CHD

Question 1

What are the three characteristics of coronary arteries in CHD?

Answer 1

Narrow lumen, thickened hardened walls and a lack of ability for them to dilate effectively

Question 2

What are three characteristics of the pain one may experience if they have stable angina?

Answer 2

heavy, squeezing or crushing pain
radiating to shoulder, neck, jaw or arms
may feel like indigestion
can last up to 30 minutes
may be caused by physical activity
may be a pattern

Question 3

What should you do if you see someone on the street with stable angina?

Answer 3

tell them to stop and rest to correct O2 balance
Use a GTN sub-lingual spray
wait 5-10 minutes, if no change give another GTN
if no effect, call 000

Question 4

What three drug classes do you use for stable angina?

Answer 4

Beta blockers, calcium channel blockers and long-acting nitrates

Question 5

What is 1st line drug therapy for stable angina?

Answer 5

Beta blockers e.g. metoprolol without intrinsic sympathomimetic activity

Question 6

What are two practice points for beta blockers? (2 marks)

Answer 6

do not stop abruptly or you may get an adrenergic surge
low dose and monitor

Question 7

What are three factors to consider when using a BB? (3 marks)

Answer 7

• type of airway disease (COPD less risky than asthma)
• choice of BB- B1 selective preferred
• start with low dose, monitor and review

Question 8

What is the second line treatment for stable angina? (2 marks)

Answer 8

CCB and nitrates

Question 9

What types of Non dihydropyridine CCB is used fro stable angina?

Answer 9

rate limiting drugs such as verapamil and diltiazem

Question 10

What is a risk of verapamil in stable angina?

Answer 10

can cause bradycardia and heart block

Question 11

If using diltiazem in stable angina, what do you need to do?

Answer 11

monitor and use cautiously

Question 12

What are 2 adverse effects of nitrates?

Answer 12

Hypotension, headache, gastric reflux

Question 13

What is a contraindication of nitrates?

Answer 13

PDE5 inhibitors

Question 14

What is the MOA of nitrates?

Answer 14

vasodilate which reduces preload by a lot and afterload by a lot to redistribute blood to ischemic zones

Question 15

What are 3 practice points for nitrates?

Answer 15

reduce risk by having a nitrate free period of 4-8 hours per day
can be MR for 16 hours in a patch
ISDN tablets have effect of 6-8 hours

Question 16

What do you use if you can’t use BBs, CCB or nitrates in CHD?

Answer 16

Nicorandil

Question 17

What is the effect of nicorandil?

Answer 17

Produces venous and arterial dilation due to its nitrate moiety and its effect to open potassium channels in vascular smooth muscle

Question 18

Name 3 adverse effects of nicorandil

Answer 18

headache, lethargy, nausea, dizziness, palpitation, flushing and myalgia

Question 19

When would you not use Ivabradine?

Answer 19

if the HR was 70bmp or under

Question 20

Do you use Ivabradine for heart failure or angina?

Answer 20

heart failure

Question 21

What is perherxiline used for?

Answer 21

myocardial oxygen utilisation

Question 21

What are the two main procedural options?

Answer 21

CABG and percutaneous coronary intervention (PCI)

Question 22

What is first line antiplatelet treatment for stable angina?

Answer 22

low dose aspirin

Question 23

Should you give statins to people with stable angina?

Answer 23

yes, regardless of cholesterol levels.

Question 24

What is the differences in definitions of NSTEMI and STEMI?

Answer 24

NSTEMI is a nontransmural necrosis and a STEMI is a transmural necrosis

Question 24

What is the difference between unstable angina and NSTEMI in terms of diagnosis?

Answer 24

Unstable Angina has negative biomarkers and a NSTEMI has positive biomarkers

Question 25

What are 3 signs and symptoms of an ACS?

Answer 25

Sudden onset of symptoms Central epigastric pain discomfort SOB Nausea Vomiting Sweating Fatigue Clammy

Question 26

List three tests for managing ACS?

Answer 26

ECG Blood tests     - cardiac enzymes - FBC Creatinine and electrolytes BGLs

Question 27

What is the priority after a STEMI is diagnosed and why? (3 marks)

Answer 27

reperfusion of the myocardium because it reduces the risk of death and damage which can have long term consequences

Question 28

Why might you not reperfuse a patient with ACS?

Answer 28

it is more than 12 hours after the symptom onset, the patient is asymptomatic and hemodynamically stable

Question 29

Why do you reperfuse a patient with a STEMI?

Answer 29

it is a total blockage of the coronary artery

Question 30

What are the two main options for reperfusion?

Answer 30

Percutaneous coronary intervention and fibrinolysis

Question 31

What type of reperfusion do you use if a patient has NSTEACS (Non-STEMI acute coronary syndrome)?

Answer 31

PCI

Question 32

How does a PCI occur?

Answer 32

Insertion of a catheter via radial or femoral artery and guided to heart. Xray control to visualise structures. Angioplasty is carried out (inflation of balloon to compress plaque) stent insertion

Question 33

What are the two types of stents used in PCI

Answer 33

Drug eluting stents and Bare metal stents

Question 34

How does a drug eluting stent work?

Answer 34

releases a cytotoxic drug to slow tissue regrowth

Question 35

Name two antiplatelet therapies

Answer 35

low dose aspirin and clopidogrel

Question 36

Name two antithrombin therapies

Answer 36

LMWH (enoxaparin and fondaparinux) Bivalirudin

Question 37

What is one fibrin selective drug for thrombolysis?

Answer 37

Fibrin selective- tenecteplase, reteplase and alteplase

Question 38

What are three complications of ACS?

Answer 38

Arrhythmias, heart failure, mural thrombus, pulmonary embolism and infarct extension

Question 39

What are three factors which make a NSTEACS patient high risk?

Answer 39

persistent chest pain/ discomfort elevated cardiac enzymes Systolic BP 90 or under Previous CABG and PCI Sustained ventricular tachycardia

Question 40

Why is post ACS treatment important? (2 marks)

Answer 40

reduce early complications and hospital started meds may be seen as more important thus improving compliance

Question 41

What are the fab four drug therapies for post-ACS therapy?

Answer 41

Antiplatelets Beta blockers ACEI (after BB stabilisation) Statin

Question 42

What is DAPT?

Answer 42

Dual anti-platelet therapy combining antiplatelets with MOAs.

Question 43

What do you need to monitor in patients on ACEIs or ARBS?

Answer 43

k+

Question 44

What factors affect CV risk?

Answer 44

Age, Aboriginal and Torres Strait Islander peoples, having a TIA recently, diabetes, Lipids, Systolic

Question 45

what are 3 characteristics of the clinical presentation of stable angina?

Answer 45

 Chest discomfort  Heavy squeezing or crushing pain which may radiate to shoulder, jaw, neck and arms  Triggered by physical activity

Question 46

what are 3 characteristics of the clinical presentation of acute coronary syndrome?

Answer 46

 SOB  N and V  Sweating  Fatigue  Central or epigastric pain  discomfort

Question 47

What are 4 drugs/drug classes you use for stable angina?

Answer 47

Beta bockers Calcium channel blockers long acting nitrates nicorandil

Question 48

What are 2 adverse effects of beta blockers?

Answer 48

AEs- bradycardia, hypotension, orthostatic hypotension, nausea, diarrhoea, dyspnoea.

Question 48

What are 2 precautions of beta blockers?

Answer 48

Contraindicated in severe and poorly controlled asthma. Bradycardia, can impair peripheral circulation, can mask clinical signs of hyperthyroidism

Question 49

What are 2 adverse effects of calcium channel blockers?

Answer 49

Nausea, headache and dizziness

Question 50

What are 2 precautions of calcium channel blockers?

Answer 50

can increase risk of muscle weakness and respiratory depression. Contraindicated in cardiogenic shock

Question 51

What are 2 precautions of long acting nitrates

Answer 51

contraindicated in hypovolaemia and raised intracranial pressure

Question 52

What are 2 adverse effects of long acting nitrates?

Answer 52

headache, flushing, palpitations, orthostatic hypotension, peripheral oedema

Question 53

What are 2 adverse effects of nicorandil?

Answer 53

headache, nausea, dizziness, lethargy, palpitations, flushing and myalgia

Question 54

What are 2 precautions of nicorandil?

Answer 54

associated with fistula formation in diverticula disease and contraindicated with PDE5 inhibitors

Question 55

What do you use for confirmed ACS?

Answer 55

P2Y12 antagonists

Question 56

What are 2 adverse effects of long acting P2Y12 antagonists?

Answer 56

bleeding and skin reactions

Question 57

What is 1 precaution of long acting P2Y12 antagonists?

Answer 57

risk of bleeding

Question 57

What are 4 cardioprotective drugs in ACS

Answer 57

Aniplatelets, beta blockers, AceIs and statins

Question 58

What drug do you use post ACS, what are 2 side effects and what are 1 precaution?

Answer 58

eplerenone SE: hyperkalaemia, hypotension and dizziness. and Precautions- hyperkalaemia

Question 59

What do you monitor with ACEIs?

Answer 59

Monitor potassium concentration and renal function

Question 60

what do you monitor with eplerenone?

Answer 60

potassium levels

Question 61

What can you do to encourage better heart health?

Answer 61

encourage them to weigh thmeselves daily, undertake physical activity, restrict salt, fluid and alcohol, smoking cessation.