Arteriosclerosis

Question 1

Chest pain: first line Inx

Answer 1

12-lead ECG

Question 2

NSTEMI: Inx after ECG

Answer 2

Exercise tolerance ECG

Bloods: Troponin (useful in myocardial damage)

Question 3

Diagnosis: exercise tolerance test - genuine ST depression

Answer 3

Angina

Question 4

ECG: what does ST depression signify

Answer 4

Acidosis in myocardium

Question 5

Chronic statble angina: definiton

Answer 5

Partly blocked coronary artery
When HR rises, ischaemia becomes significant and lactate accumulates

ECG: ST depression (acidosis in myocardium)

Question 6

Chronic stable angina: Management (4 drugs) and other management

Answer 6

Aspirin: prevent platelet aggregation
Beta-blocker (slow HR): atenolol
Nitrates (GTN/ ISMN - PRN) - dilate arteries
Statin (Simvastatin/ atorvastatin)

Angioplasty/ CABG/Angiogram

Question 7

Acei - For which CVS condition

Answer 7

Heart failure

Question 8

Coronary arteries: supply

Answer 8

Left coronary artery: anterior wall/ anterio-lateral wall

Right: inferior wall

Question 9

Angina: complication

Answer 9

If left untreated:

Acute myocardial infarction

Question 10

ECG finding: acute myocardial infarction

Answer 10

ST elevation MI (STEMI)

Question 11

Cardiogenic shock: which patient

Answer 11

When V1-V6 blocked (whole of left ventricle)

Left coronary artery blockage (both branches)

Question 12

ECG finding: inferior STEMI.

Answer 12

Lead II, III & AVF

Right coronary artery

Question 13

Heart attack (STEMI): management

Answer 13

Medical emergency (within 1-2 hours)

Unblock coronary artery: PCI, angioplasty

If not available, thrombolysis with tPA (alteplase or streptokinase)

Until then: aspirin & nitrates, beta-blocker & station (reduce ischaemia during transfer)

Question 14

Risk factors & Management: CVS

Answer 14

Diet & exercise
Stop soking
Reduce BP: low salt, drugs
Lipids: statins

Question 15

Management guidelines: Hypertension

Answer 15

ACE-inhibitor/ angiotensin II
CCB
Thiazide-like diuretic

Question 16

Hypertension Management: Why is CCB first line for afro-carribean demo.

Answer 16

different Renin-angiotension system

Dilator would work best compared to renin blocker

Question 17

Optimal medical therapy: HA

Answer 17

Intensive lifestyle modification
Aspirin
High dose station (atorvastatin 60-80mg)
optimal BP control
Assess T2DM

Aggressive management of BP and lipids improve survival

Question 18

PCSK9 inhibitor: Used for what?

Answer 18

Used when statin contraindicated

PCSK9 protein controls LDL receptors
Inhibition of PCSK9 decreases LDL recycling -> lower cholesterol

Evolocumab: monoclonal antibody

Question 19

Evolocumab (PCSK9 inhibitor): conclusion

Answer 19

Good relative risk (20%, preventing event) but non-significant improvement for absolute risk eg. death (0.1% in 3 years)