CAD

Question 1

what is pathophysiology of acute cardiac artery occlusion?

Answer 1

plaque with fibrous cap
cap ruptures
blood clot forms around rupture
occlusion

(no time for collaterals)

Question 2

is there necrosis of cardiomyocytes in NSTEMI?

is there necrosis of cardiomyocytes in unstable angina?

Answer 2

yes, but not transmural

no

Question 3

what are the 3 features of typical angina?

Answer 3

• constricting discomfort in chest front, or beck, shoulders, jaw, arms
• precipitated by exertion
• relieved by rest or GTN by 5 mins

Question 4

what the main risk factors of angina?

Answer 4

• diabetes
• smoking
• hyperlipidaemia (chol>6.47 mmol/l)

Question 5

immediate tx as soon as unstable angina or NSTEMI diagnosed?

Answer 5

MUSTS:
dual antiplatelet (asprin, clopidogrel, prasugrel )
LMWH
beta blocker (arrhythmias)
statin
ACE inhibitor to prevent remodelling
GRACE score

PERHAPS:
Nitrates 
Morphine
Oxygen
IIb/IIIa inhibitors (stronger anti-platelets for patients with higher mortality risk)

Question 6

what can cause tropinin to be raised?

Answer 6

ACS
minor myocardial injury
myocarditis
sepsis
PE