4. IHD

Question 1

IHD

Answer 1

ischemic heart disease

Question 2

Q Primary prevention

Answer 2

preventing the onset of disease; it aims to reduce the incidence of disease.

Question 3

Q Secondary prevention of CVD

Answer 3

aims to prevent the recurrence of cardiovascular events (e.g. heart attack or stroke) or complications of CVD in people diagnosed with CVD.

Question 4

Q Lifestyle advice in cardiovascular disease to include diet, alcohol, exercise and smoking. 


Answer 4

• No use of tobacco.
• Physical activity - at least 30 minutes, five times a week.
• Healthy eating.
• Not overweight.
• BP <140/90 mm Hg.
• Total cholesterol <5 mmol/L.
• Normal glucose metabolism.
• Avoidance of stress.

Question 5

Q Risk factors for cardiovascular disease - modifiable and non modifiable

Answer 5

Mod: normal stuff

Non-mod: Family history and cardiovascular disease, diabetes, Age, Gender, Ethnicity, Socioeconomic status

Question 6

BMI ranges

Answer 6

18.5 and 24.9 –healthy weight range, 25 and 29.9 –overweight range. 30 and 39.9 –obese range

Question 7

Q Acute chest pain

Answer 7

acute coronary syndrome, unstable angina, myocardial infarction
o Pain in the chest arms, back or jaw) > 15 minutes.
o nausea and vomiting, sweating and/or breathlessness, or haemodynamic instability.
o New-onset chest pain, or abrupt deterioration in stable angina, >15 m

Question 8

Q Stable chest pain

Answer 8

stable angina?
Presence of three of the features below is defined as typical angina.
Presence of two of the three features below is defined as atypical angina.
Presence of one or none of the features below is defined as non-anginal chest pain.

Anginal pain is:

constricting discomfort in the front of the chest, or in the neck, shoulders, jaw or arms
precipitated by physical exertion
relieved by rest or GTN within about 5 minutes.

Question 9

myocardial ischaemia

Answer 9

blood flow to the heart muscle (myocardium) is obstructed by a partial or complete blockage of a coronary artery by a buildup of plaques (atherosclerosis). If the plaques rupture, you can have a heart attack (myocardial infarction).

Question 10

Objective: first pass metabolism

Answer 10

the concentration of a drug is greatly reduced before it reaches the systemic circulation.

Question 11

PQ What does GTN stand for?

Answer 11

GTN stand for Glyceryl trinitrate and is administered sublingual (sl) and transdermal (top).
GTN is a drug used to vasodilate the coronary arteries. It increases the blood supply to the heart to reduce the risk of myocardial damage and treat myocardial pain (angina).

Question 12

PQ How is GTN administered to a patient (give two routes)?

… why not orally…?

Answer 12

sublingual and transdermal
After a drug is swallowed it is absorbed by the GI tract and enters the hepatic portal system. The liver metabolizes many drugs, and this first pass through the liver can substantially reduce the bioavailability of some drugs of which GTN is one. Drugs absorbed through the mucosa of the mouth or through the skin directly enter the systemic circulation, hence sublingual and transdermal routes are preferred.

Question 13

PQ What is ‘PRN’ when written on a prescription?

Answer 13

pro Re Nata’ and means as needed,

up to the maximum advised limit.