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Cardiology > Cardiovascular Disease, Angina, ACS > Flashcards

Cardiovascular Disease, Angina, ACS Flashcards

1
Q

What happens when atheromatous plaques develop?

3 main steps

A

Stiffening of the artery walls - hypertension

Stenosis - reduced blood flow (e.g. in angina)

Plaque rupture - thrombus - ischaemia

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2
Q

Non-modifiable RF for CVD (3)

A

Older age
FH
Male

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3
Q

Modifiable RF for CVD (7)

A 
Smoking
Alcohol consumption
Poor diet (high sugar and trans-fat and reduced fruit and vegetables and omega 3 consumption)
Low exercise
Obesity
Poor sleep
Stress
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4
Q

Co-morbidities that increase the risk of atherosclerosis (5)

A 
Chronic Kidney Disease
Hypertension
Inflammatory conditions - RA
Atypical Antipsychotic Medications
Diabetes
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5
Q

Primary prevention of CVD
(Patients who have never had CVD in the past)

When to start a statin?

A 
Perform QRISK3 (Risk of stroke or MI in next 10 years)
>10% - start a statin (artorvastatin 20mg)
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6
Q

Which patients are routinely offered atorvastin?

A

CKD

T1DM >10 years or 40+

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7
Q

What are the NICE recommendations for checking lipids in primary prevention?

A

Check after 3 MONTHS

Increase statin dose to aim for a 40% REDUCTION in non-HDL cholesterol

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8
Q

What are the NICE recommendations for checking LFTs in primary prevention?

A

Check LFTs within 3 MONTHS of starting statin
Check again at 12 MONTHS

Statins can cause a transient and mild rise in ALT and AST in the first few weeks
STOP if 3X UPPER LIMIT

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9
Q

What is secondAry prevention of CVD?

A

4 As
Aspirin (plus send antiplatelet for 12 months)
Atorvastatin (80mg)
Atenolol (or other beta blocker - bisoprolol)
ACE inhibitor

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10
Q

Notable side effects of statins (3)

A

Myopathy (check creatine kinase in patients with muscle pain or weakness)
T2DM
Haemorrhagic Strokes (very rarely)

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11
Q

What is angina?

A

Narrowing of coronary arteries reduces blood flow to the myocardium
During times of high demand (exercise) there is insufficient blood flow to meet demand

Stable - relieved by rest and GTN
Unstable - Symptoms come on randomly

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12
Q

How do you diagnose angina?

A

Gold Standard - CT coronary angiography

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13
Q

What are the baseline investigations for someone having CT coronary angiogram?

A

Physical Examination (heart sounds, signs of heart failure, BMI)

FBC, U&Es (prior to ACEi and other meds), LFTs (prior to statins)
Lipid profile
Thyroid function tests
HbA1C and fasting glucose

ECG

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14
Q

What are the four principles of NICE management of angina?

A

R - refer to cardiology (urgently if unstable)
A - Advise about diagnosis, management and when to call ambulance
M - medical treatment
P - Procedures - surgical interventions

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15
Q

What are the aims of medical management?

A

Immediate Symptomatic Relief
Long Term Symptomatic Relief
Secondary prevention of cardiovascular disease

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16
Q

How is immediate symptomatic relief achieved?

A

Take GTN
Repeat after 5 minutes
If there is still pain 5 minutes after the repeat dose – call an ambulance.

17
Q

How is long term symptomatic relief of angina achieved?

A

Beta blocker (e.g. bisoprolol 5mg once daily) or;

Calcium channel blocker (e.g. amlodipine 5mg once daily)

(both if symptoms not controlled by one)

Other options (not first line):

  • Long acting nitrates (e.g. isosorbide mononitrate)
  • Ivabradine (HCN chanel blocker, slow HR)
  • Nicorandil (vasodilator)
  • Ranolazine (late-sodium current inhibitor)
18
Q

How is secondary prevention of CVD achieved?

A

Aspirin (i.e. 75mg once daily)
Atorvastatin 80mg once daily
ACE inhibitor
Already on a beta-blocker for symptomatic relief

19
Q

What areas do the RCA supply?

A

Right atrium
Right ventricle
Inferior aspect of left ventricle
Posterior septal area

20
Q

What areas do the circumflex artery supply?

A

Left atrium

Left ventricle - Posterior aspect of

21
Q

What areas do the Left Anterior Descending (LAD) artery supply?

A

Anterior aspect of left ventricle

Anterior aspect of septum

22
Q

What to look for on an ECG for an MI?

A

Diagnose STEMI with:
ST elevation
New LBBB

NSTEMI - Diagnosis also needs raised troponin:
ST depression
Pathological Q waves
T wave inversion

23
Q

Associated artery and ECG leads for Anterolateral area

A

Left Coronary Artery

I
aVL
V3-6

24
Q

Associated artery and ECG leads for Anterior area

A

LAD

V1-V4

25
Q

Associated artery and ECG leads for Lateral area

A

Circumflex

I
aVL
V5-V6

26
Q

Associated artery and ECG leads for Inferior area

A

Right coronary artery

II
III
aVF

27
Q

What else causes raised troponins?

A 
CHronic renal failure
Aortic dissection
Myocarditis
Pulmonary embolism
Sepsis
28
Q

Acute NSTEMI treatment

A 
B - Beta blockers unless contraindicated
A - Aspirin 300mg stat dose
T - Ticagrelor 180mg stat dose (clopidogrel 300mg is an alternative)
M - Morphine titrated to control pain
A - Anticoagulant: LMWH 
N- Nitrates
29
Q

What is GRACE score?

A

Predicts 6 month mortality or repeat MI

<5% Low risk
5-10% Medium risk
>10% High risk

30
Q

Complications of MI

A 
D - Death (VF)
R - Rupture of heart septum or papillary muscles
E - Edema (HF)
A - Arrythmia and Aneurysm
D - Dressler's Syndrome
31
Q

What is Dressler’s Syndrome?

A

AKA Post MI syndrome

Localised immune response usually 2-3 weeks post MI
Pericarditis

Presents with:
Pleuritic chest pain
Low grade fever
Pericardial rub on auscultation

32
Q

How is Dressler’s syndrome diagnosed?

A

ECG

  • global ST elevation
  • T wave inversion

Echocardiogram
- Pleural effusion

Raised inflammatory markers (CRP ESR)

33
Q

How is Dressler’s syndrome managed?

A

NSAIDs (aspirin/ibuprofen)

Steroids in more severe cases

34
Q

Secondary prevention of ACS - Medical management

A

6 As

Aspirin (75mg OD)
Artorvastatin (80mg OD)
ACE inhibitors
Atenolol

Aldosterone antagonist for those with CHD
Another antiplatelet (clopidogrel, ticagrelor upto 12months)
35
Q

Secondary prevention - Lifestyle

A

Stop smoking
Cardiac rehabilitation (a specific exercise regime for patients post MI)
Optimise treatment of other medical conditions (e.g. diabetes and hypertension)
Reduce alcohol consumption
Mediterranean diet

Cardiology (6 decks)

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