Cardiology

Question 1

What’s the difference in symptoms between stable and unstable angina?

Answer 1

Stable angina chest pain will start with stress or exertion and stop when rested. Unstable angina can start anytime and resting won’t relieve pain

Question 2

What medications might someone with angina be on or have available? And what do the medications do?

Answer 2

GTN spray- Glyceryl trinitrate spray- rapid vasodilator
ACE inhibitors- treats hypertension
Beta blockers- reduce heart rate and strain on heart muscles
Calcium channel blockers- relax arteries and increase blood flow
Aspirin (low dose)- prevent blood clots
Statins- reduce blood cholesterol levels

Question 3

What are three main types of acute coronary syndrome?

Answer 3

STEMI
NSTEMI
Unstable angina

Question 4

What tests are used to diagnose a heart attack?

Answer 4

Electrocardiogram (ECG)- heart tracing, confirms heart attack and type
Blood tests- cardiac markers. Commonly troponin levels are measured over a period of time
Chest x-ray- looks for potential differential diagnosis. Also can check for complications of heart failure e.g. pulmonary oedema
Echocardiogram- sound waves build image of heart- can see area of damage clearer
Coronary angiogram- contrast injected to show the blockage in detail

Question 5

Why is a STEMI more serious and life threatening than a NSTEMI?

Answer 5

A ST-elevation shows that there’s a complete blockage of a coronary artery meaning there is a greater area ischaemic and damaged. An Non ST-elevation attack is still a heart attack however the coronary artery affected is only partially blocked so there’s less heart damage and a smaller area affected.

Question 6

What are the common symptoms of heart failure?

Answer 6

Breathlessness
Fatigued, exercising is exhausting
Swollen ankles and legs

Less common symptoms

• persistent cough
• wheezing
• bloating
• loss of appetite
• palpitations
• weight changes
• confusion
• dizziness
• tachycardia

Question 7

What are the stages of heart failure?

Answer 7

Stage 1- no symptoms with normal physical activity
Stage 2- no symptoms at rest, normal activity triggers symptoms
Stage 3- only minor physical activity triggers symptoms
Stage 4- discomfort at most activity, sometimes at rest too

Question 8

What medications can be used to treat heart failure?

Answer 8

Angiotensin receptor blockers (often used instead of ACE inhibitors to prevent cough)- reduce blood pressure, less strain on heart

ACE inhibitors- reduce blood pressure, still often used

Beta blockers- slow heart rate, protect from adrenaline and noradrenaline effects

Mineralocorticoid receptor agonists (MRAs)- pass urine, reduce fluid around heart, don’t affect K+

Diuretics- pass urine, reduce oedema, relieves breathlessness

Ivabradine- slows heart rate- alternative to beta blockers

Question 9

What are the main causes of heart failure?

Answer 9

Ischaemia- reduced blood flow to the heart
Valvular- damage or inefficient heart valve(s)
Myopathic- damage or problem with the cardiac muscle
Hypertensive- chronic high pressure in heart
Cor pulmonale- right sided enlargement due to lung or pulmonary disease

Question 10

What’s the difference between primary and secondary hypertension?

Answer 10

Primary- caused by multiple factors causing a high blood pressure e.g. bad diet, obesity, smokers etc
Secondary- caused by a known separate condition e.g. renal, vascular, endocrine disorder or drugs