CAD, ACS, HF

Question 1

What do ACS and CAD have in common?

Answer 1

Both examples of an ischaemic heart disease

Question 2

Stable angina = CAD or ACS?

Answer 2

CAD. Coronary artery disease

Question 3

Name 3 different drug classes used in stable angina

Answer 3

Nitrates (to increase blood supply), statins (treat underlying atherosclerosis) and antithrombotics (to prevent ACS)

Question 4

Why is unstable angina transient?

Answer 4

Pain is only present when there is a blood clot on top of a plaque which restricts blood flow even further. Body usually capable of clearing the clot

Question 5

How to differentiate between NSTEMI and unstable angina?

Answer 5

Enzyme analysis. NSTEMI will have elevations but angina won’t

Question 6

Name the best enzyme for ACS analysis / diagnosis?

Answer 6

Creatine kinase MB

Question 7

Which enzyme rises the quickest?

Answer 7

GP-BB

Question 8

NSTEMI appearance on ECG?

Answer 8

Slight depression of ST segment

Question 9

Why is there an elevation in ST on the ECG of a STEMI?

Answer 9

It indicates a large portion of the heart muscle is damaged

Question 10

What are the first medications an MI patient would receive?

Answer 10

Aspirin 300mg, GTN, pain relief

Question 11

When can fibrinolytics be used?

Answer 11

Within the first 4.5 hours

Question 12

When is PCI an option?

Answer 12

Within 30-90 minutes of the MI

Question 13

Define CABG

Answer 13

Coronary artery bypass grafting. A surgery that grafts in new vessels to bypass the blockage in the heart

Question 14

Indication of left sided HF?

Answer 14

Oedema in the legs

Question 15

Compare congestive heart failure and heart failure

Answer 15

CHF involves both sides usually. HF is just the left ventricle

Question 16

Name two compensatory mechanisms for heart failure (reduced cardiac output)

Answer 16

Increase in SNS activity, activation of RAAS

Question 17

Name the two goals of pharmacological treatment in HF

Answer 17

Improve the ability of the heart to contract

Reduce the workload of the heart

Question 18

MOA of loop diuretics?

Answer 18

They block the Na/K/Cl transporter in the loop of henle which reduces the reabsorption of these ions

Question 19

When are diuretics used in HF?

Answer 19

When there is oedema

Question 20

When are ACE inhibitors used in heart failure?

Answer 20

When there is no oedema present, just low left ventricle function

Question 21

Do ace inhibitors reduce preload or afterload?

Answer 21

Both

Question 22

Name an aldosterone antagonist

Answer 22

Spirinolactone

Question 23

Name a class of drugs that reduces mortality in HF patients

Answer 23

Beta blockers

Question 24

Which inotropic drug inhibits the Na/K ATPase pump?

Answer 24

Digoxin

Question 25

Name a vasodilator

Answer 25

Nitrates like Isosorbide mononitrate or GTN

Question 26

Name 2 beta agonists used in HF

Answer 26

Dobutamine and dopamine

Question 27

Why would beta agonists be useful in HF?

Answer 27

They increase contractility without increasing the rate.

Question 28

Which drugs are only used short term in advanced heart failure and why?

Answer 28

Beta agonists like dobutamine. They increase circulation in the short term but do not improve mortality and can actually increase myocardial oxygen demand

Question 29

Name a drug that inhibits the funny channel

Answer 29

Ivabradine

Question 30

Which drug is used in patients maxed out on ace-i’s, ARBs and beta blockers?

Answer 30

Ivabradine

Question 31

MOA of ivabradine?

Answer 31

Blocks the funny channel, which delays the action potential. This reduces HR without having any other cardiac effects

Question 32

Why do MI patients need beta blockers and ACE inhibitors?

Answer 32

To reduce the myocardial oxygen demand by reducing load on the heart

Question 33

Which enzyme is the slowest to rise

Answer 33

Creatine kinase MB