Lecture 7: Ischaemic Heart Disease Flashcards
where was the term risk factor coined
framingham heart study
what are clinical manifestations of ischaemic heart disease
- asymptomatic
- stable angina
- acute coronary syndromes, eg unstable angina, NSTEMI and STEMI acute MIs
- arrhythmias
- heart failure
- sudden death
what is stable angina
pain in breast when walking, and walking just after eating
what are the first line treatments of stable angina
- short acting nitrates plus
- beta blocker or calcium channel blocker
what are the second line treatments of stable angina
- used if patient is allergic to 1st line treatment or if it isn’t enough
- ivabradine
- long acting nitrates
what do we consider if 2nd line treatment doesn’t show results
- angiogram to see where narrowing is
- then stenting or bypass therapy
how are STEMIs and NSTEMIs differentiated
based on pattern of abnormality on ECG
whats a good diagnostic marker of myocardial infarction
troponin
what are features of a STEMI
- ST elevation
- complete coronary occlusion
what are features of an NSTEMI
- ST depression
- variable T wave abnormalities
- normal ECG
- incomplete occlusion
how does a thrombus form following plaque disruption
- adherence, activation and aggregation of platelets
- thrombin and fibrin production
- vasoactive molecules released which cause vasoconstriction
what are symptoms of acute coronary syndromes
- longer chest pain than in stable angina
- occurs at rest AND with exertion
- not relieved with sublingual GTN
elderly and diabetic present with: - breathlessness
- nausea or vomiting
- sweatiness and clamminess
what are the types of therapy for acute coronary syndromes
anti platelet - aspirin - clopidogrel/ticagrelor anti-ischaemic therapy - nitrates secondary prevention therapy - statin - ACE inhibitors - beta blockers
features of unstable angina
- angina at rest
- new onset of exertional angina
- recent acceleration or progression of angina symptoms
- normal troponin levels
