IHD

Question 1

cause of angina

Answer 1

mostly atheroma

mismatch of o2 demand and supply

Question 2

environmental exacerbating factors

Answer 2

cold weather, heavy meals, emotional stress

Question 3

supply/demand exacerbating factors for angina

Answer 3

impairment of blood flow e.g. arterial stenosis
increased distal resistance e.g. LV hypertrophy
reduced o2-carrying capacity: anaemia

Question 4

typical angina presenting patient

Answer 4

older male, FH, smoker

Question 5

stable angina definition

Answer 5

induced by effort, relieved by rest

Question 6

angina ECG

Answer 6

mainly normal

may show ST depression, flat or inverted T waves, signs of past MI

Question 7

what Ix to show how much plaque someone with angina has?

Answer 7

CT calcium scoring

CT coronary angiography

Question 8

surgical options for angina

Answer 8

percutaneous coronary intervention (PCI)

coronary artery bypass graft (CABG)

Question 9

why are cold fingers a side effect of beta blockers?

Answer 9

they dilate coronary arteries but constrict skin and muscle ones –> cold fingers

Question 10

what does negatively chronotropic mean?

Answer 10

decrease in heart rate

Question 11

what does negatively inotropic mean?

Answer 11

decrease in LV contractility (force of contraction)

Question 12

Side effects of beta blockers

Answer 12

erectile dysfunction, cold hands + feet, bradycardia

Question 13

How do nitrates work?

Answer 13

they are ventilators

increase venous capacity –> reduction in preload

Question 14

how does aspirin work?

Answer 14

cyclo-oxygenase inhibitor
reduces prostaglandin synthesis, results in decreased platelet aggregation.
Is antipyretic, anti-inflammatory, analgesic

Question 15

what do statins do?

Answer 15

reduce the amount of cholesterol produced by the liver

Question 16

what does angiotensin II do?

Answer 16

increased sympathetic activity
release of aldosterone
vasoconstriction

Question 17

what do ACE inhibitors block?

Answer 17

the conversion of angiotensin I to angiotensin II

Question 18

underlying pathology of unstable angina and evolving MI?

Answer 18

plaque rupture, thrombosis and inflammation

Question 19

what do we call acute MI?

Answer 19

STEMI - diagnosed by ECG on presentation

Question 20

How is a N-STEMI diagnosed?

Answer 20

Its retrospective

Made after troponin/other results

Question 21

modifiable risk factors?

Answer 21

age, male, family history

Question 22

presentation of acute coronary syndrome?

Answer 22

acute central chest pain lasting >20 mins

often associated with nausea, sweatiness, dyspnoea

Question 23

what would you look for on a CXR for acute coronary syndrome

Answer 23

cardiomegaly
pulmonary oedema
widened mediastinum?

Question 24

what are the most sensitive + specific markers of MI?

Answer 24

cardiac troponin levels (T and I)

Question 25

what is troponin?

Answer 25

protein complex that regulates actin:myosin contraction helps level with risk stratification

Question 26

what is CK-MB

Answer 26

one of 3 isosomes of creatine kinase. | CK-MB is mainly in the heart

Question 27

Why use opiates with caution for ACS?

Answer 27

they can delay absorption of PY12 inhibitors

Question 28

1st line management for ACS (pre-hospital)

Answer 28

MONA | morphine, oxygen, nitrate, aspirin

Question 29

What is clopidogrel and its metabolism?

Answer 29

a P2Y12 inhibitor. has to be metabolised to its active form by 2 steps in the liver great target due to its amplification role

Question 30

Side effects of anti platelet drugs

Answer 30

increased risk of bleeding, rash, GI disturbance

Question 31

what do anticoagulants target?

Answer 31

formation and/or activity of thrombin

Question 32

Complications of MI

Answer 32

cardiac arrest cariogenic shock unstable angina bradycardia, tachyarrhythmias or heart block

Question 33

pathology of NSTEMI

Answer 33

occluding thrombus causes myocardial damage --> elevation of myocardial damage markers: troponin & creatinine kinase

Question 34

STEMI

Answer 34

complete occlusion of artery by thrombus more severe symptoms ST elevation on ECG elevated troponin & creatinine kinase

Question 35

what would normal serum troponin at 12 hrs suggest?

Answer 35

unstable angina (instead of NSTEMI/STEMI)

Question 36

Medical treatment after MI

Answer 36

``` primary angioplasty/thrombolysis BBs (atenolol) ACE-i (lisinopril) or ARB (candesartan) Statin Dual anti platelet therapy: aspirin and a P2Y12 inhibitor (clopidogrel) ```

Question 37

What is cardiac tamponade?

Answer 37

pericardial effusion: fluid accumulation in pericardium --> reduced ventricular filling --> haemodynamic compromise

Question 38

LT rx angina

Answer 38

CCB/B-blocker/long acting nitrate e.g. amlodipine, atenolol, nicorandil

Question 39

Post MI what should pts do | What is contraindicated

Answer 39

Attend cardiac rehab – advice on activity etc. Lifestyle changes NSAIDS absolute CI for 2/12 post STEMI