Ischaemic Heart Disease Flashcards
what can a stable plaque become?
an unstable plaque
what can an unstable plaque become?
transient ischaemia - cardiac arrest
what can acute occlusion become?
acute MI - cardiac arrest
what can chronic closure of an artery result in?
scar formation
what 2 ways can scar formation go?
1) remodelling & scar anatomy causing ischaemic cardiomyopathy
2) cardiac arrest
What is cardiogenic shock?
inadequate systemic perfusion as a result of cardiac dysfunction.
what is an example of cardiogenic shock?
acute MI
is acute MI a multi-vessel or single-vessel disease?
multi-vessel disease, particularly occluded left anterior descending (LAD).
What is the most common cardiac symptom?
chest pain
what is angina?
= visceral pain from myocardial hypoxia
- hard to describe
- chest gestures
what are 3 things to look for in characteristic patterns?
1) provocation
2) relief
3) timing
what are symptoms of angina?
- a pressing, squeezing, heaviness, a weight on the chest
- radiating to arm(s), back, neck, jaw, teeth
- exertion, stress, cold, wind and after meals
how can symptoms of angina be relived?
after a few minutes by GTN spray.
does angina have risk factors?
yes
Symptoms of non-coronary disease i.e. arrhythmias?
- dull, knifelike stabbing
- focal, left sub-mammary in shoulder
- no pattern, at rest
- either fleeting or prolonger
- no risk factors
what are other differential diagnosis of chest pain?
1) GI
2) musculoskeletal
3) pericarditis
4) pleuritic chest pain
what 4 things in GI can cause chest pain?
1) reflux
- burning acid, water brash, provoked by food
2) peptic ulcer pain
- epigastric, point of finger gesture, release by antacids, food
3) oesophageal spasm
4) biliary colic
what 2 things in musculoskeletal can cause chest pain?
1) injury
- location
- tender
- prolonger
- exacerbated by moving
2) nerve root pain
- character
- prolonged
what are the symptoms of pericarditis?
- central
- posture related, i.e. you can find a comfortable position by re-positioning yourself
what are the symptoms of pleuritic chest pain?
- focal
- exacerbated by breathing, sharp and catching
what are 3 emergencies associated with coronary heart disease?
1) MI
- severe, autonomic upset
- ongoing pain despite morphine
2) pulmonary embolus
- breathlessness, dull (maybe pleuritic)
3) dissection of aorta
- tearing
- excruciating
- severe then eases
- back pain
what is the diagnosis of coronary heart disease?
angina
what are the pros of exercise testing?
- cheap
- reproducible
- risk stratification = + test at low workload implies poor prognosis
what are the cons of exercise testing?
- poor diagnostic accuracy
- sub-maximal tests
what are the pros of perfusion imaging?
- non invasive
- pharmacological stress in less mobile patients
- more precision than ETT
- risk stratification
what are the cons of perfuse imaging?
- radiation
- false positives & negatives
what are the pros of CT angiography?
- non-invasive
- anatomical data & risk stratification
what are the cons of CT angiography?
- radiation
- less precise than angiography, specifically when calcium is present
- cost
- risk of death & stroke
- X-ray contrast can cause renal dysfunction, rash and nausea
what is done in an angiography?
- sheath inserted into artery
- catheter advanced from wrist/groin to coronary ostium
- X-ray contrast agent injected to outline coronaries
- video fluoroscopy recorded imagines inn multiple views
what 4 drugs can be used and for what?
1) aspirin
- anti-platelet
2) B blockers
- slow heart rate, reduce O2 demand
3) statin
- reduces cholesterol
4) ACE inhibitor
- reduces blood pressure
