Ischaemic heart disease

Question 1

IHD?

Answer 1

Characterised by decreased blood supply to the heart muscle resulting in chest pain (angina pectoris), may present as stable angina or acute coronary syndrome.

Question 2

IHD unstable angina?

Answer 2

chest pain due to ischaemia without cardiac injury.

Question 3

IHD STEMI?

Answer 3

ST elevation with transmural infarction.

Question 4

IHD MI?

Answer 4

cardiac muscle necrosis resulting from ischaemia

Question 5

IHD aetiology?

Answer 5

when myocardial oxygen demand exceeds oxygen supply, usually due to atherosclerosis.

Question 6

IHD atherosclerosis pathophysiology?

Answer 6

endothelial injury leads to monocytes in the subendothelial space, differentiate into macrophages, which accumulate LDL lipids and become foam cells, which release growth factors that stimulate smooth muscle proliferation, production of collagen and proteoglycans leading to formation of atherosclerotic plaque.

Question 7

IHD risk factors (6)?

Answer 7

male,

DM,

family hist,

hypertension,

hyperlidaemia,

smoking

Question 8

IHD epidemiology?

Answer 8

common, >2%, more common in males.

Question 9

IHD symptoms of ACS?

Answer 9

acute onset chest pain, central, heavy, tight, crushing pain, radiates to arms, neck, jaw or epigastrium, occurs at rest, associated symptoms (breathlessness, sweating, nausea and vomiting)

Question 10

IHD symptoms of stable angina?

Answer 10

chest pain brought on by exertion and relieved by rest.

Question 11

IHD signs of stable angina?

Answer 11

none

Question 12

IHD signs of ACS?

Answer 12

might be no clinical signs, pale, sweating, restless, low grade pyrexia, check both radial pulses to rule out aortic dissection, arrhythmias, disturbance of BP, new heart murmurs, signs of complications.

Question 13

IHD investigations bloods?

Answer 13

FBC, U&Es, CRP, Glucose, lipid profile, cardiac enzymes for troponins and CK-MB, amylase as pancreatitis can mimic MI, TFTs, AST and LDH are raised 24hrs post-MI

Question 14

IHD investigations ECG unstable angina or NSTEMI?

Answer 14

may show ST depression or T wave inversion,

Question 15

IHD investigations ECG STEMI?

Answer 15

hyperactue T waves, ST elevation, new onset LBBB

Question 16

IHD investigations ECG relationship between leads and side of heart?

Answer 16

Inferior: II, III, aVF. Anterior: V1-V5/6. Lateral: I, aVL, V5/6. Posterior: Tall R wave and ST depression in V1-3

Question 17

IHD investigations CXR?

Answer 17

for signs of heart failure.

this x ray shows large left ventricular scar

Question 18

IHD investigations exercise ECG?

Answer 18

for patients with troponin negative ACS or stable angina with a high pretest probability of CHD.

A positive test is >1mm horizontal or downsloping ST depression measured at 80ms after the end of the QRS complex.

Question 19

IHD management stable angina?

Answer 19

minimise cardiac risk factors (patients should receive aspirin 75mg/day)

immediate symptom relief (GTN spray)

long term management of beta blockers, calcium channel blockers, nitrates.

Percutaneous coronary intervention, or coronary artery bypass graft.

Question 20

IHD management for unstable angina/NSTEMI?

Answer 20

MONABASH = morphine, oxygen, nitrates, anticoagulants, beta blockers, ace inhibitors, statins, heparin

Question 21

IHD management STEMI?

Answer 21

same as NSTEMI but use thrombolytics, and CABG (coronary artery bypass graft for patients with left main stem or 3 vessel disease

Question 22

IHD complications?

Answer 22

DARTHVADE = death, arrhythmias, rupture, tamponade, heart failure, valve disease, aneurysm, Dresslers syndrome, embolism.