lecture 10 cardiac consequences of atheroma Flashcards
ethnicity predisposed to atheroma
south east asians
risk factors you can change
smoking, diabetes mellitus, obesity, lipids, hypertension, diet, pollution, stress and exercise
risk factors you cant change
family history, gender, age and ethnicity
what forms on the fatty streak of the atheroma
fibrous cap
what is at the core of the atheroma
lipid core
what does the vessel do at first when there is an atheroma
dilates to compensate
what happens when the cap ruptures
lipid are exposed to circulation which initiates thrombotic cascade
where may angina radiate
arms
jaw
neck and teeth
how is stable angina relieved
rest and nitrites
how is stable angina confirmed
stress testing
what does the ECG look like for stable angina
normal at rest
ST depression on walking
unstable angina pathology
myocardial necrosis
symptom of unstable angina
random pain
diagnosis of unstable angina
troponin
ST elevation cause
complete occlusion of a coronary artery
how do you treat complete occlusion of a coronary artery
thrombolysis or angioplasty stent implantation
isoelectric line
flat line on the ECG
first sign of a STEMI on ECG
slight peak in the T wave
what happens after T wave peak in STEMI
ST elevation
loss of R wave
big Q wave
what supplies the inferior wall
right coronary artery
left coronary artery divides into
LAD and the left circumflex
what supples the anterior wall
LAD
what supplies the lateral wall
left circumflex
what coronary dominance do most people have
right
MI of right coronary artery ECG
inferior ST elevation MI
MI of the LAD ECG
anterior ST elevation
MI of the circumflex
lateral ST elevation
things to bear in mine after an MI
troponin falls during the following week - not another MI
what is troponin
protein
what is troponin attatched to
tropomyosin
what binds to the troponin
calcium
other causes of elevated troponin
PE, pulmonary hypertension, septicaemia
MI treatment
antiplatelets, heparin, statin and anti ischemics
STENTs
examples of antiplatelets
aspirin
clopidogrel
anti ischemic medications
vasodilators
such as beta blockers and nitrates
what happens between the healthy and necrotic tissue
there is rupture = death
PEA
how will you see left ventricular dysfunction
enlarged heart shadow on radiograph
where do the leads of a defib go
through the subclavian vein
apex LV and right atrium
