| 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 |
| What phase of the cardiac cycle does blood filling happen in | Diastole |
