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Cardiovascular > Ischaemic Heart Disease > Flashcards

Ischaemic Heart Disease Flashcards

1
Q

Epidemiology IHD?

A

-8M:1F

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2
Q

Non modifiable RFx for atherosclerotic heart disease?

A
  • Age
  • Male, post menopause female
  • FHx MI
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3
Q

Modifiable RFx for atherosclerotic heart disease?

A
  • Hyperlipidemia
  • HTN
  • DM
  • Smoking
  • Metabolic syndrome / Obesity
  • Sedentary lifestyle
  • Heavy EtOH
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4
Q

What is chronic stable angina most commonly caused by?

A

Fixed stenosis caused by an atheroma.

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5
Q

What is chronic stable angina?

A

Symptoms complex resulting from an imbalance between oxygen supply and demand in the myocardium.

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6
Q

Symptoms stable angina

A

retrosternal CP radiating to the arm / shoulder/ neck / jaw a/w N and diaphoresis.

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7
Q

Precipitants of stable angina?

A
  • Exertion
  • Emotion
  • Eating
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8
Q

What is Levine’s sign?

A

Clutching fist over sternum when describing CP

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9
Q

Hx features in stable angina?

A
  • HOPC

- Directed RFx assessment

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10
Q

Ix stable angina?

A
  • Bloods: Hb, fasting lipids / glucose
  • CXR
  • ECG
  • +/-Angio / stress test
  • Echo
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11
Q

Drugs for consideration in management of stable angina?

A
  • Antiplatelet: aspirin
  • B-blocker: metoprolol
  • Nitrates
  • CCBs
  • ACEi
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12
Q

General measures in Mx chronic stable angina?

A

Control RFx

  • Lifestyle modification -> diet and exercise
  • Treat RFx: statin, control HTN and BSLs as indicated
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13
Q

Are B-blockers indicated in chronic stable angina? Why?

A

First line therapy - decrease overall mortality.

-increase coronary perfusion and decrease demand (HR, contractility) and BP (after load).

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14
Q

Role of nitrates in chronic stable angina?

A
  • Reduce preload (venous dilation)
  • Reduce after load (arteriolar dilation)
  • Increase coronary perfusion
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15
Q

Can nitrates be taken daily?

A

No. Maintain daily nitrate free intervals to prevent tachyphylaxis.

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16
Q

Are CCBs first line in Mx chronic stable angina?

A

No. 2nd line or combo.

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17
Q

How does CCBs assist in chronic stable angina?

A

Increase coronary perfusion and decrease demand (HR, contractlity) and BP (after load).

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18
Q

When must caution be exercised w/ CCBs?

A

-Verapamil / diltiazem combined with B-blocers may cause symptomatic sinus brady / AV block.

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19
Q

Are ACEi used to treat symptomatic angina?

A

NO! Pts w/ angina tend to have CV RFx which indicate ACEi intervention.

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20
Q

What is Prinzmetal’s angina?

A

Aka variant angina.
Myocardial ischaemia 2” to vasospasm. Typically occurs b/w midnight and 8am.
ST elevation on ECG.
Rx: nitrates and CCBs

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21
Q

What is syndrome X?

A

Typical angina symptoms but normal angio. Exercise test may show schema. ?inadequate vasodilator reserve of coronary resistance vessels.

22
Q

What is ACS?

A

Includes spectrum of UA, NSTEMI, STEMI and sudden cardiac death.

23
Q

How is MI diagnosed?

A

Any 2 of:

i) symptoms of ischaemia
ii) ECG changes
iii) -Rise/fall of serum markers (troponin or CK)

24
Q

ECG changes required for MI diagnosis?

A
  • ST-T changes
  • New BBB
  • pathological Q waves
25
Q

How is NSTEMI diagnosed?

A

-meets criteria for MI w/o ST elevation of BBB

26
Q

How is STEMI diagnosed?

A

-meets criteria for MI characterised by ST elevation of new BBB

27
Q

How is UA defined?

A

Clinically defined by any of:

  • accelerating pattern of pain
  • angina at rest
  • new-onset angina
  • angina post -MI / -procedure
28
Q

Ix in ACS work up?

A
  • Hx and Ex
  • ECG
  • CXR
  • Troponin / CV biomarkers
  • FBE
  • Coags
  • UEC
  • CMP
  • Glucose
  • Lipids
29
Q

General measures in ACS Mx?

A
  • ABCs
  • O2
  • Rest, monitoring
  • Nitroglycerin
  • IV morphine
30
Q

Treatment of NSTEMI?

A

BEMOAN

  • B-blocker
  • Enoxaparin
  • Morphine
  • O2
  • ASA
  • Nitrates
31
Q

What are the complications of MI?

A

CRASHPAD

  • Cardiac Rupture
  • Arrhythmia
  • Shock
  • HTN/HF
  • Pericarditis /PE
  • Aneurysm
  • DVT
32
Q

Contraindications to B-blocker in STEMI?

A
  • Signs of heart failure
  • low output states
  • Risk of cardiogenic shock
  • Heart block
  • Asthma or airway disease
33
Q

When and which are CCBs used in STEMI Mx?

A
  • If B-blockers CIx or fail to relieve ischaemmia

- Non-dihydropyridine CCBs (e.g. diltiazem, verapamil)

34
Q

Invasive / reperfusion strategies in UA/NSTEMI?

A

-Early coronary angiography +/- revascularisation

35
Q

reperfusion options in STEMI?

A

Thrombolysis or PCI

36
Q

When is thrombolysis preferred in STEMI Mx?

A

In patients presenting early after the onset of chest pain (less than 1-2 hours) and in certain clinical subsets (less than 65 years-of-age, anterior STEMI), prehospital fibrinolysis may offer similar outcomes compared to PPCI. Benefit if PCI not available.

37
Q

Thrombolysis v PCI as first preference?

A

PCI superior efficacy and safety to thrombolysis in STEMI, performed within 90 minutes of patient arrival, whether in high or low volume centres, with or without on-site cardiac surgery. Benefits maintained up to five years follow up.

38
Q

Absolute Cix to thrombolysis in STEMI?

A
    1. Prior intracranial haemorrhage
    1. Known structural vascular lesion
    1. CNS system damage, neoplasms or structural vascular lesion (i.e. AV malformation)
    1. Recent major trauma / surgery / head injury (within 3 weeks)
    1. GIT bleeding within the last month
    1. Ischaemic stroke past 6 months
    1. Known bleeding disorder
    1. Aortic dissection
39
Q

Pre-discharge work up post ACS?

A

-ECG
-Echo
Assess residual LV systolic function

40
Q

What is sudden cardiac arrest?

A

Unanticipated, non-traumatic cardiac death in a stable pt which occurs w/in 1h or symptoms onset; VFib most common cause.

41
Q

Aetiology of sudden cardiac arrest?

A

Primary cardiac pathology:

  • ischaemia/MI
  • LV dysfunction
  • severe V hypertrophy (HCM, AS)
  • long QT syndrome
  • congenital heart disease
  • mutations in cardiac ion channels
42
Q

Acute Mx sudden cardiac arrest?

A

-CPR and defib

43
Q

Mx sudden cardiac arrest?

A
  • Ix underlying cause
  • Treat underlying cause
  • Antiarrhythmic drug therapy: amiodarone, B-blockers
  • Implantable cardiac defib
44
Q

Presenting Sx of IHD?

A
  • Ischaemic CP
  • SOB
  • Palpitatons
  • Syncope
  • Lethargy
45
Q

Target period for PCI in STEMI?

A

Goal: door to balloon time

46
Q

Adjunctive therapies (Rx) in acute MI? (i.e. in addition to revascularisation)

A
  • O2
  • IV morphine
  • Aspirin
  • IV heparin / SC clexane
  • IV GTN
  • Additional anti platelets if stent inserted
  • B blockers
  • ACEi
47
Q

Evidence for B-blcokers in acute MI?

A

B blocker post acute MI reduce morbidity and mortality.

  • Reduce rate of recurrence
  • Reduce angina
  • reduce arrhythmias
  • Improve LV function
48
Q

Example set of d/c Rx in acute STEMI?

A
  • Aspirin 100mg d
  • Atenolol 25mg d
  • Perindopril 2.5mg d
  • Atorvastatin 20mg d
  • Clopidogrel 75mg d
  • Nitrolingual spray prn
49
Q

What is the post hospital management of an AMI?

A
  • Modify lifestyly: diet, exercise, quit smoking, LoW, EtOH.
  • Modify cardiac RFx (DM, chol, HTN)
  • Medications
  • R/v at 1/12 then 6/12 (w/ rpt echo at 6/12)
50
Q

What are the relative contraindications to thrombolysis?

A
    1. TIA last 6mo
    1. Oral anticoagulant therapy
    1. Pregnancy within 1 week post partum
    1. Non compressible punctures
    1. Traumatic resuscitation
    1. Refractory HTN (sBP >180)
    1. Advanced liver disease
    1. Infective endocarditis
    1. Active peptic ulcer

Cardiovascular (22 decks)

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