Coronary Heart Disease Flashcards
Why does coronary heart disease (CHD) occur?
Due to myocardial ischaemia
Due to obstruction due to atheroma, thrombosis, embolus, stenosis or arteritis
Most common cause of myocardial ischaemia?
Atherosclerosis
Blocks coronary arteries
Risk factors for CHD
Age, males, inactivity, HT, smoking, alcohol, high fat, hyperlipidaemia, diabetes, hypercholesteroaemia
Estimating CV event risk
ASSIGN score
Risk over 10 years
20 = high risk
Types of CHD
Stable angina, acute coronary syndromes (unstable angina, STEMI + NSTEMI)
Presentation of angina
Heavy, tight, gripping chest pain on exertion, radiating to jaw/arms
Presentation of stable angina
No new symptoms, relived by rest/GTN
Presentation of unstable angina
Type of ACS
Pain on less and less exertion, GTN becomes less effective
Angina investigations
ECG to exclude ACS
>90% CVD risk = managed for stable angina
>61% CVD risk = catheter angiography
>30% CVD risk = functional testing e.g. SPECT, stress-ECG, stress-MRI
>10% CVD risk = CT angiography
Stable angina treatment
- Treat underlying causes (anaemia, diabetes, HT)
- GTN + 2nd prevention (aspirin, ACEI, statin)
- B-Blocker or rate-limiting CCB
- combo for better results - Not tolerated then monotherapy/
tolerated but still poorly managed then add on:
a.Long-acting nitrate ie. isosorbide mononitrate or Nicorandil or Ivabradine
or Ranolazine - Revascularisation (PCI, CABG)
Mechanism of PCI
Dilation of coronary artery using balloon and stent inserted via femoral/radial artery
Patient must anti-coagulated and antiplateleted beforehand
Mechanism of CABG
Medial sternotomy made and saphenous vein and internal mammary artery anatomised to ascending aorta, distal to site of blockage
What does ACS encompass?
Unstable angina, NSTEMI, STEMI
Cause of ACS
Plaque rupture/fibrous cap erosion
Leads to reduced coronary bloody flow and thus myocardial ischaemia
ACS symptoms
New onset severe chest pain
Atypical features e.g. indigestion, pleurtic pain, breathlessness
