Flashcards in CHD FoCP 1 Deck (18):
What is the order of disease progression in coronary heart disease?
Normal --> Fatty streak --> Plaque --> Obstructive atherosclerotic plaque(and exertional angina) --> Plaque fissure or erosion leading to thrombosis --> Unstable angina/acute MI/death
Define stable angina
Predictable, not worsening, usually exertional
Define unstable angina
sudden deterioration, with pain coming on at rest/waking from sleep. no cardiac enzyme release
MI with no ST elevation. release of cardiac enzymes.
Cause of stable angina
Fixed stenosis in artery due to atheromatous plaque
Cause of acute coronary syndromes
plaque rupture/fissuring leading to platelet activation and in/complete coronary occlusion
Increase in demand of myocardial tissue unmatched by supply, leadung to ischaemia. e.g. due to atheroma, thrombus, spasm or aberrant anatomy; aortic stenosis or hypertrophic cardiomyopathy
ECG findings in angina
May be completely normal (high risk patients)
What is the gold standard investigation for angina?
Coronary angiography. it is a prelude to angioplasty or coronary bypass surgery
Antiplatelets used in coronary disease
aspirin, clopidogrel, ticagrelor
statins, Ezetmibe, PCSK9 inhibitors
nitrates, Ca channel blockers, nicorandil, ivabradine, ranolazine
benefits of angioplasty post MI
superior to thrombolysis. less strokes, less repeat MIs
What is restenosis post angioplasty?
renarrowing of stents, usually in the first 6 months. due to the exuberant generation of scar tissue.
Methods of reducing restenosis
Drug eluting stents and longer duration of dual antiplatelet therapy leadig to slower endotheliasation
3 vessel coronary disease is treated how?
Risk of CABG in rest of the body
Stroke, Kidney failure, unable to come off ventilator, poorly healing leg and chest wound, disease in the grafts