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Module 103: Theme 3: Physiology of the cardiovascular system. Principles of pathology, diagnosis and treatment of cardiovascular disease > Ischemic heart disease > Flashcards

Ischemic heart disease Flashcards

1
Q

What is cardiovascular disease?

A

A disease of the heart or circulatory system which comprises coronary heart disease, cerebrovascular disease and peripheral vascular disease

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2
Q

Which study determined the concept of risk factors in cardiovascular disease?

A

Framingham heart study

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3
Q

List the controllable risk factors of coronary heart disease

A 
Cigarette Smoking
Diabetes
High blood pressure
High cholesterol
Obesity
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4
Q

List the non controllable risk factors of coronary heart disease

A

Age
Gender
Family history of premature coronary disease
Previous heart attack

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5
Q

What does atherosclerosis involve?

A

Development of a fatty streak
Lipid deposition
Intimal fibrosis

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6
Q

How does ischemic heart disease develop?

A

Atherosclerotic plaque build up within one or more coronary arteries, obstructing myocardial blood flow

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7
Q

What does the process of ischemic heart disease development cause?

A

This leads to an imbalance between myocardial oxygen supply and demand
Restricts normal increase in coronary blood flow in response to increase in myocardial oxygen demand

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8
Q

List the clinical manifestations of ischemic heart disease

A

Asymptomatic
Stable angina
Acute coronary syndromes - (Unstable angina, NSTEMI, STEMI)
Long-term - (Heart failure, Arrhythmias, Sudden death)

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9
Q

Define stable angina

A

Ischemia due to fixed atheromatous stenosis of 1 or more coronary arteries

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10
Q

Define unstable angina

A

Ischemia caused by dynamic obstruction of a coronary artery due to a plaque rupture with superimposed thrombosis and spasm
Angina at rest ( > 20mins)
New onset ( < 2 months) exertional angina (at least CCS III in severity)
Recent ( < 2months) acceleration of angina (increase in severity of at least one CCS class to at least III)
Normal cardiac biomarkers (troponin)

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11
Q

Define myocardial infarction

A

Myocardial necrosis caused by acute occlusion of a coronary artery due to a plaque rupture or thrombosis

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12
Q

Define heart failure

A

Myocardial dysfunction due to ischemia/infarction

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13
Q

Define arrythmia

A

Altered conduction due to ischemia or infarction

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14
Q

Define sudden death

A

Ventricular arrhythmia, asystole or massive myocardial infarction

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15
Q

State and define the classification of angina

A

Class I: Ordinary physical activity (such as walking and climbing stairs) does not cause angina
Class II: Angina causes slight limitation of ordinary physical activity
Class III: Angina causes marked limitation of ordinary physical activity
Class IV: Inability to perform any physical activity without angina

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16
Q

Define typical angina

A

Meets all 3 of the following characteristics:
Substernal chest discomfort of characteristic quality and duration
Provoked by exertion or emotional stress
Relieved by rest and nitrates within minutes

17
Q

Define atypical angina

A

Where only 2 of the required characteristics to diagnose typical angina are met

18
Q

Describe some ways of managing a patient with angina

A 
Short acting nitrates
Beta blockers
PCI, Stenting or CABG
Lifestyle management 
Control of risk factors
Education
19
Q

What does the definition of the type of MI depend on?

A

The findings on the ECG

20
Q

Name the 2 different types of MI

A

STEMI

NSTEMI

21
Q

In hospitals which type of MI has associated higher death rates?

A

STEMI

22
Q

Which type of MI causes an increase in the chance of the patient dying in the long term?

A

NSTEMI

23
Q

What is ACS characterised by?

A

The development of a thrombosis at the site of acute disruption of an atherosclerotic plaque within the wall of the coronary artery

24
Q

What do acute coronary syndromes consist of?

A

Unstable angina and myocardial infarcts

25
Q

Following plaque disruption, thrombus results 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

26
Q

What does a STEMI look like on an ECG?

A

ST elevation

27
Q

What is an ST elevation a sign of?

A

Complete coronary occlusion

28
Q

What does a NSTEMI look like on an ECG?

A

ST depression or normal ECG

29
Q

What does a NSTEMI ECG signify?

A

Incomplete occlusion

30
Q

What are the classical symptoms at presentation of ACS?

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. arms/jaw/back
Not relieved immediately with S/L GTN

31
Q

What are the symptoms more commonly present with ACS in elderly or diabetic patients?

A

Elderly or diabetic patients often present with:
Breathlessness
Nausea or vomiting
Sweating and clamminess

32
Q

Which immediate assessments do you do when investigating a suspected ACS?

A 
Patient history 
ECG
Physical examination
Risk stratification
Cardiac biomarkers (troponin)
33
Q

What are the therapeutic goals in ACS?

A

Restore coronary artery patency (STEMI)
Limit myocardial necrosis (STEMI)
Control symptoms

34
Q

State the medical management in ACS

A

Anti-platelet therapy
Anti-ischaemic therapy
Secondary prevention

35
Q

Describe secondary prevention methods for ACS

A 
Antiplatelet therapy
Aspirin
Ticagrelor /clopidogrel /prasugrel 
Statin
ACE inhibitors
Beta blockers
Smoking cessation 
Lifestyle modification
36
Q

State the rapid treatment given in STEMI

A

Morphine and/or nitrates for pain relief
Antiplatelet agents (aspirin + ticagrelor*)
*Clopidogrel in high risk bleeding populations
AND
‘Primary’ angioplasty (balloons, stents): artery is mechanically reopened, restoring blood flow
“Clot-busting” drug (thrombolysis): pharmacologically break up clots, restoring blood flow when access to angioplasty delayed/unavailable

37
Q

Define NSTEMI

A

Defined as the absence of persistent ST elevation (<20 minutes) on ECG, but with angina symptoms and elevated cardiac biomarkers

38
Q

Who are the high risk 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
39
Q

Describe the management of UA/NSTEMI

A 
Analgesia
Antiplatelet therapy
Anti-ischaemic therapy
Statins
Early coronary angiography with a view to revascularisation (stenting or CABG)

Module 103: Theme 3: Physiology of the cardiovascular system. Principles of pathology, diagnosis and treatment of cardiovascular disease (19 decks)

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