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ICC1 > coronary artery disease > Flashcards

coronary artery disease Flashcards

1
Q

generally speaking what is CAD ?

A

condition where there is narrowing or blockage of the coronary artery

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2
Q

what is the principle cause of CAD ?

A

atherosclerosis

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3
Q

what is the pathogenesiiss behind atheerosclerotic heart diisease ?

A

plaque buildup in coronary arteries
progressive narrowing which leads to ischemia
the narrowing eventually leads to blockage and infarction

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4
Q

what are the modifiable risk factors of CAD ?

A

smoking and tobacco use
diabetes
hypertension
physical inactivity
obesity
dyslipidemia

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5
Q

what are the 2 main coronary arteries ?

A

the left coronary giving the circumflex and the left anterior descending
the right coronary artery gives the marginal branch

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6
Q

what areas are supplied by the right coronary artery ?

A

right atrium and hence the SA node
right ventricle
interventricular septum and hence the AV node

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7
Q

what does the marginal branch off the RCA supply ?

A

the apex of the heart

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8
Q

what does the LCA supply ?

A

left atrium
left ventricle
interventricular septum and hence the AV bundle

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9
Q

what does the left circumflex artery supply ?

A

Supplies the left atrium and the posterolateral surface of the left ventricle

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10
Q

when does myocardial ischemia happen ?

A

when there is an imbalance between the supply of oxygen and the myocardial demands

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11
Q

what are the two main broad reasons for thee causes of IHD ?

A

increased demand of oxygen
decreased blood supply ( decrease in quality of quantity )

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12
Q

what is angina ?

A

transient clinical syndrome due to transient myocardial ischemia , characterized by chest pain with no cardiac tissue damage

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13
Q

what is the clinical presentation/ spectrum of prressentation of IHD ?

A

asymptomatic
angina
MI
HF
arrhythmia
sudden death

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14
Q

what are the three types of acute coronary syndrome ?

A

unstable angina
STEMI ( full thickness )
non STEMI ( non full thickness I )

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15
Q

what is the pathophysiology behind unstable angina?

A

rupture of an atheroscclerotic plaque and the subsequent formation of a thrombus

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16
Q

what are the criteria that need to be fulfilled for unstable angina ?

A

1- onset (<6 weeks) angina at exertion or at rest.
2-Angina at rest in previously exercise-induced angina.
3- Exertional angina that is not responding to increasing anti-anginal medications.

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17
Q

what is stable angina ?

A

occurs when coronary perfusion is impaired by fixed stable atheroma of the coronary arteries
no symptoms at rest
no ecg changes at rest
provoked by exercise

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18
Q

what is variant angina ?

A

also known as prinzmetal angina
angina with normal coronary arteries

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19
Q

what are the clinical features of stable angina?

A

chest pain , increased by exertion
decreased by rest or nitrates

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20
Q

what are the clinical features of variant angina ?

A

happens usually at rest
often between midnight and early morning
in association with ST segment elevation

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21
Q

what is the first line investigation in CAD ?

A

CT coronary angiography

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22
Q

what is the 2nd line investigation for CAD ?

A

myocardial perfusion scan ( Iv thallium )
stress echocardiography

23
Q

what is the 3rd line investigation for CAD ?

A

invasive coronary angiography

24
Q

what are the lab investigations for CAD ?

A
  • CBC, U&E, Creatinine, ESR
  • Cardiac enzymes (high sensitive troponin)
  • Lipid profile
  • Blood sugar
25
Q

what are the ECG changes that indicate ischemia ?

A

pathological q wave
inverted t wave
st elevation

26
Q

what does echocardiography show us ?

A

any ventricular abnormalities
evidence of structural abnormality

27
Q

what are the indications for Percutaneous coronary angiography

A

diagnostic : assessment of coronary vessels
therapeutic : angioplasty
stent insertion

28
Q

what is the coronary calcium score ?

A

low coronary calcium score makes the presence of CAD unlikely
high coronary calcium score makes CAD likely
all within the next 2-5 years

a low score is 0
a high score is above 100

29
Q

what are the side effect of nitrates ?

A

flushing
headaches
hypotension

30
Q

what must be taken into consideration when using nitrates ?

A

sildenafil ( viagra ) should not be used at the same time

31
Q

how do beta blockers work for CAD patients ?

A

reducing heart rate
reducing BP
reducing myocardial contractility

32
Q

what is b blocker withdrawal syndrome ?

A

they should not be withdrawn abruptly as rebound effects may worsen condition

33
Q

what is the mechanism of actionn of nitratess ?

A

1- act direectly on vascular smooth muscles andd cause vasodilatation
2- reduce myocardiall oxygen demand by lowerring preload and afterload

33
Q

common side effects of beta blockers ?

A

bradycardia
hypotension
bronchoconstriction
cold extremities
impotence

33
Q

what are the indications for nitrates ?

A

angina

34
Q

what are the indications for the use of calcium channel blockers ?

A

hypertension ( amlodipine)
angina
supraventricular tachycardia ( verapamil )

35
Q

what are the side effectss of ACE and ARBs ?

A

dry cough
postural hypotension
hyperkalemia
nausea
renal impairment

36
Q

what drug does not exhibit the tolerance seen with nitrates ?

A

nicorandil ( potassium channel activators )

37
Q

what is the management for angina ?

A

1- confirm that the patient is cardiac
2- determine if its stable or unstable angina

38
Q

what are the results of cardiac enzymes / troponin ?

A

unstable angina - negative
NSTEMI - positive
STEMI - positive

39
Q

what are the ECG changes for each of the presentation of ACS ?

A

unstable angina - ST depression
NSTEMI - ST depression
STEMI - ST elevation or new LBBB

40
Q

what are the types of MI ?

A

STEMI ( trans-mural)
NSTEMI ( sub-endocardial)

41
Q

what are the sites of MI in STEMI ?

A

anterior wall infarction : in anterior descending branch
lateral wall : left circumflex artery
inferior wall : right coronary artery

42
Q

what are the complications of cardiac tamponade ?

A

pulmonary edema
shock
death

43
Q

what are the late complications of myocardial infarction ?

A

myocardial aneurysm and remodelling
pericarditis

44
Q

what is seen on examination of a patient with pericarditis ?

A

friction rub

45
Q

what is the first line therapy for reperfusion ?

A

Primary Percutaneous Coronary Intervention
and give fibrinolysis before PCI

46
Q

what is the best next step in management if PPCI is unavailable for reperfusion therapy ?

A

thrombolysis

47
Q

what are the contraindications to thrombolysis use ?

A

previous history of stroke
suspected aortic dissection
intracranial neoplasm

48
Q

what drugs aree commonly used post MI ?

A

antiplatelet
ACE inhibitors
ARB
beta blockers
statins

49
Q

what is the most common complication following pericardiocentesis procedure ?

A

pneumothorax so an Xray must be performed

50
Q

what are the two types of CCBb ?

A

DHP - for hypertension
non DHP - morre cardio-selective

51
Q

what are the contraindications too CCB ?

A

heart failure ( except amlodipine )
concurrent beta blocker usage
severe hypotension

ICC1 (50 decks)

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