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Cardiovascular System > Ischaemic Heart Disease > Flashcards

Ischaemic Heart Disease Flashcards

1
Q

Why does ischaemia occur.

A

ischaemia occurs when oxygen delivery does not meet oxygen demand. (also when coronary blood flow is limited).

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2
Q

What is the commonest cause of cardiac ischaemia.

A

Atherosclerotic plaque.

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3
Q

What are the causes of cardiac ischaemia. (5)

A 
Atherosclerotic plaque.
Rupture of the atherosclerotic plaque. 
Coronary spasm. 
Emboli. 
Aortic stenosis with left ventricular hypertrophy.
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4
Q

What is are potential precipitants of coronary ischaemia (2)

A

Anaemia.

Fluid overload.

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5
Q

What are the risk factors for coronary ischaemia. (6)

A 
Obesity. 
Smoking. 
Insulin resistance/T2DM. 
High fat diet. 
Hypertension. 
High cholesterol/low-densitiy lipoprotein (LDL).
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6
Q

What is the most common cause of death worldwide.

A

Ischaemic heart disease.

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7
Q

What does the term acute coronary syndrome encompass. (3)

A

Angina.
Unstable angina.
Non-ST elevation myocardial infarction. (NSTEMI).

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8
Q

What are the clinical signs of ACS. (6)

A 
Central crushing chest pain (may radiate to neck and left arm). 
Sweating. 
Dyspnoea. 
Pallor.
Palpitations.
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9
Q

What investigations should be carried out in ACS. (10)

A 
FBC.
UandEs. 
Glucose. 
Lipids. 
Cardiac enzymes (troponin, creatinine kinase). 
CXR. 
ECG.
Exercise ECG. 
Stress echo/nuclear imaging if patient unable to exercise. 
Possible a coronary angiography.
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10
Q

How should you treat an acute presentation of ACS. (8)

A 
Oxygen. 
GTN spray. 
Aspirin. 
Clopidogrel. 
Morphine sulphate. 
Low molecular weight heparin (LMWH).
Possible GTN infusion. 
Glycoprotein IIb/IIIa inhibitors (eg tirofiban).
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11
Q

What ECG changes would you expect to see in ACE. (2)

A

T wave inversion.

ST depression.

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12
Q

What long term treatment should be considered for ACS. (7)

A 
Nitrates. 
Beta-blockers. 
Calcium channel antagonists. 
Aspirin. 
Clopidogrel (for up to 1 year following NSTEMI). 
Nicorandil. 
Coronary revascularization.
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13
Q

What is a grade 1 angina.

A

Angina on strenuous or prolonged exertion.

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14
Q

What is a grade 2 angina. (2)

A

Slight limitation of ordinary activity.

Angina on moderate activity.

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15
Q

What is a grade 3 angina. (2)

A

Marked limitation of ordinary activity.

Angina on mild activity.

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16
Q

What is a grade 4 angina. (2)

A

Unable to carry out activities without angina.

May occur at rest.

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17
Q

What is the typical cause of a ST elevation myocardial infarction (STEMI).

A

Usually occurs due to atherosclerotic plaque rupture, leading to thrombosis formation and coronary artery occlusion.

18
Q

What does atherosclerotic plaque rupture lead to. (2)

A

Thrombosis formation, leading to coronary artery occlusion.

19
Q

What are the symptoms of STEMI. (6)

A 
Central crushing pain (may radiate to the neck and left arm). 
Sweating. 
Dyspnoea. 
Pallor. 
Palpitations.
20
Q

What investigations are required if you suspect a STEMI. (10)

A 
FBC.
UandEs. 
Glucose. 
Lipids. 
Cardiac enzymes (troponin, creatinine kinase). 
CXR. 
ECG.
Exercise ECG. 
Stress echo/nuclear imaging if patient unable to exercise. 
Possible a coronary angiography.
21
Q

What ECG changes will be visible in a STEMI. (2)

A

ST segment elevation.

Q wave evolution.

22
Q

What will an Echo show in a patient with a STEMI. (2)

A

Myocardial damage with abnormal wall motion.

23
Q

What is the treatment for an acute presentation STEMI. (6)

A 
Oxygen.
GTN spray. 
Aspirin. 
Clopidogrel. 
Primary percutaneous transluminal angioplasty (PTCA).
Fibrinolysis (if PTCA not available).
24
Q

What is the long term management for a patient who has suffered a STEMI. (4)

A

Beta blockers.
ACE inhibitors.
Aspirin.
Statins.

25
Q

What are the complications of a STEMI. (7)

A 
Heart failure. 
Cardiogenic shock. 
Arrhythmias. 
Pericarditis. 
Ventricular septal rupture. 
Recurrent pain. 
LV aneurysm.
26
Q

What is the difference between stable and unstable angina. (2)

A

Stable: induced by effort, relieved by rest.
Unstable: angina of increasing frequency or severity on minimal exercise or rest.

27
Q

What would an ECG show for a person with angina. (4)

A

Usually normal.
possibly: ST depression.
Flat or inverted T-waves.
Signs of past MI.

28
Q

Give examples of lifestyle change recommendations for angina. (3).

A

Stop smoking.
Weight loss (exercise fatty).
Management of diabetes.

29
Q

Give examples of drugs used to treat angina. Give an example of each drug. (5)

A 
Aspirin. 
beta-blockers. Atenolol
nitrates.
long-acting Ca2+ antagonist. Amlodipine.
K+ channel activator. Nicorandil.
30
Q

Describe what different nitrates could be used in the treatment of angina. (2)

A

Short-term oral nitrate eg isosorbide mononitrate.

Slow release nitrate eg Imdur (R).

31
Q

In what conditions would you not give a beta-blocker for angina. (5)

A 
COPD.
asthma.
bradycardia.
coronary artery spasm.
LVF.
32
Q

Briefly describe a surgical procedure used to treat angina. What is one major complication experienced after this surgery? (2)

A

percutaneous transluminal coronary angioplasty (PTCA): Involves balloon dilatation of stenotic vessel.
20-30% suffer restenosis.

33
Q

What does acute coronary syndrome (ACS) involve.

A

Plaque rupture.
Thrombosis.
Inflammation.

34
Q

What are some of the non-modifiable risk factors for developing ACS. (3)

A

age.
gender.
family history of IHD.

35
Q

What are some of the modifiable risk factors for developing ACS. (6)

A 
smoking.
hypertension.
DM.
hyperlipidaemia. 
obesity.
cocaine.
36
Q

what is the incidence of ACS

A

5/1000 per annum

37
Q

How do you identify an acute MI (4)

A

An increase and then a decrease in biomarkers (eg troponin).
Ischaemic symptoms.
development of pathological Q-waves.
loss of myocardium on imaging.

38
Q

What are the symptoms of ACS

A 
Acute central chest pain.
Nausea.
sweatiness.
dyspnoea. 
palpitations.
39
Q

What would you expect to see using an ECG on someone with MI

A

rygf

40
Q

What are some of the symptoms of a silent infarct.

A

fsrs

Cardiovascular System (31 decks)

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