Coronary Heart Disease

Question 1

What classifies as arterial thrombosis

Answer 1

Acute myocardial infarction
Transient ischaemic attacks
Cerebral vascular accidents

From plaques

Question 2

What classifies as venous thrombosis

Answer 2

Deep vein thrombosis
Pulmonary embolism

Question 3

What is stable angina

Answer 3

Narrowing of coronary arteries due to plaques
Causes pain
Relived by GTN or rest

Question 4

How do you treat stable angina

Answer 4

S/L GTN for symptoms
antianginals- 1st like BBs and CCBs
add on: nitrates, ivabradine etc

Question 5

What consists of acute coronary syndrome

Answer 5

Myocardial infarction
- STEMI and non-STEMI
Unstable angina

Question 6

What changes on an ECG for a STEMI

Answer 6

ST is elevated

Question 7

What is Troponin T and 1

Answer 7

Its a cardiac enzyme
Troponin increases in STEMI and NSTEMI

Question 8

What is a MI? explain difference between STEMI and NSTEMI

Answer 8

Thrombosis forms at site of rupture of plaque
Prolonged ischaemia
Death of cardiac muscle cells

STEMI-> damage to full thickness of cardiac muscle
NSTEMI-> damage to partial thickness of cardiac muscle

Question 9

What enzymes increase in an NSTEMI/STEMI

Answer 9

Creatine kinase
troponin
LDH (lactate dehydrogenase) - for late presentations

Question 10

What difference between Myocardial Infarction and unstable angina

Answer 10

supply ischaemia vs demand ischaemia
Partial blockage (UA) vs. full blockage (STEMI/NSTEMI)

Question 11

How to manage a STEMI

Answer 11

Oxygen if needed
Diamorphine- pain relief (vasodilation) and antiemetic
ASPIRIN 300mg STAT
clopidogrel 300mg STAT

usually stent is used - primary percutaneous coronary intervention

OR thrombolysis is used if surgery not available eg: streptokinase, alteplase and put on heparin for 48hrs after thrombolysis

Question 12

What is used for secondary prevention after a STEMI

Answer 12

Antiplatelets (aspirin and clopidogrel)
dual for 12 mths
Beta-blockers
ACEI
Statin atorv 80mg

Question 13

How to manage an NSTEMI and Unstable angina

Answer 13

Oxygen
diamorphine
aspirin and clopidogrel
Fondaparinux until stable

NO THROMBOLYSIS OR PPCI

Question 14

What is used for secondary prevention after an NSTEMI or unstable angina

Answer 14

Antiplatelets (aspirin and clopidogrel)
dual for 12 mths -aspirin for life
Beta-blockers
ACEI
Statin atorv 80mg

Question 15

What are the types of percutaneous coronary intervention

Answer 15

Angioplasty- balloon which is inflated where plaque is, compressing the plaque and allowing blood flow

Stenting- wire mesh and balloon- can contain drugs to stop wall tissue growing into it