Lecture 11 Ischaemic Heart Disease I Flashcards Preview

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Flashcards in Lecture 11 Ischaemic Heart Disease I Deck (41)
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What is meant by ischaemic heart disease

Ischaemic heart disease is a condition where the blood flow in the coronary arteries is restricted by an obstruction


What is the significance of IHD as a disease

It kills more people worldwide than any other disease


What is the ultimate cause of death in patients with IHD

Acute myocardial infarction


What causes IHD

Ischaemic disease occurs when a fatty/fibrous plaque called an atheroma blocks the coronary artery lumen. This means that blood flow to tissues is then restricted leading to ischaemia


What happens when ischaemia occurs

Oxygen demand to the myocardium exceeds supply


How does IHD usually present

Patients with IHD often present with chest pain. This chest pain can be due to angina or myocardial infarction


What is meant by the term angina

Cardiac-related chest pain


There are two classes of risk factors in IHD what are they

Modifiable and non-modifiable


Give some examples of non-modifiable risk factors in IHD

Age male personal history (positive family history usually 1st degree relative before the age of 65)


Give some examples of modifiable risk factors in IHD

Smoking diet/obesity renal disease high blood pressure and diabetes


What class of conditions are IHD patients susceptible to when the plaque ruptures

Acute coronary syndromes


What are the different types of acute coronary syndromes

Unstable angina non-ST elevation myocardial infarction (NSTEMI) and ST-elevation myocardial infarction (STEMI)


Which is the most severe form of acute coronary syndrome



How are the three forms of acute coronary syndromes related

Unstable angina will progress to NSTEMI or potentially STEMI


Stable angina is a type of acute coronary syndrome T or F

F – it is not


How does stable angina present

Chest pain that occurs with increase physical activity or exertion but with a normal ECG


Use the diagrams below to explain the difference between stable and unstable angina

In stable angina the lipid core is often walled-off from the blood flow. In addition a large degree of healing has occurred so that the intimal layer separates and protects atheroma from the blood. This prevents progression to the ACS stage. However in unstable angina there is the addition of a platelet plug fibrous plaque and thrombus consisting of a matured fibrin clot. This has progressed to the stage at which most of the central core of the vessel is blocked


What is meant by a mural thrombus

This is where the complete core of the vessel is blocked by clot platelet plug and plaque


Anginal pain is always relieved by rest T or F

F – whilst this is true for most angina it is not the case in STEMI


Treatments used for angina based around knowing what type of angina the patients have T or F



How is stable and unstable angina treated

Stable angina patients are treated with nitrates and Ca2+ channel blockers to reduce the cardiac work. They are also treated for the underlying condition for example using statins in high cholesterol. Finally there is a degree of prophylactic treatment using anti-platelet therapy such as aspirin. Meanwhile unstable angina patients are treated as for a myocardial infarction. They are given dual anti-platelet therapy usually consisting of aspirin plus either clopidogrel or ticagrelor


Complete the table below distinguishing the acute coronary syndromes

See completed table below


Why does the ECG often appear normal in patients with angina

ECG will appear normal in stable and unstable angina unless there is a period of ischaemia at the time in which the ECG is being recorded


What is the issue with using troponin levels as an indication of heart attack

Troponin takes a while to rise during a heart attack. Hence if you measure it too early myocyte death may not have occurred yet


Which patients are sent straight to tertiary heart attack centres



What are the broad aims of the treatment for ischaemia

Reopen blocked arteries (stenting) reduce the coagulability of blood (DAPT) control of risk factors and reduce myocardial oxygen demand


What is PCI

Percutaneous coronary intervention (PCI) is a non-surgical technique used to widen the artery using dilation from within


When is PCI used as the primary treatment

In STEMI patients


Why is it important to match the stent size to the size of the patients affected vessels

Important not to be oversized as overdilation will result in massive repair response and further narrowing of the vessel


How is the stenosis in the patient’s coronary arteries viewed during stenting

A dye is injected into patients and viewed under fluoroscopy