Session 10 Flashcards
How can the lungs and pleura cause chest pain?
Pneumonia
Pulmonary embolism
Pneumothorax
How can the GI system cause chest pain?
Oesophagus reflux
Peptic ulcer disease
Cholecystitis
How can the chest wall cause chest pain?
Fractures to the ribs
Muscles
Skin
How can the CVS cause chest pain?
Myocardium - angina MI
Pericarditis
Aortic dissection
What are the non modifiable risk factors for coronary atheroma
Age
Sex (male worse)
Family history
What are the modifiable risk factors for coronary atheroma?
Hyperlipidaemia Smoking Hypertension Diabetes mellitus Obesity Exercise Stress
How do you get ischaemia of the myocardium in stable angina?
Atheromatous plaques, with a necrotic centre and fibrous cap build up in the coronary vessels and partially occlude them
When do you get chest pain in stable angina?
Upon exercise
Cold
Stress
How can you treat angina?
Nitrate sprays (Acute) Beta blockers/Ca2+ channel blockers (prevent) Aspirin, statins, ACEi (prevent cardiac episodes) Revascularisation (long term)
What is unstable angina?
Pain on rest due to increased occlusion of the arteries
What is a myocardial infarction?
Complete occlusion of a coronary artery which leads to loss of oxygen and death of the myocardium
How can the atheromatous plaque cause an embolism to form?
The fibrous cap can undergo fissuring or erosion which exposes the blood to the thombogenic material in the necrotic core. A fibrin thrombus follows a platelet clot.
What is the difference between an NSTEMI and STEMI?
NSTEMI - Non elevated ST interval. Infarct is not full thickness of the myocardium
STEMI - Elevated ST interval. Infarct is full thickness of the myocardium
How can you diagnose angina?
Mainly based on the patient history
May have some of the associated risk factors
Exercise test - graded exercise until chest pain, target HR reached, ECG change, arrhythmia issues
What does an ECG positive for angina show?
An ST depression bigger than 1mm
What can cause Acute Coronary Syndrome?
Unstable angina
STEMI
NSTEMI
How can you differentiate between unstable angina and a STEMI/NSTEMI?
T waves may be inverted in unstable angina
NSTEMI/STEMI would have Troponin in the blood as a biochemical marker
Which leads would pick up on an infarct in the Right coronary artery? (inferior)
II, III, aVF
Which leads would pick up on an infarct in the Left anterior descending? (Anterio septal)
V1, V2
Which leads would pick up on an infarct in the distal section of left anterior descending? (antero apical)
V3, V4
Which leads would pick up on an infarct in the circumflex artery? (antero lateral)
I, aVL, V5, V6
Which leads would pick up on an infarct in the proximal left circumflex artery? (extensive anterior)
I, aVL, V2 - V6
Which leads would pick up on an infarct in the right coronary artery? (true posterior)
Tall R wave in V1
How are Troponins used to indicate a STEMI/NSTEMI?
Cardiac troponin I and troponin T are important in myosin and actin interaction. They are released on the muscle cells death
What is the cardiac isoenzyme of creatinine kinase?
CK-MB
How can CK-MB and Troponins in the blood help differentiate between unstable angina and NSTEMI?
Shows there has been death of the myocardium which only occurs in an NSTEMI
What is the goal when treating unstable angina/MI?
Prevent progression to MI
Save muscle mass in an MI
What can be given as part of anti thrombotic therapy?
Anti platelet agents - Aspirin
Anticoagulants - Heparin
How can you restore perfusion to partially occluded vessels in high risk patients?
Early Percutaneous Coronary Intervention (Angioplasty) (PCI)
Coronary Artery Bypass Graft (CABG)
How can you restore perfusion to partially occluded vessels in low risk patients?
Medications
Why is Angiography useful?
Allows you to view any vessel occlusions, and from the findings can make decisions on revascularisation surgeries
What is Percutaneous Coronary Intervention (PCI)?
Angiography with stenting
What is stenting?
Inflation of a balloon inside the occluded vessel expands a mesh that holds the vessel open, increasing the lumen size and allowing for more blood to flow.
What is Coronary By Pass Grafting (CBPG)?
Take an artery from elsewhere in the body and grafting it to the heart
What arteries are commonly used in Coronary By Pass Grafting (CBPG)?
Radial artery
Saphenous vein BUT reversed because of the valves
