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103-theme 3 > ischaemic heart disease > Flashcards

ischaemic heart disease Flashcards

1
Q

name 3 types of cardiovascular disease?

A
  • coronary heart disease
  • cerebrovascular disease
  • peripheral vascular disease
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2
Q

what are the risk factors for CVD? 8

A
  • smoking
  • diabetes
  • high blood pressure
  • high cholesterol
  • obesity
  • age
  • family history of premature coronary disease
  • previous heart attack
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3
Q

what are the clinical manifestations of coronary heart disease? 2

A
  • atherosclerosis

- development of fatty streak, lipid deposition, intimal fibrosis

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4
Q

what is ischemic heart disease and myocardial ischaemia? 3

A
  • IDH occurs due to atherosclerotic plaque build up within one or more coronary arteries , thereby obstructing myocardial blood flow
  • this leads to an imbalance between myocardial oxygen supply and demand
  • there is a restriction in the normal increase in coronary blood flow which should occur in response to an increase in myocardial oxygen demand
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5
Q

what are the clinical manifestations of IHD?

A
  • asymptomatic
  • stable angina
  • acute coronary syndromes: unstable angina, NSTEMI (non-ST elevation myocardial infarction), STEMI
  • long term: heart failure, arrhythmias, sudden death
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6
Q

what is the pathology of stable angina?

A
  • ischaemia due to fixed atheromatous stenosis of one or more coronary arteries
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7
Q

what is the pathology of unstable angina?

A

ischaemia caused by dynamic obstruction of a coronary artery due to plaque rupture with superimposed thrombosis and spasm

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8
Q

what is the pathology of myocardial infarction?

A

myocardial necrosis caused by acute occlusion of a coronary artery due to plaque rupture and thrombosis

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9
Q

what is the pathology of arrhythmia?

A

altered conduction due to ischaemia or infarction

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10
Q

what is the pathology of sudden death

A

ventricular arrhythmia, asystole or massive MI

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11
Q

what are the characteristics of typical stable angina? 3

A
  • substernal chest discomfort of characteristic quality and duration
  • provoked by exertion or emotional stress
  • relieved by rest of nitrates and minutes
  • atypical angina=meets two of these characteristics
  • non anginal chest pain= lacks or meets only one
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12
Q

how are patients with stable angina managed? 4

A
  • regular medical therapy
  • short acting nitrates +beta blockers or a calcium channel blocker= first line treatment
  • second line treatment=long acting nitrates and more options
  • if these don’t work we consider an angiography-putting people on statins
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13
Q

describe acute coronary syndromes? 5

A
  • includes unstable angina and acute myocardial infarction
  • in an acute MI, STEMIs and NSTEMIs are differentiated by the specific pattern of abnormality on the ECG
  • all patients who have had an acute MI have a rise in the cardiac enzyme known as troponin which is measured on a blood test
  • troponin is released into the bloodstream following injury to the heart muscle
  • troponin levels are elevated in acute MI but not in unstable angina
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14
Q

describe the pathology of STEMI and NSTEMI? 2

A
  • in general terms, ST elevation on an ECG is a marker of a complete coronary occlusion
  • incomplete occlusion is associated with ST depression, variable T wave abnormalities or with a normal ECG
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15
Q

describe the pathological progression to atherothrombosis?

A

-ACS is characterised by the development of a thrombosis at the site of an acute disruption of an atherosclerotic plaque within the wall of the coronary artery

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16
Q

following plaque disruption, what does a thrombu result from? 3

A
  • adherence, activation and aggregation of platelets
  • thrombin and fibrin production via the coagulation cascade (and thrombin release from platelets)
  • vasoactive molecules released from platelets which cause constriction
17
Q

what are the classical ACS symptoms at presentation? 4

A
  • discomfort/pain in the centre of chest that lasts for more than a few minutes or recurs
  • discomfort/pain radiating to the other areas (left arm/jaw/back)
  • can occur at rest and/or with exertion
  • not relieved immediately with sublingual GTN
18
Q

what do elderly or diabetic patients with ACS present with? 3

A
  • breathlessness
  • nausea/ vomitting
  • sweating or clamminess
19
Q

what is the immediate assessment of patients with suspected ACS? 5

A
  • patient history
  • ECG
  • physical examination
  • risk stratification
  • cardiac biomarkers
20
Q

what are the therapeutic goals in ACS? 3

A
  • restores coronary artery patency (STEMI)
  • limit myocardial necrosis (STEMI)
  • control symptoms
21
Q

how is ACS medically managed? 3

A
  • antiplatelet- aspirin, clopidogrel, prasugrel/ ticagrelor
  • anti-ischemic therapy- nitrates
  • secondary prevention therapy- statin, ACE inhibitors, beta blockers, smoking, lifestyle modification
22
Q

what is important about STEMI treatment? 3

A
  • timely diagnosis is key to successful management
  • the most critical time is in the very early phase when the patient is liable to a cardiac arrest
  • minimising delays to treatment are associated with improved clinical outcome
23
Q

what is the treatment for STEMI? 4

A
  • morphine/nitrates for relief
  • antiplatelet
  • AND emergency primary angioplasty (balloons and stents), artery is mechanically reopened, restoring blood flow
  • clot busting drug
24
Q

describe unstable angina? 4

A
  • angina at rest (>20mins)
  • new onset (<2 months) exertional angina
  • recent (<2 months) acceleration or progression of angina symptoms
  • normal cardiac biomarkers- normal troponin levels
25
Q

how do we identify NSTEMI?

A

defined as the absence of ST elevation on ECG, but with angina symptoms and elevated troponin

26
Q

what things other than MI can cause heart attacks? 6

A
  • pneumonia
  • pulmonary embolism
  • pericarditis
  • sepsis
  • heart failure
  • uncontrolled tachyarrhythmia
27
Q

what suggests ACS patients are high risk? 7

A
  • elevated troponin levels
  • renal impairment
  • recurrent chest pain
  • dynamic ST depression
  • major arrhythmias
  • heart failure
  • elderly
28
Q

what is the management of NSTEMI? 5

A
  • analgesia
  • anti-platelet therapy
  • anti-ischaemic therapy
  • statins
  • early coronary angiography to view revascularization

103-theme 3 (18 decks)

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