Coronary Heart Disease Overview

Question 1

Sudden death in Ischaemic Heart Disease?

Answer 1

Around half of deaths and 2/3 of these are in low risk individuals or in those who have this as their first manifestation

Question 2

Describe ventricular fibrillation in relation to CHD

Answer 2

An unstable plaque in an area of electrical activity can cause ventricular fibrillation, as a result of a re-entrant circuit

Question 3

Benefit of revascularisation?

Answer 3

Relief of ischaemia and can promote survival, with good quality of life

Question 4

What is HCM?

Answer 4

Hypertrophic Cardiomyopathy

Question 5

How to clinically diagnosis angina?

Answer 5

ANIGINA IS A CLINICAL DIAGNOSIS

Visceral pain from myocardial hypoxia - hard to describe and patients often use gestures

Characteristic patterns of:
Provocation
Relief
Timing

Characteristic background:
Risk factors

Question 6

GI tract chest pain?

Answer 6

Reflux, burning, acid, waterbrash, provoked by food
Peptic ulcer pain - epigastric, boring, point of finger gesture, relief with antacids/food
Oesophageal spasm
Biliary colic

Question 7

Musculoskeletal chest pain?

Answer 7

Injury, location, tender, prolonged

Pain can be reproduced by pressing on the chest in the correct area

Question 8

Pericarditis chest pain?

Answer 8

Central and posture related

Would have had a virus previously

Question 9

Pleuritic chest pain?

Answer 9

Focal

Exacerbated by breathing, sharp, catching

Question 10

MI symptoms?

Answer 10

Severe
Associated autonomic upset
Angor animi - feeling of impending doom
Sweat, nauseous and vomiting

Ongoing pain - a good indication of MI is if there is no relief with > 10 mg morphine (although, this is not always the case)

Question 11

PE symptoms?

Answer 11

Breathlessness

Maybe, pleuritic pain

Question 12

Aortic dissection pain?

Answer 12

Tearing, excruciating pain

SEVERE but then EASES

Question 13

Advantages of exercise testing?

Answer 13

Cheap, reproducible

Risk stratification - a +ve test at low workload implies a poor prognosis

Question 14

Disadvantages of exercise testing?

Answer 14

Poor diagnostic accuracy (middle aged-women in particular have a lot of false positives on the treadmill) in important sub-groups

Sub-maximal tests

Question 15

Advantages and disadvantages of CT angiography?

Answer 15

Pros - non-invasive; good for anatomical data and risk stratification

Cons - radiation, less precise than an angiography (part. when Ca is present), cost

Question 16

Angiography procedure?

Answer 16

Sheath inserted into artery, catheter is advanced from wrist/groin to coronary ostium

X-ray contrast agent is injected to outline coronaries

Question 17

Advantages and disadvantages of angiography?

Answer 17

Pros - “gold standard”, anatomical and risk stratification and can do a follow-on angioplasty

Cons - radiation, risk (1:1000 death via stroke); also, contrast can cause renal dysfunction, rash and nausea

Question 18

Reducing risk of CHD?

Answer 18

Drugs
Lifestyle changes
Revascularisation - CABG, PCI (Percutaneous Coronary Intervention)

This also relieves symptoms

Question 19

Drugs used in treatment of CHD?

Answer 19

Aspirin - anti-platelet agent
β-blockers - slow HR and reduced oxygen demand
Statins - reduce cholesterol
ACE inhibitors - reduced BP