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Cardiology > Coronary Artery Disease > Flashcards

Coronary Artery Disease Flashcards

1
Q

What is the immediate symtom management of stable angina?

A

GTN

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2
Q

When are BBs contraindicated

A

Heart block
Heart failre
Asthma
Digoxin/verapimil

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3
Q

What is second line angina management for long term symptom relief?

A

Long acting nitrates - Isosorbide mononitrate
Ivabradine
Nicorandil
Ranolazine

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4
Q

What is issue with long acting nitrates?

A

Tolerance

Not in aortic stenosis

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5
Q

What is used as secondary prevention in angina?

A

Antiplatelet therapy- aspirin 75mg
ACEi (vasodilate to decrease BP)
Atorvastatin 80-mg

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6
Q

What advice is needed in agina?

A 
Driving
smoking
occupational hazards
diet
bp control
alcohol
DM
Cardiac rehab
Excercise increase
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7
Q

What is gold standard investigation in angina?

A

CT Coronary Angiography

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8
Q

What other investigations are needed in stable angina?

A 
Physical Examination (heart sounds, signs of heart failure, BMI)
ECG
FBC (check for anaemia)
U&Es (prior to ACEi and other meds)
LFTs (prior to statins)
Lipid profile
Thyroid function tests (check for hypo / hyper thyroid)
HbA1C and fasting glucose (for diabetes)
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9
Q

What is RAMP in the management of angina?

A

Refer to cardiology (urgent if unstable)
Advise about management and when to call an ambuilance
Medical treatment
Procedural (surgical)

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10
Q

What are 3 aims of medical management of angina?

A
  1. Immediate Symptom relief
  2. Long term symptom relief
  3. Secondary prevention of CV disease
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11
Q

What is long term symptom management of stable angina?

A

Regular BB or CCB (amlodipine), then combine

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12
Q

Which vessel is harvested for CABG?q

A

Great saphenous vein

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13
Q

What causes ACS?

A

Thrombus from athersclerotic plaque blocks- thrombus made up mostly of PLATELETS.

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14
Q

WHat does the RCA supply?

A

R side heart
Posterior septal area
Inferior L ventricle

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15
Q

What does circumflex supply?

A

LA

Posterior LV

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16
Q

What does LAD supple?

A

Anterior LV

Anterior septum

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17
Q

What is seen on ECG to diagnose STEMI?

A

ST elevation

New LBBB

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18
Q

What is done if no STEMI changes?

A

Troponin

19
Q

What ECG signs indicate NSTEMI?

A

ST depression
T wave inversion
Q waves

20
Q

If there is raised trop what is it?

A

NSTEMI

21
Q

If trop and ECG normal what is it?

A

Unstable angina

22
Q

Who experiences silent MIs?

A

Diabetic

Elderly

23
Q

How long should chest pain be present for to not just be angina?

A

20 mins

24
Q

Which ECG leads represent LAD

A

V1-4

25
Q

Which ECG leads represent Circumflex

A

I
aVL
V5,6

26
Q

Which leads indicate RCA

A

II
III
aVF

27
Q

What area is the LAD?

A

Anterior

28
Q

What area is RCA?

A

Inferior

29
Q

What area is cirucumflex?

A

Lateral

30
Q

What are diffenetials for raised trop

A 
Chronic renal failure
Sepsis
Myocarditis
Aortic dissection
PE
31
Q

What additional tests are done in ACS to angina?

A

ECHO- assess functional damage
CT coronary angiogram
CXR- pulmonary oedema or other causes

32
Q

What should be done to manage STEMI?

A

Primary PCI if within 2 hours of presentation

Thrombolysis if PCI unavailable

33
Q

Name 2 thrombolysing agents

A

Streptokinase

Alteplase

34
Q

What is done to manage NSTEMI

A 
BATMAN
BBs
Aspirin (300mg stat)
Ticagrelor stat dose
Morphine
Anticoag LMWH BD for 2-8 days
Nitrates
O2 is sats low
35
Q

What is the GRACE score?

A

6 month risk of death or repeat MI after NSTEMI

36
Q

What does GRACE indicate?

A

PCI early (within 4 days)

37
Q

What are complications of MI?

A 
Oedema
Rupture of septum or papillary muscles
Arrhythmia
Aneurysm
Dresslers Syndrome
38
Q

What is Dressler’s Syndrome?

A

Pericarditis 2-3 weeks post MI

Pleuritic chest pain, low grade fever, rub and effusion (rarely tamponade)

39
Q

What are signs of Dresslers on ECG?

A

ST elevation

T inversion

40
Q

What are signs of Dresslers on ECho?

A

Pericardial effusion

41
Q

How is Dresslers managed

A

NSAIDs (aspirin, ibuprofen)

Pred in severe cases

42
Q

What are the 6 As of secondary medical management of ACS?

A

Aspirin 75mg OD
Another platelet (Clop or Ticarelor for up to 12 months)
Atorvastatin 80mg
ACEi
Atenolol (or other BB as high as tolerated)
Aldosterone antagonist if clinical heart failure (Eplerenone)

43
Q

What secondary preventative lifestyle measures indicated in ACS

A 
Smoking
Alcohol
Mediterranean diet
Cardiac rehab
Optimise DM and HTN management

Cardiology (15 decks)

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