Coronary Artery Disease

Question 1

Characterised by angina pectoris
1

2

Answer 1

1 vasopsastic disease

Transient vasoconstriction of coronary artery

(Transient ischaemia, attack occurs at rest, attack occurs in clusters)

2 atherosclerotic disease

Coronary artery narrows due to plaque

(Stable/unstable angina or myocardial infarction)

Question 2

Acute coronary syndrome

Answer 2

Unstable angina

Myocardial infarction

Question 3

Stable angina if

Answer 3

No pain at rest

Pain due o physical exercise

Question 4

Unstable angina if

Answer 4

Present at rest
Frequent 
Lasts longer 
Occurs with less extertion
Prolonged ischemia 

Can lead to MI I’d not managed

Question 5

First 10 mins do what

Answer 5

ABC
Physical exam

Cardiac + 02 sats

325mg aspirin

Question 6

Oxygen dats need what st each %

Answer 6

Lesss than 90% =supplemented oxygen

Less than 80%= supplemented 02+ assisted ventilation

Question 7

Cardiac markers of myocardial damage

Answer 7

Tropomin T and I

Essential for diagnosis of MI

Question 8

Troponin found where

Answer 8

In cardiomyocytes
Released into blood when damaged

Take 6 hours to be released

Question 9

Negative troponins

Answer 9

Unstable angina
Non cardiac chest pain
Short attack of prinzmetal angina

Question 10

Positive troponins

Answer 10

Cardiomyocyte death

MI

Question 11

Questions to ask

Answer 11

OPQRST

ONSET
PROVOCATION
PALLIATION
QUALITY
RADIATION
SITE 
TIME COURSE

Question 12

Symptoms usually

Answer 12

Dyspnea palpitations
Nausea
Sweating

Question 13

Who’s prone to it

Answer 13

Women
Older adults (atypical presentation)
Diabetes

Question 14

Myocardial ischemia

Answer 14

Unstable angina
MI
prinzemetal angina

Question 15

Treatment for myocardial ischemia

Answer 15

Nitrates
3 sublingual doses
0.4 mg

IV if doesn’t work

Question 16

Nitrates contraindicated when

Answer 16

Hypotension
MI of RV
PDE-S inhibitors (sildenafil)

Can cause hypotension

Question 17

Myocardial ischemia symptoms

Answer 17

Chest pain
Tachycardia
Hypertensive

Beta blockers given to decrease cardiac demand

Question 18

Beta blockers contraindicated in

Answer 18

Prinzemetal angina = worsen vasoconstriction

Bradycardia

Cardiogenic shock

Acute decompressed heart failure

Cocaine related acute coronary syndrome

Question 19

Patients with underlying heart failure treatment

Answer 19

IV loop diuretic (furosemide)

Question 20

Sever + persistent chest pain treatment

Answer 20

IV morphine sulfate

2-4 mg every 5-10 mins

Question 21

ECG on who and when

Answer 21

Everyone and repeat it every 5-10 mins I’d suspicion if myocardial ischemia

Question 22

St on ecg?

Answer 22

Healthy = normal/upwards concavity
Stable angina = normal

Unstable = normal/ depressed

Question 23

MI on ECG appearance

Answer 23

NSTEMI- non-st segment elevation myocardial
ST can be normal.ST depression can be present

Deep T wave inversions over 1mm

STEMI- ST elevation

Over 1 mm in 2 or more contiguous leads or new left bundle branch block

Occurs with full thickness involvement of myocardium

Question 24

ST depression in V1/V2 means

Answer 24

Could be mirrored ST elevation in v7 8 and 9 which doesn’t show up on the ECG

This could be a posterior STEMI and need ps to be treated like one and not an NSTEMI

Question 25

Prinzemetal angina | St elevation ?

Answer 25

Normal/ depressed in short attack ST elevation in long attacks ECG changes only seen during attack so must be on ECG 24 hours

Question 26

No signs of ischemia after prinzemetal angina then you do

Answer 26

``` Further testing (stress test) Induce exercise or drugs stimulation (dobutamine) Compare coronary circulation at rest vs physical exercise ```

Question 27

Results of additional testing in prinzemetal ischemia

Answer 27

Negative stress test- artery can dilate Chest pain due to non cardiac cause Positive test - artery can’t dilate Chest pain from unstable angina Managed same as NSTEMI

Question 28

NSTEMI treatment?

Answer 28

Antithrombktic - oral antiplatelet therapy Clopidogrel Aspirin Anticagulent therapy- herapin Prevents thrombosis from embolism from ulcerated plaque

Question 29

After identifying someone at high risk of NSMETI what do u do

Answer 29

Coronary angiography + revascularization High risk: immediate Low risk: within 12 hours

Question 30

Repercussion therapy ?

Answer 30

Mechanical Stent Primary percutaneous Coronary intervention Pharmacological reperfusion- (fibrinolytic) Dine with primary PCI can’t be done within 2 hours of arrival to emergency department Reperfusiom should not be performed after 12 hours since symptoms onset

Question 31

After reperfusiom ?

Answer 31

Oral antiplatelet therapy andanticoagulent therapy