Ischaemic Heart Disease -- Session 10

Question 0

Give some modifiable risk factors for coronary atheroma

Answer 0

Exercise
Smoking
Diet -- hyperlipidaemia, obesity
Stress
Hypertension
Diabetes mellitus

Question 1

Give some common causes of chest pain

Answer 1

Lungs (pneumonia, pulmonary embolism, pneumothorax)
GI (oesophagus – reflux, peptic ulcer disease, cholecystisis)
Chest wall (costochondritis, fibrositis, skin problems)
CVS (MI, angina, pericarditis, aortic dissection)

Question 2

Give some non-modifiable risk factors for coronary atheroma

Answer 2

Gender – males have higher risk (sucks to be you Matt :-P)
Increasing age
Family history

Question 3

What are the four main modifiable risk factors for coronary atheroma?

Answer 3

Hyperlipidaemia
Smoking
Hypertension
Diabetes mellitus (doubles risk of ischaemic heart disease)

Question 4

Describe angina

Answer 4

Is caused by decreased blood supply to the myocardium
– during diastole, the filling period of coronary arteries is less so there is less blood supply to the myocardium
– have partially occluded/narrowed coronary arteries in angina
Demand of blood to ten myocardium is not met by the supply which causes ischaemia and chest pain

Question 5

Describe myocardial infarction

Answer 5

Coronary artery lumen is occluded (thrombus from ruptured atheroma tours plaque)
Blood cannot supply cardiac muscle
Ischaemia occurs followed by infarction

Question 6

Give some clinical signs of angina

Answer 6

ST depression

Narrowed coronary arteries appear on an angiogram

Question 7

Give some symptoms of angina

Answer 7

Central chest pain on exertion – returns to normal on resting
Shortness of breath (dyspnea)
Nausea, dizziness, vomiting
Fatigue

Question 8

Signs do myocardial infarction

Answer 8

ST elevation (may or may not be depending on if infarction is full thickness or not)
High creatine kinase and troponin 1 levels

Question 9

What is a non ST elevated myocardial infaction?

Answer 9

Non- full thickness infarction

Question 10

Give some symptoms of myocardial infarction

Answer 10

Central crushing chest pain, may radiate to chest and shoulders. Is not relieved by rest
Pallor
Nauseas, dizziness (can lead to syncope), vomiting

Question 11

What is unstable angina?

Answer 11

Ischaemic central chest pain which can occur at rest

Question 12

What is unstable angina caused by?

Answer 12

A transient blockage which can be due to platelet aggregation, coronary thrombosis or coronary artery spasms
– due to ischaemia rather than and increase in demand for oxygen

Question 13

Give some symptoms of acute pericarditis

Answer 13

Central stabbing chest pain
Pain is increased by lying down or deep breathing
Pain is relieved by sitting down and leaning forward
Pain can be referred to the shoulders (C4 dermatome)
Palpitations
Shortness of breath
Fatigue

Question 14

Give some signs of acute pericarditis

Answer 14

Pallor
Fiction rub upon auscultation
Can see fluid collection in pericardial sac by echo or ultrasound
May see cardiac enlargement on an x-ray
Saddle-shaped ST elevations which are unrelated to the distribution of C arteries

Question 15

Give some causes of acute pericarditis

Answer 15

Viral or bacterial infection
Tuberculosis
HIV
Uraemia pericarditis due to untreated kidney failure
Myocardial infarction 
Metastasising cancers to pericardium
Inflammatory disease

Question 16

Where can ischaemic chest pain be felt?

Answer 16

Central
Retrosternal
Left sided

Question 17

How can ischaemic chest pain be described?

Answer 17

Tightening
Heavy 
Crushing
Constricting 
Pressure
Burning epigastric pain for an inferior MI

Question 18

Describe an atheroma tours plaque

Answer 18

Plaque with a necrotic centre and fibrous cap found in the coronary vessels which occludes the lumen of the artery
– occurs when more than 70% f the lumen is occluded

Question 19

When can episodes of stable angina occur?

Answer 19

Exertion

Emotion especially after meals and in cold weather

Question 20

Give some treatments for acute episodes of angina

Answer 20

Sublingual nitrate spray or tablet

Question 21

Give some treatment that prevents episodes of angina

Answer 21

Beta blockers
Ca2+ channel blockers
Oral nitrates

Question 22

Give some treatments that prevents cardiac events

Answer 22

Aspirin
Statins
ACE inhibitors

Question 23

Why does unstable angina develop?

Answer 23

Due to an increased formation of an atheromatous plaque. Eh lumen is being occluded more