Coronary Heart Disease Flashcards
Which artery is most often occluded in acute MI?
LAD artery
Name some characteristics of angina that aid diagnosis
Pain on exertion, relieved by rest
Visceral pain
Specific timing/trigger factor
Pain assoc. with pericarditis worsens upon sitting forward. True/False?
False
Eases upon sitting forward
Name coronary revascularisation procedures
Coronary arterial bypass grafting (CABG) Coronary angioplasty (PCI)
What steps are involved in CABG?
Median sternotomy
Take saphenous vein + internal mammary artery and attach to aorta DISTAL to site of blockage
What steps are involved in PCI?
Put patient on anticoagulant + antiplatelets
Catheter to ostium of coronary artery and then feed wire down vessel
Balloon on wire inflated to allow stent to attach to vessel
Ballon, catheter and wire removed, leaving stent in place to open artery
Which coronary revascularisation - CABG or PCI - has been proven to be better? Why?
CABG is more safe and has fewer adverse effects
Which arteries are commonly used for PCI?
Femoral
Radial
ECG interpretation - cardiac territories and vessels affected
NSTEMI can show T inversion or no changes in normla leads True/False
True
how long for trpoinin level to rise in the blood after MI
3h
calsssical presentation of STEMI NSTEMI Unstable angina
SOCRTIES
Diagnosis of STEMI
high ST elevation in adjacent chest and limb leads
LBBB
high trpopine
Diagnosis of NSTEMI
CHEST PAIN
abnormal ECG
high troponin
abnormal
other invstigations
FBC and CRP
D-Dimer
Cxr
GRACE score
patient with low risk and going for PCI SHOULD BE GIVEN Prasugrel or trigrelor. However pateitns with high risk bleeding are given PO clopidogrel 300g
Managment for unstable angina
Similar to NSTEMI
asprin for all patietn and pateints with high GRACE score are given fondaparinux and early angiography
investigations for post MI
ECHO
Cardiac ehabilitation
ischaemia test to assess for inducible ischaemia
vertical arrathemia can happen post MI why
after reprfusion or cardaic catherisation
where heart block happen in post MI
fllowing inferior infracts
aneurysm happen where in post MI
fallowing an anterior MI
however it maybe silent fallowed by arrhtmias or embloic event
post MI can casues ventricular spetec defect what are the symptoms
Hypotension
palpabel parasternal thrill
What are the risk factors for plague formation BAD HART
BMI more or equal to 30 obesity
Age more or equal to 65
Diabetes
EtOH
An increase in LDL
Relatives with CAD who passed away from MI
Tobacco
Pathology of stable angina ninja nerd
Stable plaque covers by strong fibrous cap
Some of the features of subendocardial infection ninja nerd
Chest pain occurs at rest
Thrombus formation
Near Total occlusion of coronary vessels
Unreversed for at least 30 meant will cause infraction
Categorized of acute coronary syndrome
Unstable angina
NSTEMI
STEMI
Patients with prinzmetals angina should avoid ninja nerd
Beats blocker
Depression of ST segment and inversion of t wave along with high Troponin e indicate Ninja nerd
NSTEMI
Which coronary artery supply the inferior part of the heart ninja nerd
Marginal branch / RCA
Patient under go stress test has baseline myocardial perfusion which drug should NOT be used to replicate stress
Dobutamine
Elevated ST in II III AND aVF indicate ninja nerd
Inferior MI
Aspirin is used in ischemia heart disease because ninja nerd
Inhibit TXA2 production
What is the main feature of each of the fallowing drugs regards ischemia heart disease treatment
Beat blockers
Morphine
Nitroglycerin
Ca2 Blocker ninja nerd
- Decrease energy demand
- Contraindicated in
- Increase perfusion to ischemic tissues
- Should be avoided in decompensated heart failure patients
Sever Chest pain with occlusion of 3 vessels which resvascularisation approach ninja nerd
CABG
