Coronary artery disease

Question 1

What is CAD/IHD?

Answer 1

An inability to provide adequate blood supply to the myocardium. It is primarily caused by atherosclerosis of the epicardial coronary arteries.

Question 2

What are the 3 angina symptoms?

Answer 2

• Constricting, heavy chest pain radiating to jaw, neck, shoulders, or arms
  
  • Symptoms brought on by exertion or emotional stress
  • Symptoms relieved within 5 minutes by rest or GTN

Question 3

What are differentials for CAD?

Answer 3

• Aortic dissection
  
  • Pericarditis
  • PE
  • Pneumothorax

Question 4

What investigations would you do for possible CAD?

Answer 4

ECG
FBC (Hb)
Lipid profile
HbA1c and FBG

Exercise ECG
Angiography (CT or transcatheter)

Question 5

Management of CAD?

Answer 5

Lifestyle: diet and exercise

Meds: Nitrates (PRN) for symptom relief, can use long acting ones too e.g. isosorbide mononitrate

BB +/-
Ca blockers

Anti-platelets to reduce MI risk

Statins

Revascularisation: if not controlled by meds, do PCI or CABG

Question 6

Complications of CAD?

Answer 6

MI
ACS
Sudden cardiac death

Question 7

What is stable angina?

Answer 7

Symptomatic reversible myocardial ischaemia

Question 8

What is acute coronary syndrome?

Answer 8

Unstable angina, NSTEMI, STEMI

Question 9

What are risk factors for CAD?

Answer 9

Non-modifiable: age, male, family history

Modifiable: smoking, diabetes, LDL, inactivity, alcohol, diet

Question 10

What it atypical angina?

Answer 10

When 2 out of 3 classical angina symptoms are present, often seen in diabetics, elderly, women.