Coronary Artery Disease Flashcards
What are the four main causes of Coronary Artery Disease
- Atherosclerosis
- Aortitis
- Vasculitis
- Connective Tissue Disease
What is Atherosclerosis
It is a progressive inflammatory disorder of the arterial wall and is characterized by focal lipid deposits of atheroma that remain clinically stable until they become large enough to impair tissue perfusion or until ulceration or disruption of the plaque causes thrombotic occlusion or distal embolization of the vessel
What are the risk factors for developing coronary artery disease?
NON-MODIFIABLE
- Age
- Gender (Male> pre menopausal females)
- Genetics
MODIFIABLE
- Smoking
- Diabetes
- Hypertension
- Alcohol
- Obesity
- Inactivity
- Hyperlipidemia
What are the two (2) stages of management of Coronary Artery Disease
Primary and Secondary Prevention
What is Angina Pectoris
Angina pectoris is a symptom complex caused by acute myocardial ischaemia that is caused by an imbalance between myocardial oxygen supply and demand
What is the most common cause of Angina Pectoris
Atherosclerosis
Apart from Atherosclerosis list 4 other causes of Angina Pectoris
- Aortic Valve Disease
- Hypertrophic Cardiomyopathy
- Coronary Artery vasculitis
- Aortitis
List five factors that influence cardiac oxygen demand
- heart rate
-blood pressure
-myocardial contractility
-left ventricular hypertrophy - valvular disease
What are four (4) factors that influence oxygen supply to the heart
- Coronary perfusion Pressure
- Diastolic duration
- Haemoglobin/O2 Saturation
- Coronary vasomotor tone (dilated or constricted)
What is Coronary perfusion pressure
It is the difference in pressure between the Aorta in diastole and the Left Ventricle at end diastole
List 4 common activities that precipitate angina
- physical exertion
- exposure to cold
- heavy meals
- Intense emotion
List two uncommon causes of angina
- Viivd Dreams (nocturnal angina)
- Lying Flat (Decubitus Angina)
How many classes are in the Canadian Cardiovascular Society (CCS) Angina Score?
4
I, II, III, IV
What symptom ranks a patient at CCS Class I?
Angina only during strenuous or prolonged physical activity
What symptom ranks a patient at CCS Class II?
Slight limitation with angina only during vigorous physical activity
What symptom ranks a patient at CCS Class III?
Moderate limitation where symptoms occur with everyday activities
What symptom ranks a patient at CCS Class IV?
Inability to perform any activity without angina: angina at rest
Which Canadian Cardiovascular Society Angina score corresponds with this symptom?
Angina only during strenuous or prolonged physical activity
Class I
Which Canadian Cardiovascular Society Angina score corresponds with this symptom?
Angina with slight limitation only during vigorous physical activity
Class II
Which Canadian Cardiovascular Society Angina score corresponds with this symptom?
Moderate limitation where symptoms occur with everyday tasks
Class III
Which Canadian Cardiovascular Society Angina score corresponds with this symptom?
Inability to perform any activity without angina: angina at rest
Class IV
What are the symptoms that characterize Stable angina
Central chest pain/ discomfort/ SOB brought on by exertion and relieved at rest
What is the first line investigation for angina
Exercise ECG
Exercise ECG is the first line investigation for Angina, what ECG findings indicate myocardial ischaemia?
ST planar/ downward sloping depression >1mm
What investigation should be done if clinical suspicions of CAD are high but the ECG does not indicate CAD
Imaging with myocardial perfusion
Stress Echocardiography
CT coronary Arteriography
All patients diagnosed with CAD should receive antiplatelet therapy.
Name the drug, dose and duration
Aspirin 81mg (low dose) continued indefinitely
Low dose aspirin is the drug of choice for antiplatelet therapy for patients with CAD, if Aspirin casues dyspepsia which other drug can be administered?
Clopidogrel 75mg
True or False
All CAD patients should be prescribed a statin even if their cholesterol is normal
True
What is the role of anti-anginal therapy in angina Pectoris
To control symptoms using a regimen that is as simple as possible and does not cause side-effects
What are the drugs used in anti-anginal therapy
Sublingual GTN &
Beta Blockers
Ca Channel Blocker/ Long acting Nitrates
List four Ca 2+ Channel Blockers
Verapamil
Diltiazem
Amlodipine
Nifedipine
List one Long acting nitrate
Isosorbide Mononitrate
What is the difference between GTN (glycerol trinitrate) and Long Acting Nitrates?
GTN is used to relieve chest pain in the acute setting, while Long Acting Nitrates are used to prevent chest pain
What is the difference between Isosorbide Dinitrate and Isosorbide Mononitrate?
Dinitrate is used in the Mx of Heart Failure
Mononitrate is used in the Mx of chronic stable angina
Describe the moa of Nitrates in Angina
- act on the blood vessels to stimulate vasodilation
- reduces preload and afterload
- decreases myocardial oxygen demand
- increases myocardial oxygen supply through vasodilation
Describe the moa of Beta Blockers in Angina
Lower myocardial Oxygen Demand by :
slowing heart rate, reduce BP and myocardial contractility
List two Beta Blockers and their doses that can be used in anti-anginal therapy
- Bisoprolol :5-15mg
- Metoprolol (slow release) : 50-200mg
What is the moa of Ca 2+ blockers in Angina
They reduce Myocardial oxygen demand by reducing BP and myocardial contractility
Which 2 Ca Channel Blockers can be given as monotherapy in anti-anginal therapy
Non-Dihydropyridine
Verapamil
Diltiazem
Which 2 Ca Channel Blockers should not be given as monotherapy because they cause reflex tachycardia?
Dihydropyridines
Amplodipine and Nifedipine
(Given with Beta Blockers)
What is the MOA of Ca Channel Blockers : Verapamil and Diltiezam
They slow SA node firing
&
Inhibit conduction through the AV node
List two non-pharmalogical approaches to treating Angina
Percutaneous Coronary Intervention
Coronary artery Bypass Grafting
Describe Percutaneous Coronary Intervention
This involves passing a fine
guidewire across a coronary stenosis under radiographic control
and using it to position a balloon, which is then inflated to dilate
the stenosis.
What is the role of a coronary stent in Anti-Anginal Therapy
The stent is a piece of metallic ‘scaffolding’ that
can be impregnated with drugs with antiproliferative properties
that helps to maximize and maintain dilatation of a stenosed
vessel.
What is the main long term complication of Percutaneous Coronary Intervention?
Re-stenosis of the vessel
What adjunctive therapy is given to patients after PCI to improve the outcome?
P2Y12 receptor antagonists (clopidogrel, prasugrel or ticagrelor)
in combination with aspirin and heparin
Which vessels can be used as a coronary artery bypass graft
Internal Mammary Arteries
Radial Artery
Reversed Saphenous Vein
