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Theme 3 > Ischaemic Heart Disease > Flashcards

Ischaemic Heart Disease Flashcards

1
Q

CVD

A

Disease of heart or coronary system

Comprises of CHD, Cerebrovascular disease and peripheral vascular disease

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2
Q

Controllable risk factors for CHD

A 
Cigarette Smoking
Diabetes
High blood pressure
High cholesterol
Obesity
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3
Q

Non-controllable risk factors for CHD

A

Age
Family history of premature coronary disease
Previous heart attack

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4
Q

Atherosclerosis

A

Development of: Fatty Streak, lipid deposition and intimal Fibrosis

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5
Q

IHD and MI

A

IHD occurs due to atherosclerotic build up within one or more CA - obstruct myocardial flow

Imbalance

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6
Q

Clinical manifestations of IHD

A

Asymptomatic
Stable angina
Long term: HF, arrhythmias and sudden death
Acute coronary syndrome: Unstable angina, NSTEMI, STEMI

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7
Q

Classification of angina

A

I - Ordinary physical activity
II - Slight limitation of ordinary physical activity
III - Marked limitation
IV - Inability to perform any physical activity without angina

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8
Q

Acute coronary syndrome

A

Characterised by the development of a thrombosis at the site of acute disruption of an atherosclerotic plaque within the wall of the coronary artery

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9
Q

Following plaque disruption, thrombus develops from

A

Adherence, activation and aggregation of platelets

Thrombin and fibrin production via the coagulation cascade (and thrombin release from platelets)

Vasoactive molecules released from platelets which cause vasoconstriction

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10
Q

ST elevation on ECG is a marker of

A

Complete coronary occlusion

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11
Q

ST depression on ECG is a marker of

A

Incomplete occlusion

Variable T waves abnormalities or normal ECG

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12
Q

Classical ACS symptoms

A

Discomfort/pain in the centre of the chest that lasts for more than a few minutes or recurs

Discomfort/pain radiating to other areas, e.g. arms/jaw/back

Not relieved immediately with S/L GTN

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13
Q

Classical ACS symptoms - elderly

A

Breathlessness
Nausea or vomiting
Sweating and clamminess

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14
Q

Immediate assessments

A

Patient history
ECG
Physical examination

Risk stratification
Cardiac biomarkers (troponin)
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15
Q

Patient history

A

Type and site of pain
Time of onset of pain and duration
History of cardiovascular disease/risk factors

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16
Q

Therapeutic goals in ACS

A

Restore coronary artery patency (STEMI)
Limit myocardial necrosis (STEMI)
Control symptoms

17
Q

Medical management in ACS

A

Anti-platelet therapy
Anti-ischaemic therapy
Secondary prevention

18
Q

Secondary prevention in ACS

A

Antiplatelet therapy (Aspirin & Ticagrelor /clopidogrel /prasugrel)

Statin
ACE inhibitors
Beta blockers
Smoking cessation 
Lifestyle modification
19
Q

Importance of rapid treatment in STEMI n

A 
Morphine and/or nitrates for pain relief
Antiplatelet agents (aspirin + ticagrelor*)

‘Primary’ angioplasty (balloons, stents): artery is mechanically reopened, restoring blood flow
“Clot-busting” drug (thrombolysis): pharmacologically break up clots, restoring blood flow when access to angioplasty delayed/unavailable

20
Q

Unstable angina

A

Angina at rest ( > 20mins)
New onset ( < 2 months) exertional angina (at least CCS III in severity)
Recent ( < 2months) acceleration of angina (increase in severity of at least one CCS class to at least III)
Normal cardiac biomarkers (troponin)

21
Q

NSTEMI

A

Defined as the absence of persistent ST elevation (<20 minutes) on ECG, but with angina symptoms and elevated cardiac biomarkers

‘The troponin explosion’ – a positive troponin is NOT synonymous with NSTEMI

22
Q

High risk patients

A 
Elevated troponin levels
Renal impairment
Recurrent chest pain 
Dynamic ST depression or T wave changes on ECG 
Haemodynamic instability
Major arrhythmias
Heart failure
Elderly
23
Q

Management of UA/NSTEMI

A 
Analgesia
Antiplatelet therapy
Anti-ischaemic therapy
Statins
Early coronary angiography with a view to revascularisation (stenting or CABG)

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