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103 Theme 3 - Cardiovascular System > Ischaemic heart disease > Flashcards

Ischaemic heart disease Flashcards

1
Q

What is cardiovascular disease?

A

CVD is disease of the heart or circulatory system which comprises:

—Coronary heart disease

—Cerebrovascular disease

—Peripheral vascular disease

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2
Q

What proportion of deaths does CVD make up?

A

1/3

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3
Q

Is CVD the 1st, 2nd, 3rd of 4th most common cause of death in the UK?

A

2ND

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4
Q

Does CVD cause more deaths in men or women?

A

Men

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5
Q

What are the 5 controllable risk factors for CVD?

A

Cigarette Smoking

Diabetes

High blood pressure

High cholesterol

Obesity

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6
Q

What are the 3 non-controllable risk factors for CVD?

A

Age

Family history of premature coronary disease

Previous heart attack

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7
Q

What is atherosclerosis?

A

‘Hardening of the Arteries’

DEVELOPMENT OF:

  • Fatty Streak
  • Lipid deposition
  • Intimal Fibrosis
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8
Q

How does atherosclerosis cause ischaemic heart disease?

A

IHD occurs due to atherosclerotic plaque build up within one or more coronary arteries, obstructing myocardial blood flow

This leads to an imbalance between myocardial oxygen supply and demand

Restricts the normal increase in coronary blood flow which should occur in response to increase in myocardial oxygen demand

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9
Q

What are the clinical manifestations of IHD?

A
  • Asymptomatic
  • Stable angina
  • Acute coronary syndromes
  • Unstable angina
  • NSTEMI
  • STEMI

•Long-term

  • Heart failure
  • Arrhythmias
  • Sudden death
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10
Q

Complete the table

Pathology - how it occurs

A
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11
Q

Complete the table on the classification of chest pain

A
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12
Q

What is first line treatment for angina relief?

A

Short acting nitrates

Plus

Either beta blocker or CCB (calcium channel blocker)

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13
Q

What are the 3 acute coronary syndromes?

A

Includes (1) unstable angina, and (2) acute myocardial infarction (STEMIs and NSTEMIs)

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14
Q

Which patients have a rise in tropinin?

A

Troponin levels are elevated in acute MI but NOT in unstable angina

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15
Q

What are the 3 theraptic goals in ACS?

A
  • Restore coronary artery patency (STEMI)
  • Limit myocardial necrosis (STEMI)
  • Control symptoms
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16
Q

What is troponin?

A

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 blood stream following injury to the heart muscle and is a diagnostic marker of an acute MI

17
Q

How are acute MIs differentiated on an ECG?

A

In acute MI, STEMIs and NSTEMIs are differentiated by the specific pattern of abnormality on the ECG

18
Q

What is the difference between what causes an NSTEMI and a STEMI?

A
19
Q

What is acute coronary syndrome characterised by?

A

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

20
Q

Complete the diagram on the stages of atherosclerosis

A
21
Q

Following plaque disruption, what 3 things does a thrombus result from:

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 vasoconstriction

22
Q

What are the classical symptoms of acute coronary syndrome patients?

A
  • Discomfort/pain in the centre of the chest that lasts for more than a few minutes or recurs
  • Discomfort/pain radiating to other areas, e.g. left arm/jaw/back
  • Can occur at rest and/or with exertion
  • Not relieved immediately with sublingual GTN
23
Q

What symptoms do elderly or diabetic patients have with acute coronary syndrome?

A
  • Breathlessness
  • Nausea or vomiting
  • Sweating and clamminess
24
Q

What immediate assessment would you undertake for patients presenting with acute coronary syndrome?

A

First:

  • Patient history
  • ECG
  • Physical examination

Then/in parallel:

  • Risk stratification
  • Cardiac biomarkers (troponin)
25
Q

What are the 3 components of medical management in ACS?

A
  • Anti-platelet therapy
  • Anti-ischaemic therapy
  • Secondary prevention therapy
26
Q

Name some examples of the following medical management of ACS patients

Anti-platelet therapy:

Anti-ischaemic therapy:

Secondary prevention therapy:

A

Anti-platelet therapy:

  • Aspirin
  • Clopidogrel /Prasugrel /Ticagrelor

Anti-ischaemic therapy:

  • Nitrates

Secondary prevention therapy:

  • Statin
  • ACE inhibitors
  • Beta blockers
  • Smoking cessation
  • Lifestyle modification
27
Q

What are the 3 ESC guidelines on STEMIs?

A

1) Timely diagnosis of STEMI is the key to successful management
2) The most critical time is the very early phase when the patient is liable to cardiac arrest
3) Minimising delays to treatment is associated with improved clinical outcome

28
Q

How would you treat a STEMI?

A
  • Morphine and/or nitrates for pain relief
  • Antiplatelet agents (aspirin + clopidogrel)
  • Primary angioplasty (balloons, stents): artery is mechanically reopened, restoring blood flow
  • “Clot-busting” drug (thrombolysis): pharmacologically break up clots, restoring blood flow (when no access to primary angioplasty)
29
Q

What procedure is this?

A

Balloon angioplasty and stent

30
Q

What is the definition for unstable angina?

A

Angina at rest (> 20mins)

New onset (< 2 months) exertional angina

Recent (< 2months) acceleration or progression of angina symptoms

31
Q

What is an NSTEMI?

A

Defined as the absence of ST elevation on ECG, but with angina symptoms and elevated cardiac biomarkers (troponin)

32
Q

‘The troponin explosion’ – a positive troponin is NOT synonymous with NSTEMI.

What other causes of raised troponin is there?

A
  • Pneumonia
  • Pulmonary embolism
  • Pericarditis
  • Sepsis
  • Heart Failure
  • Uncontrolled tachyarrhythmia
33
Q

What are the high risk ACS patients?

A

Elevated troponin levels

Renal impairment

Recurrent chest pain

Dynamic ST depression or T wave changes on ECG

Haemodynamic instability

Major arrhythmias

Heart failure

Elderly

34
Q

How would you treat a NSTEMI / Unstable angina?

A

Analgesia

Anti-platelet therapy

Anti-ischaemic therapy

Statins

Early coronary angiography with a view to revascularisation (stenting or CABG)

35
Q

What 2 vessels can be used for coronary artery bypass surgery?

A

Saphenous vein from leg

Internal mammary artery from chest

103 Theme 3 - Cardiovascular System (19 decks)

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