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Clinical Conditions for CVS > Session 9 - Ischaemic heart disease > Flashcards

Session 9 - Ischaemic heart disease Flashcards

1
Q

Name the 4 systems found in the thorax region which can lead to chest pain

A
  • Respiratory system
  • Cardiac
  • MSK
  • Gastro-intestinal
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2
Q

Name 2 conditions in which the respiratory system is affected thus causing chest pain

A
  • Pneumonia

- Pulmonary Embolism

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3
Q

What are the symptoms of pneumonia?

A
  • shortness of breath
  • cough
  • sputum
  • fever
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4
Q

What are the symptoms of pulmonary embolism ?

A

Plueritic pain (pain coming from pleura due to irritation)

  • sharp
  • localised
  • aggravated by breathing and coughing
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5
Q

Name 3 conditions in which the cardiac system is affected thus causing chest pain

A
  • myocardial infarction (ischaemic chest pain)
  • stable/unstable angina (ischaemic chest pain)
  • pericarditis
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6
Q

Is pericarditis an ischaemic or non ischaemic chest pain?

A

Non-Ischaemic chest pain

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7
Q

What are the sign and symptoms of Pericarditis?

A

Plueritic pain

  • sharp
  • localised
  • aggravated by breathing, coughing or laying flat
  • eased with sitting up and leaning forward
  • pericardial rub heard on auscultation ( rustling noise over normal lub dub sound)
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8
Q

Name 1 condition in which the gastro-intestinal system is affected thus causing chest pain

A

Gastro-oesophageal reflux disease

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9
Q

What are the symptoms of Gastro-oesophageal reflux disease?

A
  • heart burn
  • regurgitation
  • pain aggravated by food and laying flat in bed
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10
Q

Name 2 conditions in which the MSK system is affected thus causing chest pain?

A
  • Fracture of the ribs

- costochondritis

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11
Q

Chest pain can either be cardiac (ischaemic) or pleuritic.

what are the features of a cardiac chest pain?

A
  • dull pain
  • poorly localised
  • worsened with exertion
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12
Q

Chest pain can either be cardiac or pleuritic.

What are the features of a pleuritic chest pain?

A
  • sharp pain
  • well localised
  • aggravated by breathing, coughing or positional movement
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13
Q

What is pericarditis?

A

Inflammation of the pericardium (sac around the heart/0

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14
Q

Causes of pericarditis

A
  • Viral infection (most common)
  • TB
  • Autoimmune disorders
  • Cancer
  • Chest trauma
  • After an MI
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15
Q

What is the defining feature on an ECG for pericarditis ?

A

Saddle shaped ST segment elevation

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16
Q

What is the pathophysiology of ischaemic heart disease ?

A

Atherosclerosis

17
Q

What are the modifiable risk factors for atherosclerosis?

A
  • smoking
  • hypertension
  • dyslipidaemia
  • diabetes
  • obesity
  • sedentary lifestyle
18
Q

What are the non-modifiable risk factors for atherosclerosis ?

A
  • advanced age
  • family history of early ischaemic heart disease
  • male sex
19
Q

What are the typical presentations of stable angina?

A
  • cardiac sounding chest pain
  • relieved by rest
  • aggravated on exertion e.g exercise
20
Q

When does heart tissue ischaemia occur?

A

only when metabolic demands of cardiac muscle are greater than what can be delivered via coronary arteries e.g on exertion

21
Q

Name the two conditions in which causes ischaemic heart disease make up the acute coronary syndrome

A
  • Unstable angina

- MI (STEMI/NSTEMI)

22
Q

What are the typical presentations of unstable angina?

A
  • pain occurring at rest
  • pain may be more intense
  • pain may last longer
23
Q

What are the ECG changes in an individual with unstable angina?

A
  • ST depression

- T wave inversion

24
Q

What are the blood test results for an individual with unstable angina?

A

Troponin T & I negative

25
Q

What are the typical presentations of Myocardial Infarction?

A
  • pain radiating to shoulder and jaw
  • central pain initially
  • feeling nauseous, sweaty, pallor
  • similar to unstable angina
  • cardiac sounding
26
Q

What are the ECG changes in an individual with Myocardial Infarction?

A
  • ST-elevation myocardial infarction (STEMI)

- Non-ST-elevation myocardial infarction (NSTEMI)

27
Q

What are the blood test results for an individual with Myocardial Infarction?

A
  • Troponin T & I positive
28
Q

What are the ECG changes in STEMI?

A
  • ST-segment elevation

- Hyperacute T waves

29
Q

What are the ECG changes in NSTEMI?

A
  • ST-segment depression

- T wave flattening or inversion

30
Q

Since NSTEMI and unstable angina has similar changes in ECG, how would you differentiate between the 2?

A

Troponin T & I blood test

- negative in unstable angina and positive in NSTEMI`

31
Q

What are the Investigations that are done for Acute Coronary Syndrome?

A
  • Chest Xray
  • Echocardiogram
  • Cornoary angiogram
32
Q

What are the management of STEMI?

A
  • straight to the cath lab for a percutaneous coronary intervention (PCI)
  • aspirin ( anti-thrombogenic)
  • Antiplatelets drugs
  • morphine for pain and metoclopramide to combat nausea
  • GTN spray for vasodilation
  • oxygen is saturation is less than 92%
33
Q

What are the management for NSTEMI?

A
  • Antiplatelets and antithrombotic e.g aspirin and clopidogrel
  • anti-ischaemic e,g gtn infusion and beta-blockers
  • secondary preventions e.g statins and ACE inhibitors
34
Q

What is the management for Unstable Angina?

A

GTN spray

35
Q

How is PCI/ angioplasty carried out?

A
  • a local anaesthetic is given to numb skin
  • access is either via the femoral artery in the groin or radial artery in the wrist
  • a catheter is used to place a balloon which pre-dilates the narrowed sections and then a stent with a metal scaffold to hold the vessel in place

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