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Cardiovascular System > Lecture 10 - Ischaemic Heart Disease > Flashcards

Lecture 10 - Ischaemic Heart Disease Flashcards

1
Q

What are causes of chest pain in the lungs and pleura?

A

Pneumonia
Pulmonary embolism
Pneumothorax

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2
Q

What are causes of chest pain in the GI system?

A

Oesophagus - reflux
Peptic ulcer disease
Gall bladder - biliary colic, cholecystitis

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3
Q

What are the causes of chest pain in the chest wall?

A

Ribs
Muscle
Skin

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4
Q

What are the causes of chest pain in the CVS?

A

Myocardium - angina, MI
Pericardium - pericarditis
Aorta - aortic dissection

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5
Q

What are the 3 non modifiable risks for coronary atheroma?

A

Increasing age
Male gender
Family history

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6
Q

What are the 8 modifiable risks for coronary atheroma?

A 
Hyperlipidaemia
Smoking
Hypertension
Diabetes mellitus
Exercise
Obesity
Stress
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7
Q

Where is the chest pain from IHD?

A

Central, retrosternal or left sided.

May radiate to shoulders, arms, neck, jaw, and back.

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8
Q

What sort of pain comes from IHD?

A

Tightening, heavy, crushing, constricting, pressure.

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9
Q

What sort of pain could come from an inferior MI?

A

Burning epigastric (like heartburn/indigestion)

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10
Q

How do the symptoms of IHD get progressively worse?

A

Stable angina –> unstable angina –> MI

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11
Q

What is stable angina?

A

Atheromatous plaques with necrotic centre and fibrous cap build up in coronary vessels occluding the lumen. Leads to ischaemia of myocardium.

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12
Q

How much of the lumen is occluded in angina?

A

> 70%

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13
Q

What is the chest pain in stable angina?

A

Typical ischaemic chest pain.
Brought on in brief episodes by exertion, stress and cold weather.
Mild to moderate.

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14
Q

How are acute episodes of angina treated?

A

Sub lingual nitrate spray

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15
Q

How are angina episodes prevented?

A

B blockers, Ca channel blockers, oral nitrates

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16
Q

How are cardiac events prevented in angina?

A

Aspirin, statins, ACE inhibitors

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17
Q

How is angina treated long term?

A

Revascularisation

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18
Q

What is unstable angina?

A

Progression from stable angina due to increased occlusion

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19
Q

What is the chest pain in unstable angina?

A

Ischaemic chest pain occurring at rest or on minimal exertion.
Severe and occurs with a crescendo pattern.

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20
Q

What is an MI?

A

Complete occlusion of a coronary vessel leading to an infarct of the myocardium it supplies

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21
Q

What happens in an MI?

A

The fibrous cap of the plaque is eroded, exposing the blood to the thrombogenic material in the core - platelet clot is followed by a fibrin thrombus to occlude the vessel or break off to form an embolism

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22
Q

What is the chest pain in an MI?

A

Typical ischaemic chest pain.

Severe and persistent at rest, no relief from rest or nitrate spray.

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23
Q

What are the symptoms of an MI?

A 
Chest pain
Breathlessness
Faint
Anxiety
Sweating
Pallor
Nausea
Vomiting
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24
Q

What is an NSTEMI?

A

Non ST elevated MI

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25
Q

What is the significance of an NSTEMI?

A

Infarct is not full thickness of myocardium

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26
Q

What is a STEMI?

A

ST elevated MI

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27
Q

Whar is the significance of a STEMI?

A

Infarct is full thickness of myocardium

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28
Q

What would the resting ECG show in angina?

A

Normal

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29
Q

What is the exercise stress test graded on?

A

Heart rate
Chest pain
ECG changes
Other problems

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30
Q

What is shown in a positive exercise stress test?

A

ST depression of >1mm

31
Q

What is acute coronary syndrome?

A

Group of symptoms attributed to obstruction of coronary arteries

32
Q

What is acute coronary syndrome a result of?

A

Unstable angina, STEMI and NSTEMI

33
Q

What level is the occlusion by thrombus in unstable angina?

A

Partial

34
Q

What level is the occlusion by thrombus in NSTEMI?

A

Partial

35
Q

What level is the occlusion by thrombus in STEMI?

A

Total

36
Q

What level is the myocardial necrosis in unstable angina?

A

None

37
Q

What level is the myocardial necrosis in NSTEMI?

A

Some

38
Q

What level is the myocardial necrosis in STEMI?

A

Large myocardial infarct

39
Q

What is the effect on ECG in unstable angina?

A

May have ST depression, T wave inversion or normal

40
Q

What is the effect on ECG in NSTEMI?

A

No ST elevation

41
Q

What is the effect on ECG in STEMI?

A

ST elevation

42
Q

What is the biochemical marker in the blood in STEMI and NSTEMI?

A

Troponin

43
Q

What is the ECG change minutes-hours after an MI?

A

ST elevation, T wave upright

44
Q

What is the ECG change hours-day 1/2 after an MI?

A

ST elevation, decreased T wave, decreased R wave, Q wave begins

45
Q

What is the ECG change days 1-2 after an MI?

A

Q wave deeper

46
Q

What is the ECG change days after an MI?

A

ST normalises, T wave inverted, Q wave persists

47
Q

What is the ECG change weeks after an MI?

A

ST and T normal, Q wave persists

48
Q

Which ECG leads would show an inferior infarction?

A

II, III, aVF

49
Q

Which artery would lead to an inferior infarction?

A

Right coronary

50
Q

Which ECG leads would show an antero septal infarction?

A

V1, V2

51
Q

Which artery would lead to an antero septal infarction?

A

Left anterior descending

52
Q

Which ECG leads would show an antero apical infarction?

A

V3, V4

53
Q

Which artery would lead to an antero apical infarction?

A

Left anterior descending (distal)

54
Q

Which ECG leads would show an antero lateral infarction?

A

I, aVL, V5, V6

55
Q

Which artery would lead to an antero lateral infarction?

A

Circumflex

56
Q

Which ECG leads would show an extensive anterior infarction?

A

I, aVL, V2, V3, V4, V5, V6

57
Q

Which artery would lead to an extensive anterior infarction?

A

Proximal left coronary

58
Q

Which ECG leads would show a true posterior infarction?

A

Tall R in V1

59
Q

Which artery would lead to a true posterior infarction?

A

Right coronary

60
Q

When do troponin levels rise after an MI?

A

Rise 3-4 hours after
Peak 18-36 hours
Decline slowly for 10-14 days

61
Q

When do creatine kinase levels rise after an MI?

A

Rise 3-8 hours after
Peak 24 hours
Return to normal 48-72 hours after
Specific isoenzyme for myocardium

62
Q

How are biochemical markers used?

A

Distinguishes between unstable angina and NSTEMI - no myocardium death in unstable angina

63
Q

How is unstable angina treated?

A

Preventing it from progressing to MI by:
Preventing progression of thrombosis
Restoring perfusion of partially occluded vessels

64
Q

How is the progression of thrombosis prevented?

A

Anti thrombotic therapy - antiplatelets (aspirin) and anticoagulants (heparin)

65
Q

How is perfusion restored in partially occluded vessels in high risk patients?

A

Angioplasty/percutaneous coronary intervention

Coronary artery bypass graft

66
Q

How is perfusion restored in partially occluded vessels in low risk patients?

A

Medical treatment

67
Q

How is perfusion restored in partially occluded vessels in general?

A 
Pain control
Oxygen
Organic nitrates
B blockers
Statins
ACE inhibitors
68
Q

How is angioplasty used?

A

To view any vessel occlusions

69
Q

How is pecutaneous coronary intervention used?

A

Angioplasty and stenting - inflation of a balloon inside the vessel expands a mesh to hold the vessel open

70
Q

How is coronary bypass (CBPG) grafting used?

A

Take an artery from somewhere else in the body and graft it to the heart

71
Q

Which vessels can be used for CBPG?

A

Internal mammary artery
Radial artery
Saphenous vein

72
Q

What has to be done to the saphenous vein for CBPG?

A

Reversed because of the valves

73
Q

What can cause acute pericarditis?

A 
Infection
Post MI/cardiac surgery
Autoimmune
Uraemia (kidney failure)
Malignant deposits
74
Q

What are the symptoms of acute pericarditis?

A

Central/left sided chest pain
Sharp, worse on inspiration
Improved by leaning forward

Cardiovascular System (15 decks)

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