Ischaemic Heart Disease

Question 1

what can a stable plaque become?

Answer 1

an unstable plaque

Question 2

what can an unstable plaque become?

Answer 2

transient ischaemia - cardiac arrest

Question 3

what can acute occlusion become?

Answer 3

acute MI - cardiac arrest

Question 4

what can chronic closure of an artery result in?

Answer 4

scar formation

Question 5

what 2 ways can scar formation go?

Answer 5

1) remodelling & scar anatomy causing ischaemic cardiomyopathy
2) cardiac arrest

Question 6

What is cardiogenic shock?

Answer 6

inadequate systemic perfusion as a result of cardiac dysfunction.

Question 7

what is an example of cardiogenic shock?

Answer 7

acute MI

Question 8

is acute MI a multi-vessel or single-vessel disease?

Answer 8

multi-vessel disease, particularly occluded left anterior descending (LAD).

Question 9

What is the most common cardiac symptom?

Answer 9

chest pain

Question 10

what is angina?

Answer 10

= visceral pain from myocardial hypoxia

• hard to describe
• chest gestures

Question 11

what are 3 things to look for in characteristic patterns?

Answer 11

1) provocation
2) relief
3) timing

Question 12

what are symptoms of angina?

Answer 12

• a pressing, squeezing, heaviness, a weight on the chest
• radiating to arm(s), back, neck, jaw, teeth
• exertion, stress, cold, wind and after meals

Question 13

how can symptoms of angina be relived?

Answer 13

after a few minutes by GTN spray.

Question 14

does angina have risk factors?

Answer 14

yes

Question 15

Symptoms of non-coronary disease i.e. arrhythmias?

Answer 15

• dull, knifelike stabbing
• focal, left sub-mammary in shoulder
• no pattern, at rest
• either fleeting or prolonger
• no risk factors

Question 16

what are other differential diagnosis of chest pain?

Answer 16

1) GI
2) musculoskeletal
3) pericarditis
4) pleuritic chest pain

Question 17

what 4 things in GI can cause chest pain?

Answer 17

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

Question 18

what 2 things in musculoskeletal can cause chest pain?

Answer 18

1) injury
- location
- tender
- prolonger
- exacerbated by moving

2) nerve root pain
- character
- prolonged

Question 19

what are the symptoms of pericarditis?

Answer 19

• central

- posture related, i.e. you can find a comfortable position by re-positioning yourself

Question 20

what are the symptoms of pleuritic chest pain?

Answer 20

• focal

- exacerbated by breathing, sharp and catching

Question 21

what are 3 emergencies associated with coronary heart disease?

Answer 21

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

Question 22

what is the diagnosis of coronary heart disease?

Answer 22

angina

Question 23

what are the pros of exercise testing?

Answer 23

• cheap
• reproducible
• risk stratification = + test at low workload implies poor prognosis

Question 24

what are the cons of exercise testing?

Answer 24

• poor diagnostic accuracy

- sub-maximal tests

Question 25

what are the pros of perfusion imaging?

Answer 25

• non invasive
• pharmacological stress in less mobile patients
• more precision than ETT
• risk stratification

Question 26

what are the cons of perfuse imaging?

Answer 26

• radiation

- false positives & negatives

Question 27

what are the pros of CT angiography?

Answer 27

• non-invasive

- anatomical data & risk stratification

Question 28

what are the cons of CT angiography?

Answer 28

• 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

Question 29

what is done in an angiography?

Answer 29

• 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

Question 30

what 4 drugs can be used and for what?

Answer 30

1) aspirin
- anti-platelet

2) B blockers
- slow heart rate, reduce O2 demand

3) statin
- reduces cholesterol

4) ACE inhibitor
- reduces blood pressure