Ischaemic Heart Disease

Question 1

What two subgroups comprise acute coronary syndrome?

Answer 1

• ST-elevated ACS
  
  • STEMI
• Non-ST-elevated ACS
  
  • NSTEMI
  • Unstable angina

Question 2

What is the typical presentation of someone with acute coronary syndrome?

Answer 2

• SOB (may be relieved with rest)
• Chest pain with radiation to the arm/jaw (may be relieved with rest)
• Signs of heart failure

Question 3

How can investigations distinguish between the different subgroups that comprise acute coronary syndrome?

Answer 3

• ECG
  
  • ST elevation - STEMI
  • ST depression - UA or NSTEMI
• Cardiac enzymes
  
  • Elevation - STEMI or NSTEMI
  • No elevation - UA

Question 4

What are the principles of management of unstable angina?

Answer 4

• Presumptive cardiac treatment
  
  • Oxygen, nitrates and morphine
• Acute NSTEAC
  
  • Aspirin/clopidogrel
  • Beta-blocker/CCB
  • IV nitrates
  • ACE inhibitor
• Long term
  
  • Statins/ACEIs/aspirin/BB
  • Lifestyle changes/cardiac rehab

Question 5

How can chronic ischaemic heart disease be investigated

Answer 5

• Stress ECG
  
  • If abnormal baseline (LBBB, ST abnormalities, digoxin), use stress echo or MiBi scan

Question 6

How can chronic ischaemic heart disease be managed?

Answer 6

• Nitrates (PRN or long acting)
• Aspirin/BBs/CCBs
• Statins
• Risk factor reduction
• Angiogram +/- PCI (stenting), CABG if significant areas at risk