chronic coronary synrome d

Question 1

what is angina

Answer 1

a mismatch of oxygen supply and demand

Question 2

commonest reason for angina

Answer 2

IHD

Question 3

predisposing factors for IHD

Answer 3

• Age
• Cigarette smoking
• Family history
• Diabetes mellitus
• Hyperlipidemia
• Hypertension
• Kidney disease
• Obesity
• Physical inactivity
• Stress

Question 4

exacerbating factors that affect oxygen supply

Answer 4

• Anemia
• Hypoxemia
• Polycythemia
• Hypothermia
• Hypovolaemia
• Hypervolaemia

Question 5

exacerbating factors that affect oxygen demand

Answer 5

• Hypertension
• Tachyarrhythmia
• Valvular heart disease
• Hyperthyroidism
• Hypertrophic cardiomyopathy

Question 6

environmental risk factors that make IHD worse

Answer 6

• cold weather
• heavy meals
• emotional stress

Question 7

when does myocardial ischaemia occur

Answer 7

when there is an imbalance between the hearts oxygen demand and supply, usually from an increase in demand eg exercise accompanied by limitation of supply

Question 8

3 reasons for limited blood supply

Answer 8

1. Impairment of blood flow by proximal arterial stenosis
2. Increased distal resistance eg left ventricular hypertrophy
3. Reduced oxygen-carrying capacity of blood eg anemia

Question 9

what is ohms law

Answer 9

V = IR
so
change in P = QR

Question 10

4 other types of angina

Answer 10

1. prinzmetals angina (coronary spasm)
2. microvascular angina ( syndrome x)
3. crescendo angina
4. unstable angina

Question 11

how to take a history for IHD

Answer 11

• Personal details (demographics, identifiers)
• Presenting complaint
• History of PC + risk factors
• Past medical history
• Drug history, allergies
• Family history
• Social history
• Systematic enquiry

Question 12

cardiac symptoms

Answer 12

chest pain (tightness/discomfort)
breathlessness
fluid retention
palpitation
syncope or pre can scope

Question 13

questions to ask to do with angina pain 9 (OPQRST)

Answer 13

Onset
Position (site)
Quality (nature / character)
Relationship (with exertion, posture, meals, breathing and with other symptoms) Radiation
Relieving or aggravating factors
Severity
Timing
Treatment

Question 14

factors pointing towards ischaemic cardiac pain

Answer 14

• Character
• Location
• Provoking factors
• Relieving factors
• Associated symptoms
• Associated risk factors

Question 15

what is the differential diagnosis of myocardial ischaemia when presented with chest pain

Answer 15

• Pericarditis/ myocarditis
• Pulmonary embolism/ pleurisy
• Chest infection/ pleurisy
• Dissection of the aorta
• Gastro-oesophageal (reflux, spasm, ulceration)
• Musculo-skeletal
• Psychological

Question 16

treatment for angina

Answer 16

• Reassure
• Lifestyle
– smoking
– Weight
– Exercise
– diet
• Advice for emergency
• Medication
• Revascularisation

Question 17

what investigations for angina

Answer 17

routine bloods
lipids
ECG

Question 18

impact of beta blockers on heart

Answer 18

decrease heart rate
decrease LV contractility
decrease cardiac output
decrease oxygen demand

Question 19

side effects of beta blockers

Answer 19

tiredness, nightmares
bradycardia
erectile dysfunction
cold hands and feet

Question 20

what does aspirin do

Answer 20

cyclo-oxygenase inhibitor

decrease prostaglandin synthesis

decrease platelet aggregation, antipyretic, anti inflammatory , anaglgesic

Question 21

side effect of aspirin

Answer 21

gastric ulceration

Question 22

gp level treatment of angina

Answer 22

aspirin
GTN
beta blocker
statin

Question 23

hospital level treatment of angina

Answer 23

ACE inhibitor
long acting nitrate
revascularisation
Ca ++ channel blocker
potassium channel opener
ivabradien

Question 24

pros of PCI revascularisation

Answer 24

less nvasive
convenient
repeatable
acceptable

Question 25

cons of PCI revascularisation.

Answer 25

risk stent thrombosis
risk restenosis
can’t deal with complex diseas
dual antiplatelet therapy

Question 26

pros of CABG revascularidation

Answer 26

prognosis
deals with complex disease

Question 27

cons of CABG revascularisation

Answer 27

invasive
risk of stroke, bleeding
can’t do if frail, comorbid
one time treatment
length of stay
time for recovery

Question 28

who can you not give beta blockers to

Answer 28

people who suffer from asthma because it causes bronchospasms

Question 29

what do nitrates do

Answer 29

they are venodilators
arterioles dilate
decrease BP
decrease after load
decrease venous return
decrease preload

Question 30

what do Ca++ channel blockers do

Answer 30

decrease LV contractions
decrease work
decrease heart rate
decrease oxygen demand
decrease after load