Coronary Heart Disease

Question 1

Which artery is most often occluded in acute MI?

Answer 1

LAD artery

Question 2

Name some characteristics of angina that aid diagnosis

Answer 2

Pain on exertion, relieved by rest
Visceral pain
Specific timing/trigger factor

Question 3

Pain assoc. with pericarditis worsens upon sitting forward. True/False?

Answer 3

False

Eases upon sitting forward

Question 4

Name coronary revascularisation procedures

Answer 4

Coronary arterial bypass grafting (CABG)
Coronary angioplasty (PCI)

Question 5

What steps are involved in CABG?

Answer 5

Median sternotomy

Take saphenous vein + internal mammary artery and attach to aorta DISTAL to site of blockage

Question 6

What steps are involved in PCI?

Answer 6

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

Question 7

Which coronary revascularisation - CABG or PCI - has been proven to be better? Why?

Answer 7

CABG is more safe and has fewer adverse effects

Question 8

Which arteries are commonly used for PCI?

Answer 8

Femoral

Radial

Question 9

Which type of shock is most common post MI?

Answer 9

Cardiogenic - inadequate system perfusion due to cardiac dysfunction

Question 10

What are some differential diagnoses of angina?

Answer 10

CARDIAC: pericarditis, MI, aortic dissection
GI: reflux, peptic ulcer, oesophageal spasm, biliary colic
MSK: trauma, strain, nerve root pain (tingling)
RESPIRATORY: pleuritis, PE, pneumothorax, pneumonia

Question 11

What is the management of CHD?

Answer 11

Anti-platelet - aspirin
B blocker
Statin
ACEi
Lifestyle changes
Revascularization