Pathology Flashcards
Define Ischaemic Heart Disease (IHD)
Myocardial demand for oxygen/ nutrients greater than delivery via coronary arteries
What are the causes of IHD?
- Occlusive: atherosclerosis
- Reduced O2 delivery: anaemia, hypotension
- Increased O2 requirements: LVH
Non-modifiable risk factors for IHD (4)
Age
Gender (M>F)
Family history
Genetics
Modifiable factors for IHD (5)
Smoking Alcohol Poor diet Obesity Lack of exercise
Clinical risk factors for IHD (3)
Hypertension
Diabetes
Hyperlipidaemia
Psychosocial risk factors for IHD (3)
Low control jobs = high stress
Lack of social support/ interaction
Depression
What causes angina?
Reduced blood flow –> reversible myocardial ischaemia –> chest pain
What is stable angina?
Cardiac chest pain on EXERTION, relieved by rest
What is unstable angina?
Crescendo (gets worse) cardiac chest pain at MINIMAL EXERTION, NOT relieved by rest
No cardiac biomarkers/ enzymes
What is Prinzmetal’s/ vasospastic angina?
Pain at REST, caused by coronary artery spasm
What is decubitus angina?
Pain when LYING FLAT
What are the clinical manifestations of angina? (6)
Heavy/ constricting pain to chest, jaw, neck, arms Nausea Dyspnoea Nausea Faintness Sweatiness
What is the first line treatment for angina?
- GTN spray
- Beta-blockers (bisoprolol)
How would you manage angina? (7)
- Lifestyle changes
- GTN spray
- Antiplatelet: aspirin
- Beta-blockers: bisporolol
- CCB: amlodipine
- Statin: atorvastatin
- ACEi: ramipril
What do antiplatelets do? (give examples)
Inhibits platelet aggregation (aspirin, clopidogrel [P2Y12 inhibitor])
What do beta-blockers do? (give examples)
Prevents stimulation of beta-adrenoreceptors at nerve endings of sympathetic NS.
Causes dec in HR (inc diastole for coronary artery filling) + dec contractility (dec O2 demand of the heart)
(bisoprolol, atenolol)
What do nitrates do?
Dilate systemic veins to decrease venous return to the heart.
Decreased preload –> decreased contractility –> decreased O2 demand.
Also dilate coronary arteries
What do CCB do?
Dilate systemic arteries –> decreased afterload on heart –> decreased contractility of the heart –> decreased O2 demand.
Also dilate coronary arteries
(amlodipine)
What so statins do?
Lower blood cholesterol
atorvastatin
What is a STEMI?
Obstruction of a major CA causing infarct of the heart muscle
How can you detect a STEMI?
ECG - ST elevation
Raised serum troponin I & T
What are the symptoms of a STEMI? (4)
- Severe chest pain lasting > 20mins
- Pain not relieved by GTN spray
- Pain radiation: L arm, neck, jaw
- Pale, clammy, sweating
What is an NSTEMI?
Lesser degree of obstruction of a CA than a STEMI causing infarct of the heart muscle
How can you detect an NSTEMI?
ECG - ST depression, T wave inversion
Raised serum troponin I & T levels
What are the symptoms of an NSTEMI? (3)
- Pressure, tightness/ discomfort of chest
- Radiation to jaw, neck, neck, stomach
- Dizziness, lightheadedness, nasuea, sweating, SOB
What are the treatments for ACS (STEMI, NSTEMI)? (6)
M - morphine (diamorphine)
O* - oxygen if hypoxia present
N* - nitrates (GTN spray)
A* - antiplatelet dual therapy (aspirin 300mg + clopidogrel)
IV antiemetic (metoclopramide)
Emergency PCI/ CABG or thrombolysis (streptokinase/ alteplase)
What are the long-term treatments for ACS?
- Managing risk factors
- Aspirin 75mg daily
- Statin
- B-Blocker
- ACEi
- No driving for 1 month
What are the complications for MI?
- Recurrent infarction
- Angina post infarction
- Heart failure
- Pericarditis
- Arrhythmias
Define stage 1 hypertension
Blood pressure > 140/90 (clinic)
Define stage 2 hypertension
Blood pressure > 160/100 (clinic)
Define stage 3 hypertension
Blood pressure > 180/ 110 (clinic)
How would you tackle stage 1 HT?
Advise lifestyle changes (if under 80 + no target organ damage or 10y CVD risk)
How would you tackle stage 2 HT?
Give medication regardless of age
How would you tackle stage 3 HT?
SEVERE - give medication
What is primary HT?
HT due to unknown cause
What is secondary HT?
HT caused by another condition eg kidney disease, diabetes, obstructive sleep apnoea
What are the symptoms of HT? (9)
- Asymptomatic
- Dyspnoea/ difficulty breathing
- Fatigue
- Severe headache
- Dizzy –> syncope
- Nosebleeds
- Vision problems
- Chest pain
- Signs of kidney problems
How would you treat HT non-pharmacologically?
- Treat underlying cause
- Lifestyle changes: weight loss, stop smoking, educed salt/ alcohol intake
What is step 1 treatment for hypertensive pt under 55?
ACEi (if not tolerated, ARB and last resport B-blocker)
What is step 1 treatment of black AC/ over 55yo hypertensive pt?
CCB (if not tolerated, thiazide-related diuretic)
What is step 2 treatment for hypertensive pt?
ACEi/ ARB + CCB
What is step 3 treatment for hypertensive pt?
ACEi/ ARB + CCB + D (thiazide-like diuretic)
What is step 4 treatment for hypertensive pt?
ACEi/ ARB + B + CCB + D + further diuretic
Consider specialist advice
What is heart failure?
Inadequate cardiac output for body requirements
What are the signs of right heart failure? (4)
- Peripheral oedema
- Raised JVP
- Ascites
- Liver & spleen enlargement
What are the signs of left heart failure? (5)
- Pulmonary oedema (crackles on chest exam)
- Dyspnoea
- Tachypnea (INC resp rate)
- Cyanosis (turnng blue due to lack of O2)
- PINK FROTHY SPUTUM
What are the symptoms of heart failure? (4)
- SOB on exertion, at rest, when lying flat
- Fatigue
- Wheezing
- Tachycardia
How would you investigate for heart failure? (4)
- ECG for underlying causes
- CXR: A - Alveolar oedema (bat wing), B - B-line Kerley, C - Cardiomegaly, D - dilated vessels, E - effusion (pleural)
- Serum BNP (if normal excludes HF)
- ECHO
