Ischaemic heart diseases

Question 1

Risk factors for MI

Answer 1

male, old age, smoking, hypertension, smoking, diabetes m, obesity, hypercholesteraemia, FH

Question 2

Evidence for an MI

Answer 2

+ve biomarkers (myoglobin, troponin, CK-MB), new ECG changes, ischemic symptoms, evidence on an angiogram

Question 3

Other causes of a rise in troponin

Answer 3

PE, sepsis, renal failure, sub-arachnoid haemorrhage

Question 4

Symptoms of MI

Answer 4

correct pain profile, nausea, heartburn, indigestion, abdominal pain, SOB, cold sweat, fatigue, dizziness, tachy

Question 5

Signs of an MI

Answer 5

crackles, murmurs, S3 and S4

Question 6

Things to look for in the history for a diagnosis of MI

Answer 6

hypercholesteraemia, family history of ischaemic heart disease, hypertension, previous MI or CVD, diet, smoking, alcohol, cocaine

Question 7

Investigations for MI diagnosis

Answer 7

ECG, BP, thyroid, anaemia, kidney function

Question 8

Pharmacological management of MI

Answer 8

thrombolysis, if they can’t get to a cath lab within 2 hours (TNK, alteplase, streptokinase), antiplatelets, antithrombic (heaparin, fondaparinux), beta blockers, statins, ACEi

Question 9

Mechanical (surgical) management of MI

Answer 9

PCI (contradictions - three vessel disease or left main stem) CABG (use in three vessel disease or left main stem)

Question 10

Requirements for surgery

Answer 10

lung function, liver function, mental state, ascending aorta okay, LVEF >20%

Question 11

Risk factors for stable coronary heart disease

Answer 11

hypertension, smoking, hyperliidaemia, hyperglycaemia, male, post-menopause