Chest Pain and Ischaemic Heart Disease
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Chest Pain and Ischaemic Heart Disease - Marcador
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| What are some features of ischaemic chest pain | The site is more central or left sided pain, diffuse pain Typical pattern of radiation is : Left/right or both arms and shoulders Neck, jaw , back May present with isolated pain at these sites without chest pain Tightening or heavy crushing pressure pain |
| What are some gender diffferences in presentation | Present with different symptoms Both can present with chest pain Women might also have more non-chest pain symptoms Women can get less obvious warning signs |
| What are the 2 causes of ischaemic heart disease | When myocardial oxygen supply does not meet the myocardial demand Atheromatous coronary artery occlusion |
| What are some risk factors for IHD | Non-modifiable --> Age, Male , Family History Modifiable --> Cigarette smoking, hyperlipidaemia, diabetes mellitus, hypertension Others --> harmful alcohol use, stress, depression, unhealthy diet, lack of exercise, obesity |
| What is the pathophysiology of decreasing coronary blood flow | Coronary blood flow occurs mainly in diastole when the heart muscle is relaxed however during stressful situations etc. heart rate is increased hence the time spent in diastole decreases so less blood can get to the myocardium which could lead to less supply and ischaemic heart disease |
| Which part of the heart is most vulnerable to ischaemia | Subendocardial area is the most vulnerable This is because Heart muscle is perfused from the epicardial surface to endocardial surface and myocardial wall pressure is greatest in in the subendocardial area which is closest to LV cavity |
| Features of chronic stable angina or angina pectoris | Stable plaque (no thrombus) → coronary artery narrowing Moderate reduction in blood flow --> Blood flow is sufficient enough to meet needs at rest Ischaemia only when oxygen demand increases --> Stressful situations, exercise etc. Relieved when demand decreases angina reproducible with same amount of exertion |
| What are features of history of chronic stable angina or angina pectoris | Brief episodes of ischaemic pain → mild to moderate pain Brough by exertion or emotion Relieved by rest or nitrates within 5 minutes Pain is often predictable |
| What are some treatments of angina | To increase myocardial oxygen supply : Aspirin → ↓ platelet aggregation, hence ↓ thrombus formation if plaques disrupted Statins - ↓ LDL cholesterol, ↓ progression of atherosclerosis, ↑plaque stability Revascularisation - mechanically restores blood flow To decrease oxygen demand Nitrates --> venodilator so decrease in preload Beta blockers --> Decreases Heart rate and contractility |