Ischaemic heart disease Flashcards
What is cardiovascular disease?
CVD is disease of the heart or circulatory system which comprises:
Coronary heart disease
Cerebrovascular disease
Peripheral vascular disease
What proportion of deaths does CVD make up?
1/3
Is CVD the 1st, 2nd, 3rd of 4th most common cause of death in the UK?
2ND
Does CVD cause more deaths in men or women?
Men
What are the 5 controllable risk factors for CVD?
Cigarette Smoking
Diabetes
High blood pressure
High cholesterol
Obesity
What are the 3 non-controllable risk factors for CVD?
Age
Family history of premature coronary disease
Previous heart attack
What is atherosclerosis?
‘Hardening of the Arteries’
DEVELOPMENT OF:
- Fatty Streak
- Lipid deposition
- Intimal Fibrosis
How does atherosclerosis cause ischaemic heart disease?
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
What are the clinical manifestations of IHD?
- Asymptomatic
- Stable angina
- Acute coronary syndromes
- Unstable angina
- NSTEMI
- STEMI
•Long-term
- Heart failure
- Arrhythmias
- Sudden death
Complete the table
Pathology - how it occurs
Complete the table on the classification of chest pain
What is first line treatment for angina relief?
Short acting nitrates
Plus
Either beta blocker or CCB (calcium channel blocker)
What are the 3 acute coronary syndromes?
Includes (1) unstable angina, and (2) acute myocardial infarction (STEMIs and NSTEMIs)
Which patients have a rise in tropinin?
Troponin levels are elevated in acute MI but NOT in unstable angina
What are the 3 theraptic goals in ACS?
- Restore coronary artery patency (STEMI)
- Limit myocardial necrosis (STEMI)
- Control symptoms
What is troponin?
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
How are acute MIs differentiated on an ECG?
In acute MI, STEMIs and NSTEMIs are differentiated by the specific pattern of abnormality on the ECG
What is the difference between what causes an NSTEMI and a STEMI?
What is acute coronary syndrome characterised by?
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
Complete the diagram on the stages of atherosclerosis
Following plaque disruption, what 3 things does a thrombus result from:
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
What are the classical symptoms of acute coronary syndrome patients?
- 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
What symptoms do elderly or diabetic patients have with acute coronary syndrome?
- Breathlessness
- Nausea or vomiting
- Sweating and clamminess
What immediate assessment would you undertake for patients presenting with acute coronary syndrome?
First:
- Patient history
- ECG
- Physical examination
Then/in parallel:
- Risk stratification
- Cardiac biomarkers (troponin)
