Coronary Artery Disease Flashcards
What is the def of CAD?
ischaemic heart disease is characterised by the inability to provide adequate blood supply to the myocardium and is primarily caused by atherscelerosis of the epicaridal cornoary arteries
What is the aetiology of CAD?
mostly atherosclerosis
also caused by vasospasm, endothelial and microvascular dysfunction, spontaneous thrombosis, coronary artery dissection, extrinssic compressionn
Whats is the pathophysiology of CAD?
Development of lipid rich plaques in the arterial wall arising from an inflammatory process that leads to alterations in VSMCs, matrix proteins and platelets.
Typically occur at bends in the arteries or branch points and also involves a degree of calcification
cause symptoms when 70-80% stenosed
What are the S&S of CAD?
- Angina (chest pressure, heaviness or squeezing, can radiate and worse on exertion)
- Dyspnoea
- Nausea
- Dizziness
- fatigue
What are the types of Angina?
Stable - induced by effort and relieved by rest
Unstable (crescendo) - increased frequency and severity, occurs at minimal exertion or at rest. Much higher risk of MI
Decubitus angina - precipiated by lying flat
What investigations are done for CAD?
- FBC
- Glucose
- lipid panel
- ECG
- Echo
- Exercise stress testing
- Coronary angiography
- Cardiac computed tomography angiography (CCTA)
What may an ECG show in CAD?
signs of ischaemic change or previous MI
This can include ST depression, flat or inverted T waves, Pathological Q waves, fragmented QRS
Explain exercise stress testing
Bruce protocol of exercise on treadmill or bike with ECG monitoring. ECG can show LBBB, ventricular pacing or ST depression
Duke treadmill score can be used to analyse
What are the treatment options for CAD?
- Risk factor mod i.e smoking cessation, exercise and weight loss. Control HTN and DM. Patient education
- Anti-platelet e.g aspirin 75mg or clopidogrel 75mg
- Lipid lowering therapy e.g atorvastatin 10mg or simvastatin 20mg
- Anti-HTN therapy e.g B-blocker or ACEi
- Revascularisation i.e CABG or PCI
- Anti-anginal e.g GTN sublingual spray
What are the complications of CAD?
MI
Stroke
Sudden cardiac death secondary to arrhythmia
Ischaemic cardiomyopathy
HF
What is the classification of angina?
Grade 1 = angina on strenous/prolonged ex
Grade 2 = slight limitation of ordinary activity
Grade 3 = marked limitation on ordinary activity
Grade 4 = inability to perform any activity. angina at rest