Ischaemic Heart Disease Flashcards by Katerina Fernandez

Why does ischaemia occur.

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

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What is the commonest cause of cardiac ischaemia.

Atherosclerotic plaque.

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What are the causes of cardiac ischaemia. (5)

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

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What is are potential precipitants of coronary ischaemia (2)

Anaemia.

Fluid overload.

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

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

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What is the most common cause of death worldwide.

Ischaemic heart disease.

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

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

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What are the clinical signs of ACS. (6)

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

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

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

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

T wave inversion.

ST depression.

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

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

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What is a grade 1 angina.

Angina on strenuous or prolonged exertion.

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What is a grade 2 angina. (2)

Slight limitation of ordinary activity.

Angina on moderate activity.

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What is a grade 3 angina. (2)

Marked limitation of ordinary activity.

Angina on mild activity.

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What is a grade 4 angina. (2)

Unable to carry out activities without angina.

May occur at rest.

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

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

What does atherosclerotic plaque rupture lead to. (2)

Thrombosis formation, leading to coronary artery occlusion.

What are the symptoms of STEMI. (6)

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

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

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.

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

ST segment elevation.

Q wave evolution.

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

Myocardial damage with abnormal wall motion.

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

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

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

Beta blockers.
ACE inhibitors.
Aspirin.
Statins.

What are the complications of a STEMI. (7)

``` Heart failure. Cardiogenic shock. Arrhythmias. Pericarditis. Ventricular septal rupture. Recurrent pain. LV aneurysm. ```

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

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

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

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

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

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

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

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

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

Short-term oral nitrate eg isosorbide mononitrate. | Slow release nitrate eg Imdur (R).

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

``` COPD. asthma. bradycardia. coronary artery spasm. LVF. ```

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

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

What does acute coronary syndrome (ACS) involve.

Plaque rupture. Thrombosis. Inflammation.

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

age. gender. family history of IHD.

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

``` smoking. hypertension. DM. hyperlipidaemia. obesity. cocaine. ```

what is the incidence of ACS

5/1000 per annum

How do you identify an acute MI (4)

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

What are the symptoms of ACS

``` Acute central chest pain. Nausea. sweatiness. dyspnoea. palpitations. ```

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

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What are some of the symptoms of a silent infarct.

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