Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Acute Care & Trauma > Ischaemic Heart Disease > Flashcards

Ischaemic Heart Disease Flashcards

1
Q

Define Ischaemic Heart Disease?

A

Characterised by decreased blood supply to the heart muscle resulting in chest pain (angina pectoris)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the two ways Ischaemic Heart Disease can present?

A

Stable angina or Acute Coronary Syndrome (ACS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How can ACS be further subdivided into?

A

Unstable angina
NSTEMI
STEMI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is unstable angina?

A

Chest pain at rest due to ischaemic but without cardiac injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is STEMI?

A

ST elevation with transmural infarction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is MI?

A

Cardiac muscle necrosis resulting from ischaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the epidemiology of ischaemic heart disease?

A

Common
Prevalence > 2%
More common in males
Annual incidence of MI in the UK ~ 5/1000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When does Angina Pectoris occur?

A

When myocardial oxygen demand exceeds oxygen supply

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is Angina Pectoris due to?

A

Atherosclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the rarer causes of angina pectoris?

A

Include coronary artery spasm (e.g. induced by cocaine)
Arteritis
Emboli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the pathophysiology of atherosclerosis?

A

Endothelial injury leads to migration of monocytes into the subendothelial space
These monocytes differentiate into macrophages
Macrophages accumulate LDL lipids and become foam cells
These foam cells release growth factors that stimulate smooth muscle, proliferation, production of collagen and proteoglycans
This leads to the formation of an atherosclerotic plaque

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the risk factors for Ischaemic Heart Disease?

A 
Male 
Diabetes Mellitus 
Family History
Hypertension
Hyperlipidaemia 
Smoking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the presenting symptoms of ACS?

A

Acute-onset chest pain
Central, heavy, tight, crushing pain
Radiates to the arms, neck, jaw or epigastrium
Occurs at rest
More severe and frequent pain that previously occuring stable angina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the associated symptoms of ACS?

A

Breathlessness
Sweating
Nausea and vomiting
Silent Infacts occur in the elderly and diabetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the presenting symptoms of Stable Angina?

A

Chest pain brought on by exertion and relieved by rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the signs of ACS on physical examination?

A 
Pale 
Sweating
Restless 
Low-grade pyrexia 
Check both radial pulses to rule out aortic dissection
Arrhythmias 
Disturbances of BP
New heart murmus 
Signs of complications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are signs of complications of ACS on physical examination?

A

Acute heart failure

Cardiogenic Shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is important to remember when physically examining for ACS?

A

There may be no clinical signs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What bloods would you do for Ischaemic Heart Disease?

A 
FBC 
U&Es 
CRP 
Glucose 
Lipid profile 
Cardiac enzymes (troponins and CK-MB)
Amylase (pancreatitis could mimic MI)
TFTs
AST and LDH (raised 24 and 48 hours post-MI, respectively)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What do we see on an ECG for unstable Angina or NSTEMI?

A

May show ST depression or T wave inversion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What would we see on an ECG with STEMI?

A

Hyperacute T waves
ST elevation (> 1 mm in limb leads, > 2 mm in chest leads)
New-onset LBBB
Later changes: T wave inversion and Pathological Q waves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the relationship between ECG leads and the side of the heart?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How do we use CXR in ischaemic heart disease investigations?

A

Check for signs of heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the indications for an Exercise ECG in Ischaemic Heart Disease?

A

Patient with troponin-negative ACS or stable angina with a high pretest probability of coronary heart disease
Pretest probability is based on characteristics of chest pain, cardiac risk factors, age and gender
Digoxin is associated with giving a false-positive result

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the positive test of an Exercise ECG?

A

> 1mm horizontal or downsloping ST depression measured at 80 ms after the end of the QRS complex

26
Q

What is the failed test for an Exercise ECG?

A

Failure to achieve at least 85% of the predicted maximal heart rate (220-age) and otherwise negative findings (no chest pain or ECG changes)

27
Q

What are some resting ECG abnormalities?

A

pre-excitation syndrome
>1mm ST depression
LBBB or pacemaker ventricular rhythm

28
Q

How do we use Radionuclide Myocardial Perfusion Imaging (rMPI)?

A

Uses Technetium-99m sestamibi or tetrofosmin
Can be performed under stress or at rest
Stress testing shows low uptake in ischaemic myocardium

29
Q

How do we use an Echocardiogram in Ischaemic Heart Disease?

A

Measures left ventricular ejection fraction

Exercise or dobutamine stress echo may detect regional wall motion abnormalities

30
Q

When do we do Pharmacological Stress Testing?

A

This is used in patients who are unable to exercise
Pharmacological agents can be used to induce a tachycardia
These agents are used in conjuction with various imaging modalities to detect ischaemic myocardium

31
Q

What are the pharmacological agents that can be used to induce tachycardia?

A

Dipyridamole
Adenosine
Dobutamine

32
Q

When are Dypiridamole and Adenosine contraindicated?

A

In AV block and reactive airway disease

33
Q

When is Cardiac Catheterisation/Angiography used?

A

Perfomed if ACS with positive troponin or if high risk on stress testing

34
Q

What is Coronary Calcium scoring and when is it used?

A

Uses specialised CT scan

May be useful in outpatients with atypical chest pain or in acute chest pain that isn’t clearly due to ischaemia

35
Q

What is the management plan for Stable Angina?

A 
Minimise cardiac risk factors
Immediate symptom relief 
Long-term management
Percutaneous Coronary Intervention (PCI)
Coronary Artery Bypass Graft (CABG)
36
Q

What are cardiac risk factors that should be minimised?

A

BP
Hyperlipidaemia
Diabetes

37
Q

What should all patients receive?

A

Aspirin 75 mg/day unless contraindicated

38
Q

What can be used for immediate symptom relief?

A

GTN spray

39
Q

What is the long-term management of a stable angina?

A

Beta-Blockers
Calcium Channel blockers
Nitrates

40
Q

When is Beta-blockers contraindicated?

A 
Acute Heart Failure
Cardiogenic Shock
Bradycardia
Heart Block
Asthma
41
Q

When is Percutaneous Coronary Intervention (PCI) performed?

A

In patients with stable angina despite maximal tolerable medical therapy

42
Q

What is an example of a situation when CABG is done?

A

Occurs in more severe cases

E.g. three-vessel disease

43
Q

What is the management plan for unstable angina/NSTEMI?

A 
Admit to coronary care unit
Oxygen, IV access, monitor vital signs and serial ECG
GTN
Morphine
Metroclopramide
Aspirin
Clopidogrel
LMWH
Beta-Blocker
Glucose-Insulin infusion
44
Q

Why do we adminster Metoclopramide?

A

To counteract the nausea caused by morphine

45
Q

Wnat is the Aspirin dose in the treatment of Unstable Angina/NSTEMI?

A

300 mg initially, followed by 75 mg indefinitely

46
Q

What is the Clopidogrel dose for the treatment of Unstable Angina/NSTEMI?

A

300 mg initially, followed by 75mg for at least 1 year if troponin positive or high risk

47
Q

When do we do a Glucose-insulin infusion in the treatment of Unstable Angina/NSTEMI?

A

If blood glucose > 11 mmoll/L

48
Q

Why might we consider GlpIIb/IIIa inhibitors in patients with Unstable Angina/NSTEMI?

A

In patients:
undergoing PCI
At high risk of further cardiac events

49
Q

What do we do if there is little improvement following treatment of an Unstable Angina/NSTEMI?

A

Consider urgent angiography with/without revascularisation

50
Q

What is a mneumonic to remember the acute management of ACS?

A 
MONOBASH:
Morphine
Oxygen
Nitrates
Anticoagulants (aspirin + clopidogrel)
Beta-blockers
ACE inhibitors
Statins 
Heparin
51
Q

What is the difference between STEMI management and UAP/NSTEMI management?

A

Clopidrogrel
600mg if patient is going to PCI
300 mg if undergoing thrombolysis and < 75 yrs
75mg if undergoing thrombolysis and > 75 yrs

52
Q

What is the goal of Primary PCI in management of STEMI?

A

Goal < 90 min if available

53
Q

What is the secondary prevention of the management of STEMI?

A 
Dual antiplatelet therapy (aspirin + clopidogrel)
Beta-blockers
ACE inhibitors
Statins
Control risk factors
54
Q

What advice would you give to someone who has had a STEMI?

A

No driving for 1 month following MI

55
Q

When is CABG considered?

A

In patients with left main stem or three-vessel disease

56
Q

What are the early complications of Ischaemic Heart Disease (within 24-72 hrs)?

A 
Death
Cardiogenic Shock
Heart Failure
Ventricular Arrhythmias 
Heart Block
Pericarditis 
Myocardial rupture 
Thromboembolism
57
Q

What are the late complications of ischaemic heart disease?

A 
Ventricular Wall Rupture 
Valvular Regurgitation
Ventricular Aneurysms 
Tamponade 
Dressler's Syndrome
Thromboembolism
58
Q

What is the mnemonic for complications of MI?

A 
DARTHVADE
Death
Arrhythmias 
Rupture 
Tamponade 
Heart Failure 
Valve disease 
Aneurysm
Dressler's Syndrome
Embolism
59
Q

What are the two types of ways you can do to summarise the prognosis for patients with ischaemic heart disease?

A

TIMI Score

Killip classification

60
Q

What are TIMI scores?

A 
TIMI score (0-7) can be used for risk stratification
Note: TIMI = thrombolysis in MI
High scores are associated with high risk of cardiac events within 30 days of MI
61
Q

What are the Killip classification?

A

Class I: no evidence of heart failure
Class II: mild to moderate heart failure
Class III: over pulmonary oedema
Class IV: cardiogenic shock

Acute Care & Trauma (25 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions