CHRONIC CORONARY SYNDROME

Question 1

Coronary artery disease or Coronary Heart Disease

Answer 1

Inadequate supply of blood to the myocardium due to obstruction of the epicardial coronary arteries

Question 2

Forms of coronary artery disease

Answer 2

Stable or Chronic
Acute disease or Unstable

Question 2

Modifiable risk factors of atherosclerotic CVD

Answer 2

Diabetes mellitus
Obesity
Microalbuminuria
Atherogenic dyslipidaemia
Hyperglycemia
Hypertension
Stress
Physical inactivity
Smoking/Alcohol
Diet and nutritional deficiencies

Question 2

Types of acute coronary syndromes

Answer 2

Unstable angina
Non-ST-segment elevation MI
ST-segment elevation MI

Question 2

Non-modifiable risk factors

Answer 2

Age
Gender(male)
Heredity
Ethnicity
Inflammation
Family history of CV disease

Question 2

Psychosocial risk factors

Answer 2

Employment status
Educational factors
Physical and social environment
Income level
Behavioural risk
Psychological factors

Question 3

Tradition ASCVD risks

Answer 3

Diabetes
Hypertension
Dyslipidemia
Smoking
Physical inactivity
Obesity
Unhealthy diet

Question 4

Determinants of myocardial blood demand

Answer 4

Heart rate
Myocardial wall stress
Systolic blood pressure
Myocardial contractility

Question 5

Determinants of myocardial blood supply

Answer 5

Coronary artery diameter and tone
Collateral blood flow
Perfusion presure
Heart rate ( duration of diastole)

Question 6

Classification of angina

Answer 6

1. Constricting discomfort in the front of the chest or in the neck, jaw, shoulder, or arm
2. Precipitated by physical exertion
3. Relied by rest or nitrates within 5 minutes

Typical angina meets all three
Atypical angina meets two
Non-anginal chest pain meets only one or none

Question 7

Investigations for CCS

Answer 7

Rest ECG
Stress/Exercise ECG
Echocardiogram (rest and stress)
CT coronary angiogram
Cardiac MRI
Cardiac scintigraphy
Invasive coronary angiogram

Question 7

Lifestyle modifications

Answer 7

Smoking cessation
Healthy diet
Physical activity
Healthy weight

Question 7

Cardiac scintigraphy

Answer 7

Examines blood flow to the myocardium at rest and during exercise

Question 7

Ranolazine

Answer 7

improves exercise tolerance by interacting with sodium channels

Question 8

Medications for CCS

Answer 8

Aspiring
Statins
Nitrtaes
Beta blockers
Calcium channel blockers
Ranolazine
Ivabradine
Trimetazidine
NICORANDIL
ACEIs/ARBs

Question 9

Nicorandil

Answer 9

K activator
Nitrate component- vasodilation

Question 10

Trimetazidine

Answer 10

Blocks fatty acid beta oxidation by inhibiting the enzyme long-chain-3-ketoacyl-CoA thiolase

Question 11

Standard therapy for angina and CAD

Answer 11

1. BB or CCB
2. BB + DHP-CCB
3. Add 2nd line drug
4. Add nicorandil, ranolazine or trimetazidine

Question 12

Angina and CAD with high heart rate (>80bpm)

Answer 12

1. BB or Non-DHP-CCB
2. BB + CCB
3. BB + Ivabradine
4. Add nicorandil, ranolazine or trimetazidine

Question 13

Angina and CAD with low heart rate (<50bpm)

Answer 13

1. DHP-CCB
2. Switch to LAN
3. DHP-CCB + LAN
4. Add nicorandil, ranolazine or trimetazidine

Question 14

Angina and CAD with LV dysfunction or Heart failure

Answer 14

1. BB
2. BB + LAN or BB + Ivabradine
3. Add another 2nd line drug
4. Add nicorandil, ranolazine or trimetazidine

Question 15

Angina and CAD with Low blood pressure

Answer 15

1. Low dose BB or Low dose CCB
2. Switch to Ivabradine, Ranolazine or Trimetazidine
3. Combine two 2nd line drugs
4. ADD nicorandil, ranolazine or trimetazidine

Question 16

Interventions for CCS

Answer 16

Percutaneous Transluminal Coronary Angioplasty (PTCA)

Question 17

Surgery for CCS

Answer 17

Coronary artery bypass grafting (CABG