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ESA2 - Various > Ischaemic heart disease > Flashcards

Ischaemic heart disease Flashcards

1
Q

What is the mat common cause for ischaemia

A

Coronary atheroma

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2
Q

Non modifiable risk factors for coronary atheroma

A

Age increasing
Sex male
Family history, genetics, ethnicity.

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3
Q

Modifiable risk factors for coronary atheroma

A

Hyperlipidaemia
Hypertension
Diabetes
Smoking

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4
Q

When does coronary flow occur

A

During diastole

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5
Q

Which direction does coronary flow occur

A

From the epicardium to endocardium

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6
Q

Describe the process of coronary atheroma

A

Atheroma tours plaque with necrotic centre and fibrous cap can build up in coronary vessels.
Lumen occluded

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7
Q

What is a stable plaque

A

Small necrotic core
Large fibrous cap
Less likely to rupture

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8
Q

What is a vulnerable plaque

A

Large necrotic core
Thin fibrous cap
More likely to rupture

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9
Q

What happens when a plaque fissures

A

Blood is exposed to thrombogenic material in necrotic core causing a platelet clot in the blood followed by a fibrin thrombus.
This may totally occlude the artery

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10
Q

Site of ischaemic chest pain

A

Central
Retrosternal
Left sided

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11
Q

Where does ischaemic chest pain radiate

A

Shoulders, arms on the left side

Neck, jaw, epigastrium, back

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12
Q

Quality of ischaemic chest pain

A

Tightening, heavy, crushing, pressure

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13
Q

What is stable angina

A

Atheromatous plaque occlude>70%
Moderate reduction in blood flow, but sufficient at rest.
Ischaemia during high activity
No monocyte injury or necrosis

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14
Q

When does stable angina chest pain occur

A

Brief episodes through exertion, emotional stress, after meals, cold

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15
Q

How is angina treated

A 
Nitrate spray (venodilator)
Calcium channel blockers
Beta blockers
Aspirin
Statins
Revascularisation
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16
Q

How does aspirin work

A

Blocks platelets from making thromboxane a2
This activates platelet aggregation
Thus platelet aggregation is inhibited
Reduced thrombus formation

17
Q

How do statins act

A

Lower cholesterol production, reducing progression of atherosclerosis
Increase plaque stability

18
Q

What is unstable angina

A

Ischaemic chest pain that occurs at rest.

Severe pain with crescendo pattern

19
Q

What is diagnosis of angina based on

A

History

Exercise stress test

20
Q

What is the exercise stress test

A 
Graded exercise on a treadmill until
Target heart rate is reached
Chest pain occurs
ECG changes
Other problem
21
Q

ECG changes in exercise stress test

A

ST depression

22
Q

History of MI

A 
Central crushing chest pain
Radiates to shoulder arm jaw back
Severe pain at rest
No precipitant
Not relieved by nitrate or rest
Sympathetic signs
Sweating palor tachycardia cold clammy skin
23
Q

Describe occlusion by thrombus, myocardial necrosis, ECG and biomarkers in unstable angina

A

Occlusion is partial
No necrosis
ST depression, T wave inversion or normal
No biomarkers

24
Q

Describe occlusion by thrombus, myocardial necrosis, ECG and biomarkers in NSTEMI

A

Partial occlusion
Some necrosis
No ST elevation
Troponin

25
Q

Describe occlusion by thrombus, myocardial necrosis, ECG and biomarkers in MI

A

Total occlusion
Large necrosis
ST elevation
Troponin

26
Q

Give to investigations for Mi

A

ECG

Cardiac biomarkers

27
Q

ECG changes in STEMI

A

Pathological Q
ST elevation
T inversion
In ECG lead facing infarct

28
Q

Give 2 cardiac biomarkers used

A

Cardiac troponin

Creatine kinase MB

29
Q

Describe troponin changes in mi

A 
Released on myocyte death
Very sensitive and specific
Rise 3 hours after pain
Peak at 18-36 hours
Decline slowly for 14 days
30
Q

CKMB changes in mi

A

Rise 3-8 hours after onset
Peak at 24 hours
Normal within 2-3 days

31
Q

What is angiography

A

Used to view any occlusion
Catheter through femoral artery to coronary artery
Contrast radioactive dye allows imaging of arteries.

32
Q

Per cutaneous cornary intervention

A

Angioplasty and stenting

Inflation of balloon inside occluded vessel expands a mesh that holds the vessel open, increasing the lumen

33
Q

Coronary artery bypass grafting

A

Involves taking artery from somewhere else in the body and grafted into heart.
If saphenous vein is taken, reversed due to valves.

34
Q

Symptoms of acute pericarditis

A

Central, left sided chest pain
Sharp, worse on inspiration
Improved by leaning forward

35
Q

Give 4 systems that may cause chest pain

A 
Lungs
GI
-oesophagus reflux
-gall bladder
Chest wall
-ribs
-muscle
-skin
Cvs
-pericardium
-myocardium
-aorta

ESA2 - Various (21 decks)

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