Case introduction

Question 1

define coronary artery disease and ischaemic heart disease

Answer 1

narrowing of the lumen of the coronary arteries resulting in an imbalance between the supply of oxygen and myocardial demand resulting in myocardial ischaemia and chest pain

Question 2

what is atherosclerosis

Answer 2

a process where over time, the walls of the arteries can become furred up with fatty deposits known as atheroma

Question 3

what are the 2 types of angina

Answer 3

stable and unstable

Question 4

what are the types of acute coronary syndromes

Answer 4

NSETACS

• unstable angina
• NSTEMI

Question 5

what are STEMI

Answer 5

• heart attack

- myocardial infarction

Question 6

what is stable angina

Answer 6

attacks are brought on by an obvious trigger (eg exercise) and improve with medication and rest

Question 7

what is unstable angina

Answer 7

attacks are more unpredictable, occurring with no obvious trigger and continuing despite resting

Question 8

what are NSTEMI

Answer 8

1. narrowed blood vessels (atherosclerosis) and thrombolysed plaques (atheromatous plaque rupture)
2. may get transient blocked artery, causing pain
3. thrombolysed plaques- blood will pass but risk of going onto developing STEMI/death
4. treated according to severity
   - reduction of platelet activity
   - treatment to relieve symptoms
   - treatment to reduce cardiovascular risk

Question 9

what are STEMI and how are they caused

Answer 9

1. narrowed due to build up of atherosclerosis and then clot has blocked artery
   - need to reopen blocked coronary artery
2. more pain than angina and lasts longer
3. sweaty, nausea and pale
4. GTN S/L doesn’t always work

Question 10

give examples of signs and symptoms of coronary heart disease

Answer 10

1. signs: ECG and biochemical markers (troponin)

2. symptoms- chest pain, anxiety, sweaty, shortness of breath, nausea

Question 11

give examples of non modifiable risk factors for CVD

Answer 11

1. family history
2. age
3. gender
4. ethnicity

Question 12

give examples of modifiable risk factors for CVD

Answer 12

1. hyperlipidaemia
2. smoking
3. hypertension
4. diabetes mellitus
5. personality
6. abdominal obesity

Question 13

describe the process of diagnosis of CVD

Answer 13

1. ECG
   - NSTEMI: ST depression/T wave inversion
   - STEMI: ST elevation
   - Previous STEMI: Q waves
2. cardiac enzymes- troponin T on presentation
3. history- good patient story and PMH