Chronic Coronary Disease Flashcards
Difference between NSTEMI and STEMI?
NSTEMI: partial blockage of coronary artery
STEMI: complete blockage of coronary artery
What does chronic coronary disease consist of?
- ACS hx (MI, unstable angina)
- hx of coronary revascularisation (post-CABG, post-PCI)
- angina (stable, vasospastic, microvascular)
- cardio conditions due to coronary disease
Etiology of coronary disease?
Build up of fat in the coronary arterial wall
How does acute coronary syndrome happen?
Fatty (atherosclerotic) plaque ruptures, leading to thrombosis -> block artery -> no oxygen to heart
Symptoms of CCD? Difference between typical angina, atypical angina and non-anginal chest pain?
- 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
Nonpharm for CCD?
- encourage physical activity
- healthy diet (avoid trans fats, reduce Na, limit sugar)
+ the usual
Are omega-3 fatty acids, vitamins and calcium beneficial in reducing risk of CVD events?
No
What is the recommended dose of aspirin in CCD?
Low dose aspirin: 75-100mg
What is the recommended treatment for patients with CCD but no PCI or >12m from ACS?
Aspirin for >12m
What is the recommended treatment for patients with CCD and prior ACS +- PCI?
DAPT for 12m (possible to extend by 1-3y if low bleeding risk)
What is the recommended treatment for patients with CCD and PCI with drug-eluting stent, with low-moderate bleeding & ischaemic risk?
DAPT for 6m, then SAPT for >6m
What is the recommended treatment for patients with CCD and PCI with drug-eluting stent, with high bleeding risk?
DAPT for 1-3m, then P2Y12 for 6m, then SAPT
What drugs should be used as DAPT for pts with PCI WITHOUT history of ACS?
aspirin + clopidegrel
What drugs should be used as DAPT for pts with PCI AND history of ACS?
aspirin + clopidogrel / ticagrelor / prasugrel
What are the first line treatment options for relief of anginal symptoms?
BB, CCB, long-acting nitrates + SL / spray nitroglycerin
Should you use short-acting CCBs (e.g. nifedipine)? Why?
No, associated with increased CV events
BB and CCB CI?
- severe bradycardia (HR < 50bpm)
- high-degree AV block
- sick sinus syndrome (without pacemaker)
- HFrEF (non-DHP CCB)
BB & CCB MOA for CCD?
- decrease inotropy
- decrease HR (decrease oxygen demand)
- decrease coronary vascular resistance & increase coronary blood flow (increase oxygen supply) (CCB)
Which drug should be prioritised in the first year after MI?
BB
Important DDI with nitrates?
Space apart from avanafil by 12h, sildenafil & vardenafil by 24h and tadalafil by 48h
What’s the standard therapy for anginal symptoms?
1st step: BB or CCB
2nd step: BB + DHP-CCB
3rd step: add second line drug
If HR > 80bpm, what is the therapy for anginal symptoms?
1st step: BB or non-DHP-CCB
2nd step: BB + CCB
3rd step: BB + ivabradine
If HR < 50bpm, what is the therapy for anginal symptoms?
1st step: DHP-CCB
2nd step: switch to LAN
3rd step: DHP-CCB + LAN
4th step: add ranolazine or trimetazidine
If pt has LV dysfunction or HF, what is the therapy for anginal symptoms?
1st step: BB
2nd step: BB + LAN or BB + ivabradine
3rd step: add 2nd line drug
If pt has low BP, what is the therapy for anginal symptoms?
1st step: low dose BB / non-DHP CCB
2nd step: switch to ivabradine, ranotazine or trimetazinde
3rd step: combine two 2nd line drugs
What is the target BP goal for pts with CCD?
< 130/80 mmHg
What is the 1st line for pts with CCD and HTN?
ACEi/ARB +- BB
What is the 1st line statin for pts with CCD?
High intensity statin
Which SGLT2i is recommended for CCD?
Canagliflozin, empagliflozin
Recommended vaccinations for CCD?
Pneumococcal, influenza
