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BSMS 103 > Theme 3 - IHD and ACS > Flashcards

Theme 3 - IHD and ACS Flashcards

1
Q

what is the main characterisation of coronary heart disease?

A

build up of cholesterol deposits in coronary arteries

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2
Q

what is cerebrovascular disease?

A

build up of cholesterol in the arteries supplying the brain

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3
Q

what is peripheral vascular disease?

A

furring of the arteries in the lower limbs

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4
Q

what is the main characterisation of IHD?

A

atherosclerotic progression in the intimial layer of one or more blood vessels

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5
Q

what does plaque progression in blood vessels cause?

A

myocardial blood flow is obstructed and reduced oxygen availability therefore ischaemia

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6
Q

what are the four main clinical manifestations of IHD?

A

asymptomatic (silent iscahemia), stable angina, acute coronary syndrome (unstable angina, STEMI, NSTEMI), long term (heart failure and death)

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7
Q

what is the pathology of stable angina?

A

fixed atheroma in more than one coronary artery

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8
Q

what is the pathology of unstable stable angina?

A

ischaemia due to dynamic obstruction eg plaque rupture

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9
Q

what is the pathology of an MI?

A

myocardial necrosis dude to acute occulusion of a CA due to plaque rupture or thrombosis

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10
Q

what is the pathology of heart failure?

A

myocardial dysfunction due to infarction or ischaemia - scarring affects electrics

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11
Q

what is the pathology of sudden cardiac death?

A

ventricular arrhythmia, asystole or massive MI

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12
Q

what is the cause of ischaemia?

A

obstruction leading to an imbalance between myocardial oxygen supply and demand - circulation cant meet needs

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13
Q

what are the three main classifications of chest pain?

A

typical angina, atypical angina and non anginal chest pain

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14
Q

what are the three criteria must chest pain meet to be classified as typical angina?

A

1) sub or retrosternal chest discomfort
2) provoked by exertion or stress
3) relieved by rest or nitrates (in mins)

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15
Q

how is atypical angina characterised?

A

must meet 2 of

1) sub or retrosternal chest discomfort
2) provoked by exertion or stress
3) relieved by rest or nitrates (in mins)

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16
Q

how is non anginal chest pain characterised?

A

meets one or none of

1) sub or retrosternal chest discomfort
2) provoked by exertion or stress
3) relieved by rest or nitrates (in mins)

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17
Q

what is first line treatment for stable angina?

A

short acting nitrates plus beta blockers or calcium blockers (and focus on lifestyle management)

18
Q

what is second line treatment for stable angina?

A

ivabradine (inhibits funny current), long acting nitrates, nicorandil or invasive techniques such as PCI stenting

19
Q

what conditions are acute coronary syndromes?

A

unstable angina, STEMI and NSTEMI

20
Q

what will be detected in a blood test after a patient has had an acute MI?

A

raised troponin levels

21
Q

would a patient with unstable angina have raised troponin levels?

A

no

22
Q

from what time can troponin be detected in the blood after an MI and for how long?

A

can be detected within 3 hours and stay there for 2 weeks

23
Q

what is ST elevation a marker of?

A

complete coronary occlusion

24
Q

what are four factors the can be associated with an NSTEMI?

A

ST depression, variable T wave, normal ECG, increased troponin level

25
Q

what type of occlusion is associated with an NSTEMI?

A

incomplete occlusion

26
Q

where does thrombosis develop and what is the development of these associated with?

A

develops at the site of disruption of an atherosclerotic plaque within the wall of a coronary artery
- associated with acute coronary syndromes

27
Q

what is the sequence of the development of a plaque?

A

normal –> fatty streak –> fibrous plaque –> atherosclerotic plaque

28
Q

what causes a thrombosis when a plaque ruptures?

A

adherence, activation and aggregation of platelets

29
Q

what molecule released from plats also aids thrombus formation

A

thromboxane A2

30
Q

what are the main presenting symptoms of ACS (MI and UA)?

A
  • discomfort and pain in the centre of the chest - recurring or lasts for few mins
  • radiating pain to left arm, jaw and back
  • occurs at rest or exertion
  • no relieved immediately by sublingual nitrates
31
Q

what do elderly/diabetic patients with an ACS present with?

A

breathlessness, nausea and vomiting and sweatiness/clamminess

32
Q

what emergency investigation should be carried out if a patient is having a STEMI?

A

emergency angiogram to find where the occlusion is

33
Q

what are the four main therapeutic goals in ACS?

A

1) restore coronary artery patency in a STEMI
2) limit myocardial necrosis
3) control symptoms
4) then medical management - anti plaits, anti iscahemic, and secondary prevention therapy

34
Q

what is involved in primary medical management of ACS?

A
  • anti plat agents eg aspirin, clopidogrel, prasugrel, ticagrelor
  • anti ischaemics - nitrates (SL or infusion)
35
Q

what secondary prevention therapy can be given to patients being discharged after ACS?

A
  • statins to lower cholesterol
  • ACE inhibitors/beta blockers - decreasing BP will help remodelling
  • smoking cessation/lifestyle modification
36
Q

what is the most critical time in a STEMI?

A

in the very early phase when patient is liable to cardiac arrest

37
Q

how can a coronary artery be re-opened in a STEMI?

A

with a primary angioplasty - artery is mechanically opened using a balloon/stent to restore blood flow

38
Q

what may be used in a STEMI if there is no access to primary angioplasty?

A

thombolytics - clot busting drugs

39
Q

what four things can characterise unstable angina?

A

angina at res, new onset (asymptomatic to symptoms In less than 2 months), recent acceleration of symptoms, normal cardiac biomarkers eg troponin

40
Q

what other conditions may troponin be elevated in?

A

pneumonia, PE, pericarditis, sepsis

41
Q

how is unstable angina/NSTEMI managed?

A

analgesia, anti plats/ischaemics, statins, angiogram wifin 72 hours to see if they need a stent

42
Q

what does a coronary bypass involve and who may this be given to?

A
  • anatomoses from the saphenous vein or internal mammary artery to the occluded artery
  • may be given to stable patients with no ST elevation

BSMS 103 (23 decks)

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