angina

Question 1

when does it occur

Answer 1

when there is a mismatch between blood supply and metabolic demand

Question 2

ECG changes

Answer 2

• ST-T changes

Question 3

symptoms

Answer 3

• chest pain (heavy, tight)
• central pain
• pain can radiate to jaw/arms

Question 4

what does adenosine do

Answer 4

stimulate nerve endings and produce pain

Question 5

who gets it

risk

Answer 5

• increase with age
• hypertension
• hyperlipidaemia
• diabetes
• obesity
• smoking

Question 6

diagnosis

Answer 6

largely clinical

Question 7

when does pain occur

Answer 7

usually during exercise

Question 8

when does unstable angina pain occur

Answer 8

at rest

Question 9

what can be found on examination

Answer 9

• S4
• anaemia
• thyrotoxicosis
• hyperlipidaemia

Question 10

investigations

Answer 10

• FBC
• troponin (unstable)
• ECG
• echo
• CXR

Question 11

what is first line treatment

Answer 11

to change their lifestyle

Question 12

management algorithm

Answer 12

1. lifestyle + nitrates
2. beta blocker or calcium
3. ivabradine/nicorandil/ranolazine
4. revascularisation
5. PCI or CABG

Question 13

side effect of isosorbide mononitrate

Answer 13

• headache

- flushing

Question 14

what does bisoprolol do

Answer 14

• inhibit beta-adrenoreceptor
• reduces heart rate and BP
• reduces myocardial oxygen consumption

Question 15

cautions for use of beta blockers

Answer 15

• COPD

- acute heart failure

Question 16

side effects of beta blockers

Answer 16

• fatigue
• peripheral vasoconstriction
• sexual dysfunction
• bronchospasm

Question 17

side effect of verapamil

Answer 17

constipation

Question 18

side effect of amlodipine

Answer 18

• ankle oedema

- reflex tachycardia

Question 19

how does ivabradine work

Answer 19

• inhibits pacemaker current (funny current)

Question 20

side effects of ivabradine

Answer 20

• bradycardia

- sick sinus syndrome

Question 21

how does ranolazine work

Answer 21

inhibits late sodium channels into cardiac cells

Question 22

how is ranolazine metabolised

Answer 22

by cytochrome P450

Question 23

ranolazine SE

Answer 23

• constipation
• dizziness
• lengthened QT

Question 24

mechanism of aspirin

Answer 24

reversible inhibition of COX1 and thromboxane

Question 25

when should clopidogrel be used

Answer 25

aspirin intolerance

Question 26

when is atorvastatin used

Answer 26

to reduce LDL cholesterol

Question 27

what are first line drugs

Answer 27

• beta blocker
  then
• calcium channel (amlodipine or verapamil)

Question 28

what are second line drugs

Answer 28

• nicorandil
• ivabradine
• long acting nitrates
• ranolazine

Question 29

what does nicorandil stimulate

Answer 29

cyclic guanosine monophosphate production producing vasodilatation

Question 30

when patient is diagnosed what is first thing given

Answer 30

• GTN

- aspirin/statin/ACE inhibitor

Question 31

what is percutaneous coronary intervention

Answer 31

process of dilating a coronary artery stenosis by introducing an inflatable balloon and metallic stent

Question 32

how is PCI administered

Answer 32

via the femoral, radial or brachial artery

Question 33

what is best for administering PCI

Answer 33

radial artery

Question 34

what are SE of PCI

Answer 34

• bleeding
• haematoma
• dissection
• psuedoaneurysm

Question 35

how long should antiplatelet therapy be given after PCI

Answer 35

6-12 months

Question 36

what is coronary artery bypass graft

Answer 36

arteries or veins are anastomosed to the ascending aorta distal to the area of stenosis

Question 37

whats better PCI or CABG

Answer 37

PCI