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CVS > Ischaemic Heart Disease > Flashcards

Ischaemic Heart Disease Flashcards

1
Q

What are the common cardiovascular causes of chest pain?

A

Myocardial Ischaemia
Pericarditis
Aortic Dissection

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2
Q

How would the pain of ischaemia be described?

A

Central, tightening pain

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3
Q

How would the pain associated with pericarditis be described?

A

Sharp pain
Worse on inspiration
Relieve on leaning forward

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4
Q

How would the pain associated with aortic dissection be described?

A

Tearing pain

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5
Q

What are the common respiratory causes of chest pain?

A

Infection e.g. pneumonia
Pulmonary embolism
Pneumothorax

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6
Q

What are the common GI causes of chest pain and where might the pain be felt?

A

Reflux oesophagitis (burning pain, worse when lying down)
Gastric, gall bladder, pancreatic disease
Chest and epigastric pain

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7
Q

What are the common musculoskeletal causes associated with chest pain?

A

Trauma
Muscle pain
Bone metastases

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8
Q

What is ischaemic heart disease

A

Where the O2 supply of the heart does not meet the demand of the heart

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9
Q

What 2 things does the myocardial oxygen supply depend on?

A

Coronary blood flow

O2 carrying capacity of the blood

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10
Q

What 3 things does the myocardial oxygen demand on?

A

Heart rate
Wall tension
Contractility

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11
Q

What is the most common cause of the narrowing of the coronary vessels?

A

Atheromatous coronary artery disease

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12
Q

How would you describe the blood flow of the heart?

A

Flows from the epicaridium to the endocardium

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13
Q

Which part of the heart tissue is most susceptible to ischaemia

A

The sub endocardial muscle

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14
Q

What other disorders can cause ischeamia by decreasing the O2 supply to the myocardium

A

Decrease in coronary blood flow
Severe hypotension
Non atheromatous causes of coronary artery narrowing (collagen)
Severe anaemia

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15
Q

What other disorders can cause ischaemia by increasing the O2 demand of the myocardium

A

Tachycardias
Thyrotoxicosis
Aortic stenosis –> increased after load

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16
Q

Give some examples of non-modifiable risk factors for coronary artery disease

A
  • Increasing age
  • Being male (females catch up after menopause)
  • Family History
17
Q

What are the four most important modifiable risk factors for coronary artery disease? And give 2 more examples

A
  1. Hyperlipidaemia
  2. Cigarette Smoking
  3. Hypertension
  4. Diabete Mellitus

Lack of exercise and obesity

18
Q

What is the structure of an atheromatous plaque

A

Necrotic core

Fibrous cap

19
Q

What is the difference between a stable and an unstable plaque

A

Stable plaque: small necrotic core, thick fibrous cap (less likely to fissure or rupture)
Unstable plaque: Large necrotic core, thin fibrous cap
Fibrous cap can undergo erosion or fissuring –> exposes blood to thrombogenic material in the necrotic core –> platelet clot –> fibrin thrombus

20
Q

How might an unstable plaque cause a presentation of acute coronary syndrome

A

The unstable plaque fissures and a thrombus forms
–> sudden reduction in artery lumen –> acute severe reduction in blood flow –> critical ischaemia

Can lead to myocyte injury/necrosis

21
Q

Describe stable angina

A

Transient ischaemia during periods of increased demand which is relieved when stopped. Blood flow is sufficient at rest
There is no myocyte injury or necrosis

22
Q

Describe the pain associated with ischaemia

A

Central, retrosternal or left sided
Pain can radiate to: shoulder, arms, neck, jaw, epigastrium, back
Tightening, heavy, crushing, constricting, pressure

23
Q

Describe the pattern of chest pain seen in stable angina

A
  • Brief episodes, mild to moderate central crushing pain with typical radiation
  • Brought on by exertion, emotional stress
  • Relieved by rest or nitrates after 5mins
24
Q

How would a diagnosis of stable angina be made

A

-Based on history
Examination is likely to show nothing specific but may have related signs
e.g. signs related to risk factors; increased BP, corneal arcus
e.g. signs of atheroma elsewhere e.g. loss of foot pulses
LV dysfunction
Resting ECG is usually normal

25
Q

Explain the process of a stress ECG

A

Patient undergoes graded exercise whilst connected to an ECG until

  • Target HR is reached
  • Chest pain
  • ECG changes
  • Other problems such as arrhythmias, low BP
26
Q

What is seen on a positive stress ECG

A

ST depression of 1mm or more (horizontal/downsloping)

Test results are prognostic i.e. if test strongly positive then evidence of more occlusion of vessel

CVS (6 decks)

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