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Competency > Chronic Coronary Disease > Flashcards

Chronic Coronary Disease Flashcards

1
Q

Difference between NSTEMI and STEMI?

A

NSTEMI: partial blockage of coronary artery

STEMI: complete blockage of coronary artery

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2
Q

What does chronic coronary disease consist of?

A
  • ACS hx (MI, unstable angina)
  • hx of coronary revascularisation (post-CABG, post-PCI)
  • angina (stable, vasospastic, microvascular)
  • cardio conditions due to coronary disease
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3
Q

Etiology of coronary disease?

A

Build up of fat in the coronary arterial wall

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4
Q

How does acute coronary syndrome happen?

A

Fatty (atherosclerotic) plaque ruptures, leading to thrombosis -> block artery -> no oxygen to heart

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5
Q

Symptoms of CCD? Difference between typical angina, atypical angina and non-anginal chest pain?

A
  • constricting discomfort in chest, jaw, shoulder, arm (tight, squeezing, heavy) -> may radiate to arm, back, abd, neck
  • precipitates: physical exertion
  • relieve: rest or nitrates within 5-10min

Typical: all 3 sx
Atypical: 2 sx
Non-anginal: 0/1 sx

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6
Q

Nonpharm for CCD?

A
  • encourage physical activity
  • healthy diet (avoid trans fats, reduce Na, limit sugar)
    + the usual
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7
Q

Are omega-3 fatty acids, vitamins and calcium beneficial in reducing risk of CVD events?

A

No

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8
Q

What is the recommended dose of aspirin in CCD?

A

Low dose aspirin: 75-100mg

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9
Q

What is the recommended treatment for patients with CCD but no PCI or >12m from ACS?

A

Aspirin for >12m

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10
Q

What is the recommended treatment for patients with CCD and prior ACS +- PCI?

A

DAPT for 12m (possible to extend by 1-3y if low bleeding risk)

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11
Q

What is the recommended treatment for patients with CCD and PCI with drug-eluting stent, with low-moderate bleeding & ischaemic risk?

A

DAPT for 6m, then SAPT for >6m

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12
Q

What is the recommended treatment for patients with CCD and PCI with drug-eluting stent, with high bleeding risk?

A

DAPT for 1-3m, then P2Y12 for 6m, then SAPT

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13
Q

What drugs should be used as DAPT for pts with PCI WITHOUT history of ACS?

A

aspirin + clopidegrel

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14
Q

What drugs should be used as DAPT for pts with PCI AND history of ACS?

A

aspirin + clopidogrel / ticagrelor / prasugrel

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15
Q

What are the first line treatment options for relief of anginal symptoms?

A

BB, CCB, long-acting nitrates + SL / spray nitroglycerin

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16
Q

Should you use short-acting CCBs (e.g. nifedipine)? Why?

A

No, associated with increased CV events

17
Q

BB and CCB CI?

A
  • severe bradycardia (HR < 50bpm)
  • high-degree AV block
  • sick sinus syndrome (without pacemaker)
  • HFrEF (non-DHP CCB)
18
Q

BB & CCB MOA for CCD?

A
  • decrease inotropy
  • decrease HR (decrease oxygen demand)
  • decrease coronary vascular resistance & increase coronary blood flow (increase oxygen supply) (CCB)
19
Q

Which drug should be prioritised in the first year after MI?

A

BB

20
Q

Important DDI with nitrates?

A

Space apart from avanafil by 12h, sildenafil & vardenafil by 24h and tadalafil by 48h

21
Q

What’s the standard therapy for anginal symptoms?

A

1st step: BB or CCB
2nd step: BB + DHP-CCB
3rd step: add second line drug

22
Q

If HR > 80bpm, what is the therapy for anginal symptoms?

A

1st step: BB or non-DHP-CCB
2nd step: BB + CCB
3rd step: BB + ivabradine

23
Q

If HR < 50bpm, what is the therapy for anginal symptoms?

A

1st step: DHP-CCB
2nd step: switch to LAN
3rd step: DHP-CCB + LAN
4th step: add ranolazine or trimetazidine

24
Q

If pt has LV dysfunction or HF, what is the therapy for anginal symptoms?

A

1st step: BB
2nd step: BB + LAN or BB + ivabradine
3rd step: add 2nd line drug

25
Q

If pt has low BP, what is the therapy for anginal symptoms?

A

1st step: low dose BB / non-DHP CCB
2nd step: switch to ivabradine, ranotazine or trimetazinde
3rd step: combine two 2nd line drugs

26
Q

What is the target BP goal for pts with CCD?

A

< 130/80 mmHg

27
Q

What is the 1st line for pts with CCD and HTN?

A

ACEi/ARB +- BB

28
Q

What is the 1st line statin for pts with CCD?

A

High intensity statin

29
Q

Which SGLT2i is recommended for CCD?

A

Canagliflozin, empagliflozin

30
Q

Recommended vaccinations for CCD?

A

Pneumococcal, influenza

Competency (30 decks)

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