Ischaemic Heart Disease Flashcards
What are the common cardiovascular causes of chest pain?
Myocardial Ischaemia
Pericarditis
Aortic Dissection
How would the pain of ischaemia be described?
Central, tightening pain
How would the pain associated with pericarditis be described?
Sharp pain
Worse on inspiration
Relieve on leaning forward
How would the pain associated with aortic dissection be described?
Tearing pain
What are the common respiratory causes of chest pain?
Infection e.g. pneumonia
Pulmonary embolism
Pneumothorax
What are the common GI causes of chest pain and where might the pain be felt?
Reflux oesophagitis (burning pain, worse when lying down)
Gastric, gall bladder, pancreatic disease
Chest and epigastric pain
What are the common musculoskeletal causes associated with chest pain?
Trauma
Muscle pain
Bone metastases
What is ischaemic heart disease
Where the O2 supply of the heart does not meet the demand of the heart
What 2 things does the myocardial oxygen supply depend on?
Coronary blood flow
O2 carrying capacity of the blood
What 3 things does the myocardial oxygen demand on?
Heart rate
Wall tension
Contractility
What is the most common cause of the narrowing of the coronary vessels?
Atheromatous coronary artery disease
How would you describe the blood flow of the heart?
Flows from the epicaridium to the endocardium
Which part of the heart tissue is most susceptible to ischaemia
The sub endocardial muscle
What other disorders can cause ischeamia by decreasing the O2 supply to the myocardium
Decrease in coronary blood flow
Severe hypotension
Non atheromatous causes of coronary artery narrowing (collagen)
Severe anaemia
What other disorders can cause ischaemia by increasing the O2 demand of the myocardium
Tachycardias
Thyrotoxicosis
Aortic stenosis –> increased after load
Give some examples of non-modifiable risk factors for coronary artery disease
- Increasing age
- Being male (females catch up after menopause)
- Family History
What are the four most important modifiable risk factors for coronary artery disease? And give 2 more examples
- Hyperlipidaemia
- Cigarette Smoking
- Hypertension
- Diabete Mellitus
Lack of exercise and obesity
What is the structure of an atheromatous plaque
Necrotic core
Fibrous cap
What is the difference between a stable and an unstable plaque
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
How might an unstable plaque cause a presentation of acute coronary syndrome
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
Describe stable angina
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
Describe the pain associated with ischaemia
Central, retrosternal or left sided
Pain can radiate to: shoulder, arms, neck, jaw, epigastrium, back
Tightening, heavy, crushing, constricting, pressure
Describe the pattern of chest pain seen in stable angina
- Brief episodes, mild to moderate central crushing pain with typical radiation
- Brought on by exertion, emotional stress
- Relieved by rest or nitrates after 5mins
How would a diagnosis of stable angina be made
-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
