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Year 3 > Ischaemic Heart Disease > Flashcards

Ischaemic Heart Disease Flashcards

1
Q

What are the three layers of the heart muscle?

A

Endocardium, Myocardium, Epicardium

Endocardium resembles endothelial cells; myocardium is the thickest layer formed of cardiomyocytes; epicardium forms the visceral layer of the pericardium.

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2
Q

What is hs-CTN and its significance?

A

High-sensitivity cardiac troponin, either troponin I (hs-cTnI) or troponin T (hs-cTnT)

It has high sensitivity and specificity for measuring sub-clinical cardiac damage.

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3
Q

What is the normal range for troponin T?

A

14 ng/L

Levels above this indicate myocardial damage or infarction.

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4
Q

What characterizes atherosclerosis?

A

Thickening of the tunica intima due to hypercholesterolemia, LDL infiltration, and inflammation

This process leads to foam cell formation, necrotic core development, and possible plaque complications.

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5
Q

What are the two types of aortic dissection according to Stanford classification?

A

Type A and Type B

Type A involves the ascending aorta and is a medical emergency; Type B occurs in the aortic arch or descending aorta.

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6
Q

What are common risk factors for aortic dissection?

A
  • Hypertension
  • Atherosclerotic disease
  • Male sex
  • Connective tissue disorders
  • Bicuspid aortic valve
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7
Q

What are common clinical signs of aortic dissection?

A
  • Tearing chest pain radiating to the back
  • Tachycardia
  • Hypotension
  • Signs of end-organ hypoperfusion
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8
Q

What is pericarditis?

A

Inflammation of the pericardial sac surrounding the heart

It typically presents with pleuritic chest pain that is relieved by sitting forward and may be associated with symptoms like fever and cough.

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9
Q

What are the causes of pericarditis?

A
  • Infection (bacterial, tuberculosis, HIV)
  • Malignancy
  • Autoimmune conditions (lupus, rheumatoid arthritis)
  • Dressler syndrome
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10
Q

What is cardiac tamponade?

A

Build-up of fluid in the pericardial sac causing cardiac compression

It presents with sharp pain, breathlessness, and signs similar to pericarditis.

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11
Q

What are the signs of cardiac tamponade?

A
  • Decreased palpable pulse
  • Tachycardia
  • Hypotension
  • Muffled heart sounds
  • JVP distention
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12
Q

What are the non-modifiable risk factors for myocardial infarction (MI)?

A
  • Elderly
  • Male sex
  • Family history
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13
Q

What are the modifiable risk factors for myocardial infarction (MI)?

A
  • Diabetes
  • Poor diet
  • Hypertension
  • Dyslipidemia
  • Sedentary lifestyle
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14
Q

What characterizes stable angina?

A

Chest pain occurs with exertion and is relieved by rest

It is caused by increased myocardial oxygen demand due to ischemia.

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15
Q

What are the investigations for stable angina?

A
  • Contrast-enhanced CT angiography
  • 12-lead ECG
  • Chest X-ray
  • Cardiac enzymes
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16
Q

What are the first-line treatments for stable angina?

A
  • Beta blockers
  • Calcium channel blockers

Treatment choice depends on patient tolerance.

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17
Q

What is acute coronary syndrome (ACS)?

A

A group of conditions describing acute sudden loss of blood flow to the heart

This includes STEMI, non-STEMI, and unstable angina.

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18
Q

What is the presentation of STEMI?

A
  • Central crushing chest pain
  • Diaphoresis
  • Shortness of breath
  • Pain radiating to neck/jaw/left arm
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19
Q

What is the role of troponin in myocardial infarction diagnosis?

A

Troponin rises rapidly after myocardial injury

It serves as an important indicator for acute coronary syndrome.

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20
Q

What are the complications of aortic dissection?

A
  • Aortic rupture
  • Aortic regurgitation
  • Myocardial ischemia
  • Cardiac tamponade
  • Stroke
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21
Q

What is the significance of GRACE scoring system?

A

Estimates the risk of death from myocardial infarction following initial acute coronary syndrome.

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22
Q

What are the characteristics of Prinzmetal angina?

A

Transient coronary artery spasm triggered by vasoconstriction stimuli

Patients respond to nitrates and may have a higher risk with metabolic disorders.

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23
Q

What are the symptoms of pulmonary embolism?

A
  • Sudden shortness of breath
  • Chest pain worsening with breathing
  • Anxiety
  • Coughing blood
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24
Q

What is the management for pulmonary embolism?

A

Anticoagulants and fibrinolytic therapy

Occasionally, a pulmonary embolectomy may be performed.

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25
Q

What is the presentation of oesophageal rupture?

A

Sudden retrosternal chest pain, respiratory distress, severe vomiting

May also present with subcutaneous emphysema.

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26
Q

What are the investigations for oesophageal rupture?

A
  • FBC for inflammatory markers
  • CT scan to show air or fluid in the thoracic cavity
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27
Q

What are the key symptoms of acute myocardial infarction (MI)?

A

Symptoms include:
* Syncope
* Coma
* Dyssrhythmia
* Acute confusional state
* Hyperglycaemic crisis

These symptoms can vary in presentation among individuals.

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28
Q

What does ECG show in STEMI?

A

ECG shows:
* ST elevation
* T wave peak/hyperacute T waves
* Left bundle branch block

Location of ST elevation indicates area of ischaemia.

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29
Q

What are the complications of untreated myocardial infarction?

A

Complications include:
* Myocardial rupture
* Cardiac tamponade
* Papillary muscle damage
* Acute heart failure
* Pericarditis
* Pulmonary embolism

These complications can lead to severe consequences if not addressed promptly.

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30
Q

How is Non-STEMI diagnosed?

A

Non-STEMI is diagnosed by:
* Rise in cardiac enzymes
* Symptoms fitting acute coronary syndrome
* Absence of ST elevation on ECG

ST depression and T wave inversion may be present.

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31
Q

What does a Q wave on ECG indicate?

A

A Q wave indicates:
* Negative deflection before QRS complex
* Absence of electrical activity due to extensive infarction
* Sign of previous myocardial infarction

Q waves are more common in STEMI than in Non-STEMI.

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32
Q

What does the acronym MOAN stand for in initial management of MI?

A

MOAN stands for:
* Morphine
* Oxygen therapy
* Aspirin
* Nitrates

This approach is aimed at pain relief and improving oxygenation.

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33
Q

What is the purpose of coronary artery calcium scoring?

A

Coronary artery calcium scoring is used to:
* Assess degree of calcification in coronary artery disease
* Identify significant plaque burden with a score over 400

It involves low radiation scanning techniques.

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34
Q

What are the NICE guidelines for early management of STEMI?

A

NICE guidelines include:
* Offer aspirin as soon as possible
* Assess eligibility for reperfusion therapy
* Dual anti-platelet therapy
* Angiography with PCI if presenting within 12 hours
* Fibrinolytic therapy as an alternative

Proper adherence to guidelines can improve outcomes.

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35
Q

What is the gold standard for treating STEMI?

A

The gold standard is:
* Percutaneous coronary intervention (PCI)

PCI involves angiography and balloon angioplasty to restore blood flow.

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36
Q

What are the phases of cardiac rehabilitation?

A

The phases of cardiac rehabilitation are:
* Phase 1: Acute phase
* Phase 2: Subacute phase
* Phase 3: Intensive outpatient therapy
* Phase 4: Independent ongoing conditioning

Each phase focuses on different aspects of recovery and rehabilitation.

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37
Q

What are common signs pointing to acute coronary syndrome?

A

Signs include:
* Elevated JVP
* Hypotension
* S3 or S4 heart sounds
* Uncoordinated apex beat

These signs indicate possible ventricular dysfunction.

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38
Q

What does the acronym ABCD represent in pharmacological management?

A

ABCD stands for:
* ACE inhibitors
* Beta blockers
* Calcium channel blockers
* Diuretics

Each medication class plays a role in managing heart function and symptoms.

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39
Q

What is Dressler’s syndrome?

A

Dressler’s syndrome is characterized by:
* Pericarditis
* Fever
* Pleuritic pain
* Pericardial effusion

It can increase the risk of cardiac tamponade and constrictive pericarditis.

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40
Q

What are the risk factors for myocardial infarction?

A

Risk factors include:
* Atherosclerosis
* Smoking
* High triglyceride count
* Low HDL
* Sedentary lifestyle
* Family history of coronary artery disease

Addressing these factors can help prevent MI.

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41
Q

What are poor prognostic factors for MI treatment?

A

Poor prognostic factors include:
* Old age
* Diabetes
* Low left ventricular ejection fraction
* Smoking
* Low socioeconomic status

These factors can complicate recovery and increase mortality risk.

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42
Q

What cardiac markers confirm a diagnosis of myocardial infarction?

A

Cardiac markers include:
* Troponin T and I
* Creatine kinase-MB

Troponin is the most sensitive and specific marker.

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43
Q

What is the significance of the ischaemic penumbra zone?

A

The ischaemic penumbra zone refers to:
* Area around the umbra zone where many myocardial cells are alive
* Potential for recovery if blood flow is restored

This zone can recover with timely intervention.

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44
Q

What is the recommended agent for thrombolysis in STEMI?

A

The recommended agent is:
* Alteplase

It is a recombinant form of human tissue plasminogen.

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45
Q

What should be avoided in patients with significant left ventricular dysfunction?

A

Patients should avoid:
* Calcium channel blockers

These can worsen heart function in such cases.

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46
Q

What is stunned myocardium?

A

The damage where many myocardial cells are alive but inactive.

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47
Q

What does an echocardiogram show immediately after a myocardial infarction (MI)?

A

A regional wall motion of inactivity, indicating absent or abnormal contractility of the myocardium.

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48
Q

What are the risks associated with myocardial stunning?

A

Heart failure, myocardial necrosis, and mitral regurgitation due to papillary muscle dysfunction.

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49
Q

What happens to the penumbra zone after successful PCI/thrombolysis after 3 months?

A

The penumbra zone overtakes the umbra zone, showing little regional wall abnormalities on echocardiogram.

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50
Q

What is chronic ischemia characterized by on an echocardiogram?

A

Reduced activity and regional wall motion abnormality without scars from a previous MI.

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51
Q

How is chronic ischemia managed?

A

With revascularizing techniques through PCI or CABG surgery.

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52
Q

What causes Type 1 myocardial infarction (MI)?

A

Spontaneous atherosclerotic plaque rupture and thrombosis.

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53
Q

What indicates myocardial necrosis in Type 1 MI?

A

A rise in the hs-CTN1 concentration in the context of suspected ACS and signs of myocardial ischemia on ECG.

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54
Q

What triggers Type 2 myocardial infarction (MI)?

A

A mismatch between demand and supply of oxygen due to conditions like tachyarrhythmia or severe anemia.

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55
Q

What are the diagnostic criteria for myocardial infarction?

A

Evidence of myocardial necrosis, rise and/or fall in biomarkers, new ST segment and T wave changes, new left bundle branch block, development of Q waves, imaging showing regional wall motion abnormality, and identification of intracoronary thrombosis.

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56
Q

What defines Type 3 MI?

A

Cardiac death prior to measuring blood samples for cardiac biomarkers with symptoms indicating myocardial ischemia.

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57
Q

What characterizes Type 4a MI?

A

Caused by PCI, with a rise in cardiac troponin correlating to myocardial ischemia and new loss of viable myocardium on imaging.

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58
Q

What is Type 4B MI caused by?

A

Thrombosis with the use of a stent.

59
Q

What causes Type 5 MI?

A

Coronary artery bypass grafting.

60
Q

What is Ticagrelor?

A

A non-competitive P2Y12 antagonist that binds irreversibly and acts as an anti-platelet.

61
Q

What is the impact of coronary artery disease on myocardial perfusion?

A

It can result in acute and chronic myocardial perfusion, decreasing myocardial contractility and left ventricular function.

62
Q

What occurs during acute myocardial perfusion?

A

Stunned myocardium leading to transient reversible myocardial contractile dysfunction.

63
Q

What is hibernating myocardium?

A

Chronic myocardial perfusion due to narrowed coronary artery causing chronic coronary contractile dysfunction.

64
Q

Which investigations are used for coronary artery disease?

A

ECG, echocardiogram, stress test, serum markers for creatine kinase and troponin, C-reactive protein, ESR, and liver function tests.

65
Q

What can cause elevated BNP levels?

A

Volume overload, but can be falsely high in kidney disease and falsely low in obesity.

66
Q

What are complications of coronary artery disease?

A

Arrhythmias, including sinus bradycardia, tachycardia, AV block, ventricular arrhythmia, high-grade AV block, and atrial fibrillation.

67
Q

What is a d-dimer?

A

A degradation product of blood clots that indicates blood clotting disorders.

68
Q

What are the layers of the heart muscle?

A

Endocardium, Myocardium, Epicardium

Endocardium resembles endothelial cells; Myocardium contains cardiomyocytes with intercalated disks and gap junctions; Epicardium is the visceral layer of the pericardium.

69
Q

What is hs-cTn and its significance?

A

High-sensitivity cardiac troponin, includes troponin I (hs-cTnI) and troponin T (hs-cTnT), indicating myocardial damage

Normal range for troponin T is 14 ng/L; for troponin I, 0-20 ng/L in men and 0-15 ng/L in women.

70
Q

What characterizes atherosclerosis?

A

Thickening of the tunica intima due to hypercholesterolemia, LDL infiltration, and foam cell formation

Inflammatory state leads to necrotic core formation; calcified plaques are less likely to rupture.

71
Q

What is aortic dissection?

A

A life-threatening condition caused by tearing of the tunica intima of the aorta

Results in false lumen formation and compromised blood flow to vital organs.

72
Q

What are the two types of aortic dissection classified by the Stanford classification?

A

Type A: involves the ascending aorta; Type B: occurs in the aortic arch or descending aorta.

73
Q

What are common risk factors for aortic dissection?

A
  • Hypertension
  • Atherosclerotic disease
  • Male sex
  • Connective tissue disorders
  • Bicuspid aortic valve
74
Q

What are the symptoms of aortic dissection?

A

Tearing chest pain radiating to the back, tachycardia, hypotension

Signs of end organ hypoperfusion include acute limb ischemia and renal failure.

75
Q

What diagnostic tools are useful for aortic dissection?

A

CT scan and ECHO

Elevated D-dimers and lactate levels can also indicate aortic dissection.

76
Q

What is pericarditis?

A

Inflammation of the pericardial sac surrounding the heart

Typically presents with pleuritic chest pain relieved by sitting forward.

77
Q

What are the causes of pericarditis?

A
  • Infection (bacterial, tuberculosis, HIV)
  • Malignancy
  • Autoimmune conditions (lupus, rheumatoid arthritis)
  • Dressler syndrome
78
Q

What are the symptoms of cardiac tamponade?

A

Sharp pain worsening with deep breathing or lying flat, breathlessness, dysphagia, hoarseness

Signs include tachycardia, hypotension, muffled heart sounds, and JVP distention.

79
Q

What is the risk of pulmonary embolism?

A

Worsening chest pain when breathing, sudden shortness of breath, coughing blood

Symptoms of DVT may accompany it.

80
Q

What are the non-modifiable risk factors for myocardial infarction?

A
  • Elderly
  • Male sex
  • Family history
81
Q

What are the modifiable risk factors for myocardial infarction?

A
  • Diabetes
  • Poor diet
  • Hypertension
  • Dyslipidemia
  • Sedentary lifestyle
82
Q

What is stable angina?

A

Chest pain occurring with exertion, relieved by rest

Caused by increased oxygen demand due to ischemia distal to atherosclerotic plaque.

83
Q

What are the investigations for stable angina?

A
  • Contrast-enhanced CT angiogram
  • 12 lead ECG
  • Chest X-ray
  • Cardiac enzymes
84
Q

What is acute coronary syndrome?

A

A group of conditions that describe acute sudden loss of blood flow to the heart

Includes STEMI, non-STEMI, and unstable angina.

85
Q

What is STEMI?

A

Myocardial infarction with ST elevation on ECG due to complete occlusion of blood supply

Causes transmural infarction and may present with long-lasting crushing chest pain.

86
Q

What factors increase myocardial oxygen demand?

A
  • Heart rate
  • Systolic blood pressure
  • Myocardial wall tension
  • Myocardial contractility
87
Q

What is the GRACE scoring system used for?

A

Estimating the risk of death from myocardial infarction following an initial acute coronary syndrome event.

88
Q

What are signs of unstable angina?

A
  • Chest pain at mild exertion/rest
  • Severe pain
  • JVP distention
  • Mitral regurgitation murmur
89
Q

What is the management for stable angina?

A

First line treatment with a beta blocker or calcium channel blocker

Lifestyle modifications and pharmacological management with nitrates and statins are also important.

90
Q

What is the presentation of pericarditis?

A

Central chest pain that is pleuritic, relieved by sitting forward, associated with breathlessness and tachycardia.

91
Q

What is the management for cardiac tamponade?

A

Drainage of pericardial fluid and supportive therapy with IV colloids and adrenaline.

92
Q

What is the presentation of oesophageal rupture?

A

Sudden retrosternal chest pain, respiratory distress, severe vomiting, subcutaneous emphysema.

93
Q

What are the symptoms of oesophageal spasm?

A

Squeezing chest pain, difficulty swallowing, sensation of an object stuck in the throat.

94
Q

What is the typical pain presentation in women experiencing angina?

A

Pain in the neck, jaw, throat, abdomen, or back, often accompanied by nausea and shortness of breath.

95
Q

What is the consequence of untreated STEMI?

A

Coagulation necrosis of cardiomyocyte, infiltration by neutrophils and macrophages, progression to fibrosis.

96
Q

What will the ECG show in STEMI?

A

ST elevation, T wave peak/hyperacute T waves, left bundle branch block.

97
Q

What are the complications after an untreated myocardial infarction (MI)?

A
  • Myocardial rupture
  • Cardiac tamponade
  • Papillary muscle damage
  • Acute heart failure
  • Pericarditis
  • Pulmonary embolism
98
Q

How is Non-STEMI diagnosed?

A

Rise in cardiac enzymes, symptoms fitting acute coronary syndrome, absence of ST elevation.

99
Q

What symptoms may present in Non-STEMI?

A
  • Angina at rest
  • New-onset severe angina
  • Increased frequency and duration of pre-existing angina
100
Q

What does a Q wave on ECG indicate?

A

Negative deflection before QRS complex, indicating absence of electrical activity due to extensive infarction.

101
Q

What are the signs of hypercholesterolaemia?

A
  • Xanthelasma plaques around the eyes
  • Corneal arcus rings
  • Xanthelasma plaques on skin or tendons
102
Q

What are signs pointing to acute coronary syndrome?

A
  • Elevated JVP
  • Hypotension
  • S3 or S4 heart sounds
  • Dyskinetic apex beat
103
Q

True or False: In the initial stages of acute coronary syndrome, ECG may be normal in 20% of individuals.

A

True

104
Q

What does the acronym MOAN stand for in initial management?

A
  • Morphine
  • Oxygen therapy
  • Aspirin
  • Nitrates
105
Q

What is the purpose of coronary artery calcium scoring?

A

To assess calcified plaques in coronary artery atherosclerosis.

106
Q

What does a calcium score over 400 indicate?

A

Significant plaque burden with atherosclerosis.

107
Q

What is the recommended agent for thrombolysis in STEMI?

A

Alteplase, a recombinant form of human tissue plasminogen.

108
Q

What are complications of primary PCI?

A
  • Coronary artery dissection
  • Bleeding from arterial puncture
  • Increased thrombosis risk
  • Stroke
  • Need for emergency coronary artery bypass
  • Renal failure
109
Q

What is Dressler’s syndrome?

A

A triad of pericarditis, fever, pleuritic pain, and/or pericardial effusion due to pericardial injury.

110
Q

What are the phases of cardiac rehabilitation?

A
  • Phase 1: Acute phase
  • Phase 2: Subacute phase
  • Phase 3: Intensive outpatient therapy
  • Phase 4: Independent ongoing conditioning
111
Q

What is the most sensitive and specific cardiac marker for myocardial infarction?

A

Troponin I and T.

112
Q

Fill in the blank: Patients with __________ should receive dual antiplatelet therapy regardless of risk.

A

NSTEMI

113
Q

What lifestyle changes are recommended for ongoing management of cardiac health?

A
  • Smoking cessation
  • Alcohol reduction
  • Dietary changes
  • Exercise and weight loss focus
114
Q

What is the risk score system used for managing patients with NSTEMI?

A

GRACE score.

115
Q

What characterizes unstable plaques in relation to acute coronary syndrome (ACS)?

A

Large lipid core, thin fibrous cap, presence of macrophages and lymphocytes.

116
Q

What are two zones of damage in myocardial infarction?

A
  • Ischaemic umbra zone
  • Ischaemic penumbra zone
117
Q

What is the role of calcium channel blockers in cardiac management?

A

Should be avoided in significant left ventricular dysfunction.

118
Q

What imaging technique is used to assess blood vessels for occlusion?

A

Coronary angiography.

119
Q

What is the significance of early prominent T waves on ECG?

A

Early sign of acute myocardial infarction.

120
Q

What should be monitored in patients with suspected acute myocardial infarction?

A

Cardiac troponin levels and continuous ECG monitoring.

121
Q

What should be avoided in patients with suspected aortic dissection?

A

Thrombolysis.

122
Q

What is stunned myocardium?

A

A state where many myocardial cells are alive but in a state of inactivity.

123
Q

What does an echocardiogram show immediately after a myocardial infarction (MI)?

A

Regional wall motion inactivity, indicating absent or abnormal contractility of the myocardium.

124
Q

What are the risks associated with myocardial stunning?

A

Heart failure, myocardial necrosis, and mitral regurgitation due to papillary muscle dysfunction.

125
Q

What happens to the penumbra zone after 3 months of successful PCI/thrombolysis?

A

The penumbra zone overtakes the umbra zone, showing little regional wall abnormalities.

126
Q

What characterizes chronic ischaemia in the myocardium?

A

Reduced activity and regional wall motion abnormality on echocardiogram without previous MI scars.

127
Q

How is chronic ischaemia managed?

A

Through revascularizing techniques such as PCI or CABG surgery.

128
Q

What causes Type 1 myocardial infarction?

A

Spontaneous atherosclerotic plaque rupture and thrombosis, typically associated with coronary artery disease.

129
Q

What indicates myocardial necrosis in Type 1 MI?

A

A rise in the hs-CTN1 concentration in the context of suspected ACS.

130
Q

What is Type 2 myocardial infarction caused by?

A

Mismatch between demand and supply of oxygen due to factors like tachyarrhythmia or severe anemia.

131
Q

What are the diagnostic criteria for myocardial infarction?

A

Evidence of myocardial necrosis, rise and/or fall in cardiac troponin, new ST segment and T wave changes, new left bundle branch block, development of Q waves, imaging showing regional wall motion abnormality, and identification of intracoronary thrombosis.

132
Q

What is a Type 3 myocardial infarction?

A

Cardiac death prior to measuring blood samples for cardiac biomarkers with signs of myocardial ischaemia.

133
Q

What characterizes Type 4a myocardial infarction?

A

Caused by PCI, indicated by rise in cardiac troponin and correlation to myocardial ischaemia.

134
Q

What is Type 4B myocardial infarction associated with?

A

Thrombosis with the use of a stent.

135
Q

What causes Type 5 myocardial infarction?

A

Coronary artery bypass grafting (CABG).

136
Q

What is ticagrelor?

A

A non-competitive P2Y12 antagonist that binds irreversibly and acts as an anti-platelet.

137
Q

What is the effect of stenosis over 70%-80% in coronary artery disease?

A

Reduces resting blood supply, diminishing contractile capacity and producing angina.

138
Q

What is acute myocardial perfusion and its effect?

A

Results in a stunned myocardium causing transient reversible myocardial contractile dysfunction.

139
Q

What is chronic myocardial perfusion and its effect?

A

Due to narrowed coronary artery, causing hibernating myocardium and chronic contractile dysfunction.

140
Q

What investigations are used for coronary artery disease?

A
  • ECG
  • Echocardiogram
  • Stress test
  • Serum markers for creatine kinase and troponin
  • C-reactive protein and ESR
  • Liver function test
141
Q

What can elevated BNP indicate?

A

Volume overload but can be falsely high in kidney disease and falsely low in obesity.

142
Q

What are common complications of coronary artery disease?

A
  • Arrhythmias
  • Sinus bradycardia
  • Tachycardia
  • AV block
  • Ventricular arrhythmia
  • High-grade AV block
  • Atrial fibrillation
143
Q

What is a d-dimer?

A

A degradation product of blood clots used to indicate blood clotting disorders.

Year 3 (37 decks)

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