Q

Why is Fondaparinux used instead of heparin?

A

Fandoparinux specifically inhibits factor Xa while heparin binds to antithrombin III to enhance its inhibition of thrombin and Xa.
Longer half life so administered once daily so more convenient. heparin needs frequent dose adjustments.
Lower risk of heparin-induced thrombocytopenia (low platelets) and osteoporosis.

(However, Fondaparinux cannot easily be reversed in bleeding emergencies and contraindicated in severe renal impairment.)

27
Q

Is heparin used for treating an arterial thrombus?

A

Not typically, often arterial thrombi are rich in platelets and fibrin. Heparin works by promoting activity of antithrombin III which inhibits thrombin and factor Xa, primarily affecting thrombi in veins.
Increases risk of bleeding.
Slower onset of action.

28
Q

What is used to treat an arterial thrombus?

A

May be antiplatelet agent like aspirin or P2Y12 inhibitor and anticoagulants.
Thrombolytic therapy like tissue plasminogen activator
Surgical thrombectomy

29
Q

What are the 3 components of Virchow’s triad?

A

Blood stasis
Hypercoagulability
Endothelial injury

30
Q

What factors might cause blood stasis and increase chance of a venous thrombosis?

A

Immobilisation:
Surgery
Long haul flight
Trauma

31
Q

What is used to treat venous thrombosis?

A

Heparin or LMWH
Warfarin
DOAC
Surgery

32
Q

When would the treatment of DVT be more aggressive?

A

History of DVT or PE
Cancer
Thrombophilia
Severe obesity
Immobilisation
Heart failure
Chronic kidney disease

33
Q

Heparin is a g_______ which binds to and promotes antithrombin which inhibitors factors _, _ and _

A

glycosaminoglycan
2 (thrombin), 9 and 10

34
Q

What is used to monitor heparin?

A

aPTT (intrinsic pathway involves all factors that are inhibited by antithrombin which heparin promotes)

35
Q

True or false, heparin is given by continuous infusion

A

True

36
Q

How is LMWH given?

A

Once daily, weight-adjusted dose given subcutaneously

37
Q

Is Heparin Induced Thrombocytopenia more common after LMWH or UFH?

A

UFH although can occur rarely in either.

38
Q

How does warfarin work?

A

Antagonist of vitamin K. Vitamin K is needed for synthesis of factors 2, 7, 9 and 10 and also protein C and S. Therefore interferes with clotting cascade so acts as anti-coagulant

39
Q

How is warfarin monitored?

A

PT (prothrombin time)
Extrinsic pathway involves 7 - blocked by warfarin as requires vitamin K to be made

40
Q

Which factors do DOACs act on?

A

Factor II (thrombin) and X

41
Q

True or false: DOACs require blood tests and monitoring

A

False

42
Q

Can DOACs be used in pregnancy?

A

No

43
Q

Why are DOACs not used in metal heart valves?

A

Mechanical valves create turbulent blood flow and increase risk of thrombus formation. Vitamin K more traditional choice as inhibits more coagulation factors.
Also DOACs aren’t reversible in case of bleeding or emergency surgery.

44
Q

How is aspirin an anti-platelet?

A

Inhibits cyclo-oxygenase irreversibly
Inhibits thromboxane formation so platelets don’t adhere to each other so lack of platelet aggregation and platelet plug formation.

45
Q

How does Clopidogrel work?

A

Prevent ADP (released by platelet bound to VWF) binding to P2Y12 receptors on platelets inhibiting further signalling for platelet aggregation. Prevents platelet plug.

46
Q

What is the gold standard diagnosing tool for stable angina?

A

CT angiography showing stenosed atherosclerotic arteries

47
Q

What is the order of meds given for stable angina?

A

GTN spray
(lifestyle modifications)

1) CCB (not if also have HF) or Beta-blocker (not for asthmatics)

2) CCB and Beta-blocker
Make sure CCB is non-rate limiting or could cause bradycardia

3) CCB and BB and another antianginal like trabradine or nitrates

Consider patient starting ACE-i, aspirin, statin or htn treament

Revascularisation surgically

48
Q

What are surgical options for severe angina?

A

PCI (Balloon stent coronary artery)

CABG (bypass graft, LAD bypassed by LMA)

49
Q

What is a positive for PCI over CABG?

A

Less invasive

50
Q

What is a negative of PCI over CABG?

A

Risk of stenosis

51
Q

What is a positive of CABG over PCI?

A

Better prognosis

52
Q

What is a negative of CABG over PCI?

A

More invasive

2a Cardio (36 decks)

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