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Cardiology > Ischaemic Heart Disease > Flashcards

Ischaemic Heart Disease Flashcards

1
Q

What two main classifications can ischaemic heart disease be divided into? what do they both consist of?

A

chronic IHD and acute coronary syndrome
chronic - stable angina, variant angina, silent myocardial ischaemia
ACS - unstable angina, MI

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2
Q

Explain briefly the pathophysiology underlying IHD

A

Build up of fatty plaques w/in coronary artery walls leading to:

  1. gradual narrowing - less blood = less O2 reaching myocardium when there is increased demand
  2. risk of sudden plaque rupture, can cause sudden occlusion of an artery
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3
Q

Explain briefly how fatty plaques are formed

A
  1. endothelial dysfunction (big RFs = smoking, HTN, hyperglycaemia)
  2. Fatty infiltration by LDL particles
  3. Macrophages phagocytose oxidised LDL, turn into foam cells
  4. Smooth muscle proliferation and migration from tunica media into intima -> formation of fibrous capsule covering the plaque
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4
Q

What are unmodifiable RFs for IHD?

A
  1. age
  2. m > f
  3. FHx
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5
Q

What are modifiable RFs for IHD?

A
  1. smoking
  2. DM
  3. HTN
  4. Hypercholesterolaemia
  5. Obesity
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6
Q

What is stable angina

A

angina induced by effort and relieved by rest

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7
Q

What is unstable angina?

A

angina of increasing frequency or severity, occurring on minimal exertion or rest

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8
Q

What is decubitus angina?

A

precipitated by lying flat

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9
Q

What is prinzmetals angina?

A

angina due to coronary artery vasospasm

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10
Q

How does angina usually present?

A
  1. central chest tightness or heaviness

2. may radiate to arm (usually L), neck, jaw or teeth

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11
Q

What are precipitants of angina other than exercise?

A

emotion
cold weather
heavy meals

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12
Q

What sx is angina associated w?

A

SOB
nausea
sweating
faintness

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13
Q

What are the Ix for angina?what may they show?

A
  1. ECG - usually normal, may show inverted/flat T waves, ST depression or signs of past MI
  2. Exercise ECG
  3. Cardiac CT
  4. Coronary angiogram
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14
Q

What is the pharmacological management of stable angina?

i. Sx relief
ii. Prevention

A 
Sx relief: 
1. GTN spray 
2. beta-blockers or CCB e.g. diltiazem
3. Long acting nitrate e.g. isosorbide
4. Nicorandil 
Prevention:
1. Aspirin 75mg OR clopidogrel
2. ACEi (esp in DM)
3. Statins (irrespective of lipid levels)
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15
Q

What is the conservative management of stable angina?

A

stop smoking
exercise
weight loss

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16
Q

What is the surgical management of stable angina?

A

Percutaneous transluminal coronary angioplasty

17
Q

What clinical features point to a diagnosis of unstable angina?

A
  1. Increase then decrease in cardiac biomarkers - troponin
  2. ECG ischaemic changes
  3. Sx of ischaemia
  4. Pathological Q waves
18
Q

What is the presentation of unstable angina?

A

chest pain
SOB, sweating, N+V
Signs:
pallor, tachycardia, 4th HS, HF (raised JVP, basal creps), pansystolic murmur

19
Q

What groups of pts are prone to silent MIs?

A

elderly and diabetic

20
Q

what post-MI changes are seen on an ECG after:

i. hours
ii. days

A

i. tall T waves, ST elevation, new LBBB
ii. T wave inversion, pathological Q waves

NB there can also be ST depression or it may be normal

21
Q

What cardiac enzymes are used to help detect an MI? What changes would you expect to see in their levels post MI including when they peak and return to baseline

A
  1. Troponin (T + I):
    - increase w/in 3-12hrs from onset of chest pain
    - peak at 24-48hrs
    - decrease to baseline over 5-14 days
  2. creatine kinase:
    - increase w/in 3-12hrs from onset of chest pain
    - peak at 24hrs
    - return to baseline after 48-72hrs
22
Q

Give the management of a STEMI

A
  1. Aspirin 300mg (consider clopidogrel or ticagrelor)
  2. Morphine 5-10mg IV
  3. GTN
  4. O2
  5. Resolve perfusion of arteries:
    i. Primary PCI - within 12hrs
    ii. Thrombolysis - ideally <30m from admission
23
Q

When is thrombolysis contraindicated in the management of STEMIs

A

beyond 24hrs

24
Q

Give the management of an NSTEMI

A
  1. ASPIRIN
  2. nitrates or morphine to relieve pain
  3. Antithrombin rx - fondaparinux, unfractionated heparin
  4. Antiplatelet: ticagrelor, prasugrel if PCI (continue either for 12m)
  5. IV glycoprotein IIb/IIIa receptor antagonists - eptifibatide or tirofiban if increased risk of CV events
  6. Coronary angiography w/in 96hrs of 1st admission
25
Q

list the complications of MI

A
  1. Cardiac arrest
  2. Cardiogenic shock
  3. Bradycardias or heart block
  4. Tachyarrhythmias - VF/VT
  5. Pericarditis
  6. LV aneurysm
  7. VSD
  8. Acute mitral regurgitation
  9. DVT/PE - give enoxaparin until fully mobile
  10. Systemic embolism
  11. Chronic HF
26
Q

How would you treat bradycardia or heart block post MI ?

A

sinus Brady - atropine

heart block - pacemaker if needed

27
Q

When is the risk of post MI pericarditis higher?what clinical features signify this?

A

first 48hrs following. transmural MI

pericardial rub + pericardial effusion on echo

28
Q

What is dresser’s syndrome?

how is it treated?

A

autoimmune reaction 2-6weeks post-MI as myocardium recovers

rx: NSAIDs

29
Q

Why is there a risk of LV aneurysm post mi?
what would make you suspicious of this complication?
how would you treat this ?

A

ischaemic damage weakening myocardium
persistent ST elevation and LV failure
surgical and anticoagulant as increased risk of stroke

30
Q

When increases the risk of post-MI mitral regurgitation? What signs would indicate this?

A

infero-posterior MI due to ischaemia or rupture of papillary muscle
sx: pulm oedema and early-mid systolic murmur

Cardiology (13 decks)

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