Acute Coronary Syndrome and Angina

Question 1

What medications are used in the management of stable angina?

Answer 1

1st line - CCB (eg verapamil or ditiazem) OR BB (atenolol)
GTN sublingual for attacks
Statins and aspirin for prevention

Question 2

In angina the combination of which drugs cause heart block and are therefore contraindicated?

Answer 2

Beta blockers and non-dihydropyridine calcium channel blockers (verapamil and dilatiazam)

Question 3

What’s the GRACE ACS score?

Answer 3

Global registry of acute cardiac events

In patients with acute ACS it gives the 6months mortality risk score

Question 4

What type of drugs are eptifibatide and tirofiban ?

Answer 4

Glycoprotein IIb/IIIa receptor antagonists

They are given in ACS in patients with a high risk GRACE score, and who are undergoing angiography within 96 hours of hospital admission.

Question 5

What do you give to patients about to have PCI for a STEMI?

Answer 5

Aspirin 
P2Y12-receptor antagonist (ticagrelor or clopidogrel)
Unfractioned heparin (if PCI in 24hrs, or fondaparinux if no PCI)

Question 6

What’s teitze syndrome?

Answer 6

Benign inflammation of costal-chondral joints

Question 7

What is decubitus angina?

Answer 7

Induced by lying down

Question 8

What is prinzmetal or variant angina?

Answer 8

Occurs at rest due to coronary spasm, get ST elevation during attack which subsides with pain. Causes transmural ischemia

Rx with calcium channel blockers +/- long acting nitrates

Question 9

What is unstable angina?

Answer 9

Increases rapidly with severity, occurs at rest, high risk for MI

Question 10

What is cardiac syndrome x?

Answer 10

Patient with angina, a positive exercise test and normal coronary arteries

Probably due to small vessel disease

Question 11

How to calculate the likely hood of coronary artery disease?

Answer 11

Age
Gender
Type of chest pain (non-anginal, atypical angina,typical angina)
Low or high risk (diabetes, smoking And hyperlipidema)

More likely if ECG ST changes or Q waves.

Question 12

What is an NSTEMI?

Answer 12

Partial/ Subendocardial infarct -

ST depression

Question 13

Diagnostics for ACS?

Answer 13

ECG

Trop T
Trop I
CK-MB (useful for re-infarct)

Question 14

Complications of MI early to late?

Answer 14

0-24 hours: arrthymias, cardiogenic shock.
1-2 days: pericarditis
3-14 days: myocardial rupture
After 2 weeks: heart failure

Question 15

What is tirofiban?

Answer 15

GP 11b/111a antagonists

An antiplatelet

Question 16

MI of which vessel is likely to give sinus bradycardia?

Answer 16

Inferior MI (right coronary artery, right circumflex)

And also blocks. As supplies the AV node.

Question 17

Which MI leads to mitral regurg and why?

Answer 17

RCA (posterior/ inferior MI)

Loss of papillary muscles - leads to MR

Question 18

ST elevation in leads: I, aVL v5 and v6 indicate which view and which vessel?

Answer 18

Anterolateral

Left circumflex artery

Question 19

ST elevation in leads: II, III and aVF indicate which view and which vessel?

Answer 19

Inferior

Right coronary artery

Question 20

ST elevation in leads: V2-v4 indicate which view and which vessel?

Answer 20

Anterior septal

Left anterior descending

Question 21

ST elevation in leads: V2-v6 indicate which view and which vessel?

Answer 21

Anterior

LEft main stem

Question 22

ST elevation in leads: V1, v2, v3 (recip) indicate which view and which vessel?

Answer 22

Posterior

Right coronary artery

Question 23

What are the indications for CABG?

Answer 23

Left main stem disease
Triple vessel disease
Refractory angina
Unsuccessful angioplasty

Question 24

How long off driving for CABG?

Answer 24

1 month

Question 25

Why do you give BB and fondaparinux in NSTEMI?

Answer 25

BB- limits ischemia

Fondaparinux - reduces clot

Question 26

At what Qrisk score do you need to start a station?

Answer 26

> 10%

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