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Module 103: The Heart, Lungs and Blood > Theme 3: Lecture 7 - Ischaemic heart disease > Flashcards

Theme 3: Lecture 7 - Ischaemic heart disease Flashcards

1
Q

What comprises cardiovascular disease

A
  • Coronary heart disease
  • Cerebrovascular disease
  • Peripheral vascular disease
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2
Q

Coronary heart disease

A

Build up of cholesterol deposits in the coronary arteries

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3
Q

Cerebrovascular disease

A

Build up of cholesterol deposits in the arteries supplying the brain

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4
Q

Peripheral vascular disease

A

Build up of cholesterol deposits in arteries of the lower limb

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5
Q

Controllable risk factors for CHD

A 
Cigarette Smoking
Diabetes
High blood pressure
High cholesterol
Obesity
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6
Q

Non controllable risk factors for CHD

A

Age
Family history of premature coronary disease
Previous heart attack

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7
Q

According to the Framingham heart study, does your risk of CHD increase with an increasing number of risk factors

A

yes

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8
Q

How does ischaemic heart disease cause myocardial ischaemia

A
  • IHD occurs due to atherosclerotic plaque build up within one or more coronary arteries, obstructing myocardial blood flow
  • This leads to an imbalance between myocardial oxygen supply and demand
  • Restricts the normal increase in coronary blood flow which should occur in response to increase in myocardial oxygen demand
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9
Q

What are the clinical manifestations of ischaemic heart disease (8)

A
  • Asymptomatic
  • Stable angina
  • Acute coronary syndromes (Unstable angina, NSTEMI, STEMI)

Long-term:

  • Heart failure
  • Arrhythmias
  • Sudden death
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10
Q

What pathology causes unstable angina

A

ischaemia caused by dynamic obstruction of a coronary artery due to plaque rupture with superimposed thrombosis and spasm

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11
Q

Definition of typical angina

A

Meets all 3 of the following criteria:

  • substernal chest discomfort of characteristic quality and duration
  • provoked by exertion or emotional stress
  • relieved by rest and/or nitrates within minutes
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12
Q

Definition of atypical angina

A

Meets 2 of the following criteria:

  • substernal chest discomfort of characteristic quality and duration
  • provoked by exertion or emotional stress
  • relieved by rest and/or nitrates within minutes
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13
Q

Definition of non anginal chest pain

A

Lacks or only meets one of these criteria:

  • substernal chest discomfort of characteristic quality and duration
  • provoked by exertion or emotional stress
  • relieved by rest and/or nitrates within minutes
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14
Q

First line treatment for angina relief

A

Short acting nitrates plus:
-beta blockers or calcium channel blockers
-

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15
Q

What is second line treatment for angina

A

consider PCI stenting or CABG

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16
Q

What do acute coronary syndromes include

A
  • unstable angina

- MI (STEMI and NSTEMI)

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17
Q

What is the diagnostic marker for an acute MI

A

Troponin which is measured in a blood test

18
Q

When are troponin levels elevated

A
  • In acute MI

- Not in unstable angina

19
Q

How are STEMIs and NSTEMIs differentiated

A

by the specific pattern of abnormality on the ECG

20
Q

What is ST elevation on an ECG a marker of generally

A

complete coronary occlusion

21
Q

What is incomplete occlusion associated with on an ECG

A
  • ST depression
  • Variable T wave abnormalities
  • Normal ECG
22
Q

How to acute coronary syndromes develop

A

ACS is characterised by the development of a thrombosis at the site of acute disruption of an atherosclerotic plaque within the wall of the coronary artery

23
Q

How do thrombi develop following plaque disruption in an artery

A
  • Adherence, activation and aggregation of platelets
  • Thrombin and fibrin production via the coagulation cascade (and thrombin release from platelets)
  • Vasoactive molecules released from platelets which cause vasoconstriction
24
Q

What are the classical symptoms of acute coronary syndromes

A
  • Discomfort/pain in the centre of the chest that lasts for more than a few minutes or recurs
  • Discomfort/pain radiating to other areas, e.g. left arm/jaw/back
  • Can occur at rest and/or with exertion
  • Not relieved immediately with sublingual GTN
25
Q

What are symptoms seen in elderly or diabetic patients with acute coronary syndromes

A
  • Breathlessness
  • Nausea or vomiting
  • Sweating and clamminess
26
Q

Immediate assessment of patients with suspected ACS

A 
First: 
-Patient history 
-ECG
-Physical examination
Then/in parallel:
-Risk stratification
-Cardiac biomarkers (troponin)
27
Q

What are the goals for patients with coronary artery syndromes

A
  • Restore coronary artery patency (being open/unobstructed)
  • Limit myocardial necrosis
  • Control symptoms
28
Q

What is the medical management in acute coronary syndromes

A
  • Anti-platelet therapy
  • Anti-ischaemic therapy
  • Secondary prevention therapy
29
Q

Which drugs are used in anti-platelet therapy

A
  • Aspirin

- Clopidogrel /Prasugrel /Ticagrelor (P2Y12 receptor antagonists which is a receptor for ADP)

30
Q

Which drugs are used for anti-ischaemic therapy

A

Nitrates

31
Q

What is used in secondary prevention therapy

A
  • Statin
  • ACE inhibitors
  • Beta blockers
  • Smoking cessation
  • Lifestyle modification
32
Q

Treatment for STEMI

A

-Morphine and/or nitrates for pain relief
-Antiplatelet agents (aspirin + clopidogrel)
AND
-Primary angioplasty (balloons, stents): artery is mechanically reopened, restoring blood flow
-“Clot-busting” drug (thrombolysis): pharmacologically break up clots, restoring blood flow (when no access to primary angioplasty)

33
Q

Definitions for unstable angina

A
  • Angina at rest (> 20mins)
  • New onset (< 2 months) exertional angina
  • Recent (< 2months) acceleration or progression of angina symptoms
  • Normal cardiac biomarkers (troponin)
34
Q

Definition of an NSTEMI

A

Defined as the absence of ST elevation on ECG, but with angina symptoms and elevated cardiac biomarkers (troponin)

35
Q

What other conditions is a positive troponin seen in other than MI (6)

A
  • Pneumonia
  • Pulmonary embolism
  • Pericarditis
  • Sepsis
  • Heart Failure
  • Uncontrolled tachyarrhythmia
36
Q

Who are high risk ACS patients (8)

A
  • Elevated troponin levels
  • Renal impairment
  • Recurrent chest pain
  • Dynamic ST depression or T wave changes on ECG
  • Haemodynamic instability
  • Major arrhythmias
  • Heart failure
  • Elderly
37
Q

How are unstable angina and NSTEMIs treated

A
  • Analgesia
  • Anti-platelet therapy
  • Anti-ischaemic therapy
  • Statins
  • Early coronary angiography with a view to revascularisation (stenting or CABG)
38
Q

What pathology causes stable angina

A

Ischaemia due to fixed atheromatous stenosis of one or more coronary arteries

39
Q

What pathology causes MI

A

myocardial necrosis caused by acute occlusion of coronary artery due to plaque rupture and thrombosis

40
Q

What pathology causes heart failure

A

myocardial dysfunction due to ischaemia or infarction

41
Q

What pathology causes arrhythmia

A

altered conduction due to ischaemia or infarction

42
Q

What pathology causes sudden death

A

ventricular arrhythmia, asystole or massive myocardial infarction

Module 103: The Heart, Lungs and Blood (51 decks)

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