CHD FoCP 1 Flashcards

1
Q

What is the order of disease progression in coronary heart disease?

A

Normal –> Fatty streak –> Plaque –> Obstructive atherosclerotic plaque(and exertional angina) –> Plaque fissure or erosion leading to thrombosis –> Unstable angina/acute MI/death

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2
Q

Define stable angina

A

Predictable, not worsening, usually exertional

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3
Q

Define unstable angina

A

sudden deterioration, with pain coming on at rest/waking from sleep. no cardiac enzyme release

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4
Q

Define NSTEMI

A

MI with no ST elevation. release of cardiac enzymes.

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5
Q

Cause of stable angina

A

Fixed stenosis in artery due to atheromatous plaque

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6
Q

Cause of acute coronary syndromes

A

plaque rupture/fissuring leading to platelet activation and in/complete coronary occlusion

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7
Q

Stable angina

A

Increase in demand of myocardial tissue unmatched by supply, leadung to ischaemia. e.g. due to atheroma, thrombus, spasm or aberrant anatomy; aortic stenosis or hypertrophic cardiomyopathy

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8
Q

ECG findings in angina

A

May be completely normal (high risk patients)

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9
Q

What is the gold standard investigation for angina?

A

Coronary angiography. it is a prelude to angioplasty or coronary bypass surgery

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10
Q

Antiplatelets used in coronary disease

A

aspirin, clopidogrel, ticagrelor

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11
Q

Lipid management

A

statins, Ezetmibe, PCSK9 inhibitors

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12
Q

Anti-anginals

A

nitrates, Ca channel blockers, nicorandil, ivabradine, ranolazine

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13
Q

benefits of angioplasty post MI

A

superior to thrombolysis. less strokes, less repeat MIs

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14
Q

What is restenosis post angioplasty?

A

renarrowing of stents, usually in the first 6 months. due to the exuberant generation of scar tissue.

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15
Q

Methods of reducing restenosis

A

Drug eluting stents and longer duration of dual antiplatelet therapy leadig to slower endotheliasation

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16
Q

3 vessel coronary disease is treated how?

A

CABG

17
Q

Risk of CABG in rest of the body

A

Stroke, Kidney failure, unable to come off ventilator, poorly healing leg and chest wound, disease in the grafts

18
Q

What intervention is used quickly in NSTEMI and immediately in STEMI?

A

Percutaneous coronary intervention (PCI) in cath lab