L16: Angina And ACS

Question 1

What are the 2 main arteries of the heart

Answer 1

Right main coronary artery

Left main coronary artery

Question 2

What does the left main coronary artery branch into

Answer 2

Left anterioir descending artery

Circumfelx artery

Question 3

Which area of the heart does the right coronary artery supply

Answer 3

Right ventricle inferioir wall of the left ventricle

Question 4

Which area does the left anterior descending artery supply

Answer 4

Anterior lateral wall of the left ventricle

Question 5

Which area does the cirucumflex artery supple

Answer 5

Posterioir and inferioir part of the heart

Question 6

What is angina caused by

Answer 6

Narrowing or occlusion of the coronary artery by atheroma

Question 7

What happnes to the cells in the heart when there are imbalances between myocardial oxygen supply

Answer 7

Ischaemia

Question 8

What is the pathogenesis of angina

Answer 8

There is atherscloerisis deposition which causes narrowing of the vessel

Question 9

If the athersclerotic plaque ruptures what happens to the blood vessel

Answer 9

Becomes occluded

Question 10

What can occlusion of a vessel lead to

Answer 10

Stroke
Critical leg ischaemia
Myocardial infarction

Question 11

What are the risk factors for atherosclerosis

Answer 11

Hyperlipidemia e.g cholesterol
Hypertension
Diabetes: 1 and 2
Increasgin age
Male 
Genetics
Obesity
Infection

Question 12

What are the clinical manifestations e.g diseases of ichaemic heart disease

Answer 12

Angina: stable (with exercise), unstable (at rest)
Myocardial infarction: st elevated or non st elevated
Cardiac death
Cardiac failure
Arrhythmia: atrial fibrillation, ventricular arrthymias

Question 13

What are the differential diagnosis for angina

Answer 13

Musculoskeletal pain
Thoracic, cervical root pain
Peptic ulcer
Oesophageal reflux

Question 14

What is the character of cardiac pain

Answer 14

Squeezing
Heavy
Retrosternal discomfort

Question 15

Where is the location of cardiac pain

Answer 15

Mid thorax

Radiation to both arms or neck,Jaw

Question 16

What is cardiac chest pain usually worsened by

Answer 16

Exercise
Excitement
Stress
Cold weather
After meals

Question 17

What is cardiac chest pain usually releived by

Answer 17

Rest

Nitrates e,g gtn spray

Question 18

What are other associated symptoms of cardiac chest pain

Answer 18

Dyspnoea
Sweating
Palpitation
Fatigue

Question 19

What are the clinical signs of angina or ischaemic heart disease

Answer 19

Hyperlidipemia; arcus, xanthalama
Hypertension
Peripheral vascular disease
Diabetes
Anaemia
Murmus: aortic stenosis

Question 20

What is unstable angina

Answer 20

Chest pain that comes at rest and is prolonged cardiac chest pain

Question 21

What are the investigations of ischaemic heart disease

Answer 21

12 lead ecg 
FBC: anaemia 
Lipids
Hba1c- diabetes
Thyroid function 
Ct coronary angiography
Stress testing e.g treadmill
Invasive coronary angiography

Question 22

What is a hallmark of myocardial ischaemia on an ECG

Answer 22

St segment depression

Question 23

What is a hallmark of myocardial infarction

Answer 23

ST elevation

Question 24

What are the features of an acute myocardial infarction (stemi) on a ECG

Answer 24

Normal
St elevation
Q waves
T wave inverted

Question 25

What is a STEMI

Answer 25

Myocardial infarction with st elevation

Question 26

What is the cause of STEMI

Answer 26

Occlusion of a coronary artery via a thrombus

Question 27

What will a stemi show on a ECG

Answer 27

St elevation Q waves T wave inversion

Question 28

How can we manage risk factors

Answer 28

``` Smoking cessation Hyperlipidemia- give statns Lower hypertension Dietary modification Control diabetes Physical acitvity ```

Question 29

What medical therapy can we give

Answer 29

Beta blockers: to slow the heart reate down Nitrate: decrease coronary artery tone and allow vasodilation Revascularisation: ballon angioplasty and stenting

Question 30

What is the medical therapy for stable angina

Answer 30

``` Antiplatelet therpay Short acting nitrates e.g gtn spray Beta blocker Long acting nitrate Pottassium channel opener eg nicorandil ```

Question 31

What is nstemi

Answer 31

Non st elevatio myocardial infarction

Question 32

How is nstemi manageed

Answer 32

Aspirin Antianginal therapy Fondaparinux

Question 33

What are the management for revascularisation if NSTEMI risk is high

Answer 33

Coronary artery bypass graft- for left main coronary artery | PCI (angioplasty and stentig)- for patients with perisisten symptoms for st elevation MI

Question 34

What is the initial management of ACS

Answer 34

``` MONAC Morphine Oxygen Nitrate Aspirin Clopedigrol ```

Question 35

What is the gold standard treatment for STEMI

Answer 35

PCI- within 12 hours of symptoms onsent

Question 36

What is the secondary prevent management of ACS

Answer 36

Ace inhibitor- arb if intoleratd Dual antiplatelet therapy Statin Beta blocker

Question 37

What is the management of stable angina

Answer 37

``` GTN Beta blocker Calcium channel blocker Long acting nitrate Antiplatelet therapy ```

Question 38

What changes are seen in nstemi on a ecg and a troponin blood test

Answer 38

St depression T wave inversion High troponin

Question 39

What ECG changes and troponin blood tests seen in unstable angina

Answer 39

Ecg normal | Troponin normal

Question 40

With which scoring system do we decide if people with nstemi need a angiography now or later on

Answer 40

Using the grace score

Question 41

What is the secondary prevention for all ACS

Answer 41

Statin Dual antiplatelet therapy Beta blocker Ace inhibitor

Question 42

What is a angiography

Answer 42

X-ray to visualise the blood vessel