Coronary Artery Disease Flashcards
Understand, diagnose and treat CAD (30 cards)
Myocardial Ischaemia
Myocardial demand for O2 and Nutrients outstrips supply.
Two disease groups where main pathophysiology is myocardial ischaemia
Stable Angina
Acute Coronary Syndrome
3 Types of Angina
Exersional angina pectoris
Varient Angina
Cardiac Syndrome X
3 Diseases in Acute Coronary Syndrome
ST Elevation Myocardial Infarction
NSTEMI
Unstable Angina
Mechanism of myocardial Ischaemia
Mechanical vessel obstruction
Systemic reduction oxygenated blood flow
Local causes of myocardial ischaemia
Atheroma Thrombosis Arterial Spasm Embolus Coronary Arteritis Coronay Ostial Stenosis
Systemic causes myocardial ischaemia
anaemia
carboxyhaemoglobulinaemia
hypotension
Risk factors Coronary artery disease
\+ Age Male \+ family Hx Smoker Obesity High Fat Diet Sedentary Lifestyle Psychological stressors High Alcohol intake Coagulopathies NSAIDs -COXIBS
calculate risk 5 yearly using ….
QRISK3
>10% statins
<10% lifestyle optimisation
Angina features
is clinical diagnosis
"Cardiac" chest pain Central/retrosternal pain sweating anxiety with attacks breathlessness
Classical Angina Pectoris
angina pain
provoked by exercise (esp after food/in cold/ emotional)
relieved with rest / GTN
Varient Angina (/ Prinzmetal’s A)
angina pain
at rest
caused by arterial spasm
Cardiac Syndrome X
angina pain
positive exercise test
normal coronary arteries on angiography
Angina Investigations
in V High risk patients, likely angina and low risk population
BP: screen comorbid HTN
Bloods: FBC, Cholesterol TFT
ECG: normal between attack
Echo:Screen co-morbid abnormality
Ultra High Risk: Cardiac Catheterisation
Probable Angina: SPECT stress testing
Low risk group: CT angiography
Angina Managment
Patient education: lifestyle management, employment, sex, risk
Symptomatic Relief: GTN , BBlocker/CCB
(2nd Line: long active nitrate/ rate control/vasodilator)
Cardiac prevention: Statin, 75mg Asprin (OR cloplidigrel post stroke TIA) (+ ACE inhibitor if DM. CKD, CF)
Treatment resistance = dual therapy with BBlocker AND CCB / referral for revascularisation (PCI/CABG)
Unstable Angina
Angina pain:
At rest / prolonged in nature / chreschendoing
NO RISE TROP
MI Diagnosis
Prolonged myocardial ischaemia causing death of myocytes.
Trop T >30 @ 6 hours or doubling post 3 hours + at least one of
- Cardiac Pain
- suggestive ECG changes (ST elevation/ q waves)
- recent PCI/CABG
Management ACS
Morphine 5mg + Antiemetic
Oxygen 2l nasal cannula (unless COPD etc)
Nitrates GTN
Asprin 300mg
Beta Blocker
Access for revascularistation - Revascularise if suitable
if not suitable
ACE Inhibitor,
Statin
Heparin (Fondaparinux)
Revascularisation Options
STEMI / High risk consider for revacularisation
If <12 hours and can have PCI within 2 hours: PCI
If not Fibrinolysis. Alteplase / streptokinase
High risk of complications CABG
PCI for Angina
Balloon dilatation and stent induction.
Anterior MI
Left Anterior Descending artery
Major cardiac supply
Anterior MI ECG signs
ST elevation: in V1-V6 +/- 1 +/- aVL
Tombstoning
Isolated J point elevation
Inferior MI ECG signs
ST elevation: II, III, aVF
ST suppression in I & aVL
Posterior MI ECG signs
ST depression in v1-v4
R:S wave >1
Posterior ECG ST elevation leads v7-v9
