Management of Ischaemic Heart Disease Flashcards
(50 cards)
What is the recommended daily intake of salt?
<6g (1tsp)
What is the recommended daily intake of added sugar?
<30g (includes sugar in fruit juices)
What is the weekly recommended amount of exercise?
150 mins moderate aerobic (e.g. brisk walking) + 2 strength training sessions
75mins vigorous aerobic (e.g. jogging) + 2 strength training sessions
30mins 5 days a week
What smoking cessation services are available?
Smoking cessation clinics Pharmacy 1:1 support Support groups (on- and off-line) Nicotine-replacement therapy (e.g. lozenges, patches, gum) Champix
What are the recommendations regarding alcohol consumption?
No more than 14 units per week (roughly 6 pints of beer or 7 glasses of wine)
Spread over at least 3 days
With several alcohol-free days per week
How much of our overall daily energy intake should come from saturated fat?
<10%
How do you calculate BMI? What is a healthy BMI range? Over what BMI is classified obese?
Weight (kg) / height (meters squared)
18.5 - 24.9
>30 is obese
What score is used to grade the severity of stable angina?
Canadian Cardiovascular Society Angina Score
Class 1 - no limitation, pain only on very strenuous activity
Class 2 - slight limitation, pain on vigorous activity
Class 3 - moderate limitation, pain on normal activity
Class 4 - severe limitation, inability to conduct everyday activities without pain
What are the first investigations that should be conducted in a patient presenting with a history suspicious of stable angina?
ECG Bloods: - FBC (anaemia) - TFT (thyrotoxicosis) - Troponin (MI) - Lipids (RF) - HbA1c (RF)
In what 2 situations is a CT coronary angiogram indicated in patients presenting with a clinical features of stable angina?
1) If there is no established coronary artery disease/IHD
2) If PCI/CABG is being considered
Give 3 indications for exercise ECG
To confirm diagnosis of stable angina in cases of diagnostic uncertainty
Assessing extent/burden of disease in patients with known IHD
Pre-operative assessment in patients with known IHD
What is considered a positive result on exercise ECG?
> 2mm ST depression
with or without symptoms/T wave inversion
What two medications would you prescribe for an uncomplicated patient with a new diagnosis of stable angina?
Nitrates (usually GTN spray) +
Beta-blocker (bisoprolol/metoprolol)
If initial beta-blocker therapy fails to control symptoms, what 2 steps should be taken next?
1) Increase dose to max tolerate
2) Add Amlodipine or nifedipine
If beta-blockers are contra-indicated or not tolerated, what anti-anginal drug is given 2nd line?
Verapamil/diltiazem
What are the 3 third-line anti-anginal drugs that may be considered if patient cannot tolerate BB/CCB
Ivabradine
Nicorandil
Ranolazine
What is a common problem with nitrates and how is this overcome?
Pharmacological tolerance with prolonged use –> increased effective dose
Have 6-8hr ‘drug holidays’, best overnight
What are the 2 main indications for PCI in stable angina?
- 2 vessel disease
- inadequate symptom control on maximum medical therapy
Does PCI improve survival in stable angina?
No
What medication should be given after PCI?
6m Clopidogrel/Ticagrelor + lifelong Aspirin
When is CABG indicated in stable angina? (3 indications)
- 2 vessel disease
- L main stem disease
- Diabetes
Does CABG improve survival in stable angina?
Yes
What secondary prevention should be given to patients with established cardiovascular disease?
- Aspirin 75mg
- 80mg Atorvastatin
- Lifestyle modification
- Manage HTN and Diabetes
Arrange these STEMI ECG features in order of appearance over time:
A) ST elevation + Q waves + inverted t waves
B) ST elevation, no q waves, normal t waves
C) Q waves + inverted t waves, no ST elevation,
D) Q waves, normal t waves, no ST elevation
1) B
2) A
3) C
4) D
