Angina and ACS

Question 1

What are the treatments for angina?

Answer 1

Conservative

Beta blockers e.g. atenolol

Aspirin and ticagrelor (antiplatelet)

Nitrates

Calcium channel blockers

Statins

Question 2

What is the treatment for STEMI and NSTEMI long term?

Answer 2

PCI/ prasugrel before PCI

Aspirin

Statin

Ticagrelor

(clopidogrel if tocareglor not available - ticagrelor for more severe cases)

Question 3

What is the difference between STEMI and agina?

Answer 3

angina is <30 minutes, >50% occlusion

MI = >90% occlusion and more than 30 minutes

Question 4

What are the treatments for heart failure?

Answer 4

Hydralazine (Afro carribean)

Electrical pacing

Ivabrandine ?75bpm

Sacubutril valsartan

Beta blocker

ACE inhibitors

Looop diuretics

Digoxin

Question 5

What are the treatments for atrial fibrillation?

Answer 5

Statin

CHA2DS2VASC score

Rate control - beta blocker, calcium channel blockers and digoxin

Rthym control - Ablation, pacing, pill in a pocket

Question 6

What is the difference between cardiac and non-cardiac chest pain?

Answer 6

Cardiac = heavy, crushing pain. Non-cardiac = sharp

Cardiac = radiates to jaw or shoulder. Non-cardiac = does not radiate

Cardiac = not pleuritic. Non-cardiac = can be pleuretic or hurt when pressed.

Cardiac = sweating, vomiting, clammy, dyspnea. Non-cardiac = .dysphagia, tender to touch, acid reflux, burning sensation

Cardiac = periodic, non-cardiac = regular

Question 7

Risk factors

Answer 7

Modifiable - hyperlipidemia, diabetes, obesity, hypertension

Non-modifiable - age, sex, genetics

Question 8

What suggests a posterior STEMI?

Answer 8

· Dominant R wave (R/S ratio > 1) in V2 In patients presenting with ischaemic symptoms, horizontal ST depression in the anteroseptal leads (V1 …

Question 9

What are the types of heart failure?

Answer 9

Systolic

Diastolic

Right - cor pulmonale - JVP raised, organomegaly, oedema, facial engorgement

Left - pulmonary oedema,

Low output - post mi

High output e.g. anaemia

Question 10

Investigations for heart disease

Answer 10

Bedside - ECG, BP

Bloods - FBC, glucose, lipids U and E’s, enzymes

Imaging - CXR and echo

Question 11

Aortic stenosis causes

Answer 11

1. Older age/ calcification
2. Certain heart conditions present at birth (congenital heart disease) such as a bicuspid aortic valve

Question 12

Aortic stenosis treatment

Answer 12

TAVI and balloon angioplasty

Question 13

Mitral regurgitation causes

Answer 13

HOCM with SAM

Endocarditis

Annular calcification

Rupture

Dilated cardiomyopathy

Question 14

Mitral regurgitation treatments

Answer 14

Valve repair and replacement

Question 15

Causes of myocardits

Answer 15

In - idiopathic 50%

Venuzela - virus

Bad - bacterial

Soldiers - spirochaete

Pay -parasite

Drug - drugs

Tax - toxins