Ischaemic Heart Disease Flashcards
what is ischaemic heart disease
narrowing of arteries- same as coronary heart disease
can IHD cause sudden death
yes but not common
what percentage of IHD deaths common
50% (rare as not many deaths from IHD)
what does a family history of CHD put diagnosed patients at greater risk of
ventricular fibrillation
what types of plaque causes transient ischemia
unstable plaque
what causes an acute MI
and acute occusion
what does a chronic closure of an artery cause
scar formation
how does scar formation affect the electrical conductivity of the heart
can cause ventricle fibrillation as potentially allows re-entrance circuit (as signals circle the scar)
when can a clot cause VF
when affecting electrically sensitive area of the heart
how does disordered cardiac muscle fibres affect treatment of fibrillation and cardiomyopathy
harder to treat
defibrillation less effective
what is cardiogenic shock
Inadequate systemic perfusion as a result of cardiac dysfunction
what circulatory effects does an MI cause
build up of pressure in heart and lungs- oedema and systemic inflammation response
what is the key thing to treat in an MI
ischaemia
how is angina diagnosed
visceral, dull, pain from myocardial hypoxia
gestures (tight fist over/holding chest)
characteristic patterns of
provocation, relief (rest), timing (1-2 mins)
risk factors
describe the pain of angina
Pressing, squeezing, heaviness, a weight,
Radiating to arm(s), back, neck, jaw, teeth
what can provoke angina
Exertion, stress, cold wind, after meals
what other than rest can relieve angina
GTN spray
what are the differential diagnosis of chest pain
GI tract (reflux, prptic ulcer, oesophageal spasm, biliary colic)
musculoskeletal (injury, nerve root pain)
pericarditis
pleuritic pain
what causes of chest pain are emergencies
MI- severe, ongoing despite morphine
Pulmonary Embolus- breathlessness, dull
dissection of aorta- tearing, excruciating
what is associated with autonomic upset
sweating, SOB, fear, impending doom
does angina always accompany CHD
no
what is exercise testing
BP and ECG recorded during exercise
what is perfusion imaging
is a non-invasive imaging test that shows how well blood flows through (perfuses) your heart muscle
what are the pros and cons of perfusion imaging
pros
non invasive more precise than ETT
cons
radiation, false pos and negs
what is a CT angiography
injecting contrast to get 3d reconstruction of coronary circulation
what are the cons of CT angiography
less precise than angiography, costly
what is ETT
exercise tolerance test
what is angiography
sheath inserted into artery from wrist/groin to coronary ostium
x ray contrat agent injected to outline coronaries
video fluoroscopy recorded in multiple views
what are the pros and cons of angiography
best imaging
cons
risk of death/stroke (low)
radiation
contrast; renal dysfunction, rash, nausea
how do you reduce the risks of CHD (death/disability)
drugs, lifestyle, revascularisation
what drugs are used to treat CHD
aspirin- antiplatelets
beta blockers- slow heart rate, reduce o2 demand
statin- reduces cholesterol
ACE inhibitor- reduces blood pressure
what is coronary revascularisation
restoring blood flow to the heart e.g. coronary artery bypass
how is the heart accessed in a coronary artery by pass
median sternotomy
what vessels are used in a coronary artery bypass
Long saphenous vein
Internal Mammary artery
what is cardioplegia
temporary cessation of cardiac activity
what are the complications of coronary artery bypass
death, stroke, MI, atrial fibrillation, infection, cognitive impairement, sternal malunion, renal failure
define and describe PCI
Percutaneous coronary intervention
(angioplasty with stent)
non-surgical procedure that uses a catheter to place a small structure called a stent to open up blood vessels in the heart that have been narrowed by plaque buildup
what are the complications of PCI
death, stroke, MI, renal failure, bleeding, vascular complications; stent thrombosis or restenosis
what is restenosis
the recurrence of narrowing of a vessel
describe the PCI technique
vascular access anti platelet drugs, anticoagulation catheter to ostium (opening)of coronary guidewire down vessel balloons threaded over wire stents implanted ballon, catheter and wires removed
what makes a patient suitable for revascularisation
multi vessel disease
left main disease
diabetes
co-morbidities
what are the pros of radial artery access
dual supply to hand, superficial, compressible, no adjacent nerve/vein
what are the cons of radial artery access
smaller, prone to spasm, occlusion
what is haematoma
solid swelling of clotted blood within the tissues
how is a STEMI revascularised
PCI
what is acute coronary syndrome and how is it revascularised
any group of clinical symptoms compatible with acute myocardial ischemia and includes unstable angina (UA), non—ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI).
angiography with a view to revascularisation
