Coronary Artery Disease

Question 1

What is the immediate symtom management of stable angina?

Answer 1

GTN

Question 2

When are BBs contraindicated

Answer 2

Heart block
Heart failre
Asthma
Digoxin/verapimil

Question 3

What is second line angina management for long term symptom relief?

Answer 3

Long acting nitrates - Isosorbide mononitrate
Ivabradine
Nicorandil
Ranolazine

Question 4

What is issue with long acting nitrates?

Answer 4

Tolerance

Not in aortic stenosis

Question 5

What is used as secondary prevention in angina?

Answer 5

Antiplatelet therapy- aspirin 75mg
ACEi (vasodilate to decrease BP)
Atorvastatin 80-mg

Question 6

What advice is needed in agina?

Answer 6

Driving
smoking
occupational hazards
diet
bp control
alcohol
DM
Cardiac rehab
Excercise increase

Question 7

What is gold standard investigation in angina?

Answer 7

CT Coronary Angiography

Question 8

What other investigations are needed in stable angina?

Answer 8

Physical Examination (heart sounds, signs of heart failure, BMI)
ECG
FBC (check for anaemia)
U&Es (prior to ACEi and other meds)
LFTs (prior to statins)
Lipid profile
Thyroid function tests (check for hypo / hyper thyroid)
HbA1C and fasting glucose (for diabetes)

Question 9

What is RAMP in the management of angina?

Answer 9

Refer to cardiology (urgent if unstable)
Advise about management and when to call an ambuilance
Medical treatment
Procedural (surgical)

Question 10

What are 3 aims of medical management of angina?

Answer 10

1. Immediate Symptom relief
2. Long term symptom relief
3. Secondary prevention of CV disease

Question 11

What is long term symptom management of stable angina?

Answer 11

Regular BB or CCB (amlodipine), then combine

Question 12

Which vessel is harvested for CABG?q

Answer 12

Great saphenous vein

Question 13

What causes ACS?

Answer 13

Thrombus from athersclerotic plaque blocks- thrombus made up mostly of PLATELETS.

Question 14

WHat does the RCA supply?

Answer 14

R side heart
Posterior septal area
Inferior L ventricle

Question 15

What does circumflex supply?

Answer 15

LA

Posterior LV

Question 16

What does LAD supple?

Answer 16

Anterior LV

Anterior septum

Question 17

What is seen on ECG to diagnose STEMI?

Answer 17

ST elevation

New LBBB

Question 18

What is done if no STEMI changes?

Answer 18

Troponin

Question 19

What ECG signs indicate NSTEMI?

Answer 19

ST depression
T wave inversion
Q waves

Question 20

If there is raised trop what is it?

Answer 20

NSTEMI

Question 21

If trop and ECG normal what is it?

Answer 21

Unstable angina

Question 22

Who experiences silent MIs?

Answer 22

Diabetic

Elderly

Question 23

How long should chest pain be present for to not just be angina?

Answer 23

20 mins

Question 24

Which ECG leads represent LAD

Answer 24

V1-4

Question 25

Which ECG leads represent Circumflex

Answer 25

I aVL V5,6

Question 26

Which leads indicate RCA

Answer 26

II III aVF

Question 27

What area is the LAD?

Answer 27

Anterior

Question 28

What area is RCA?

Answer 28

Inferior

Question 29

What area is cirucumflex?

Answer 29

Lateral

Question 30

What are diffenetials for raised trop

Answer 30

``` Chronic renal failure Sepsis Myocarditis Aortic dissection PE ```

Question 31

What additional tests are done in ACS to angina?

Answer 31

ECHO- assess functional damage CT coronary angiogram CXR- pulmonary oedema or other causes

Question 32

What should be done to manage STEMI?

Answer 32

Primary PCI if within 2 hours of presentation | Thrombolysis if PCI unavailable

Question 33

Name 2 thrombolysing agents

Answer 33

Streptokinase | Alteplase

Question 34

What is done to manage NSTEMI

Answer 34

``` BATMAN BBs Aspirin (300mg stat) Ticagrelor stat dose Morphine Anticoag LMWH BD for 2-8 days Nitrates O2 is sats low ```

Question 35

What is the GRACE score?

Answer 35

6 month risk of death or repeat MI after NSTEMI

Question 36

What does GRACE indicate?

Answer 36

PCI early (within 4 days)

Question 37

What are complications of MI?

Answer 37

``` Oedema Rupture of septum or papillary muscles Arrhythmia Aneurysm Dresslers Syndrome ```

Question 38

What is Dressler's Syndrome?

Answer 38

Pericarditis 2-3 weeks post MI | Pleuritic chest pain, low grade fever, rub and effusion (rarely tamponade)

Question 39

What are signs of Dresslers on ECG?

Answer 39

ST elevation | T inversion

Question 40

What are signs of Dresslers on ECho?

Answer 40

Pericardial effusion

Question 41

How is Dresslers managed

Answer 41

NSAIDs (aspirin, ibuprofen) | Pred in severe cases

Question 42

What are the 6 As of secondary medical management of ACS?

Answer 42

Aspirin 75mg OD Another platelet (Clop or Ticarelor for up to 12 months) Atorvastatin 80mg ACEi Atenolol (or other BB as high as tolerated) Aldosterone antagonist if clinical heart failure (Eplerenone)

Question 43

What secondary preventative lifestyle measures indicated in ACS

Answer 43

``` Smoking Alcohol Mediterranean diet Cardiac rehab Optimise DM and HTN management ```