Coronary Heart Disease

Question 1

Why does CHD occur?

Answer 1

occurs due to ischemia of the heart, usually due to mechanical obstruction caused via atheroma, thrombosis, embolus, stenosis or arteritis

Question 2

What is the most common cause of myocardial ischaemia?

Answer 2

atherosclerosis

blocks the coronary arteries

Question 3

Aetiology of CHD

Answer 3

	↑age
	Males more commonly affected
	Familial link
	Smoking
	High fat diet/obesity
	Low physical activity
	Hypertension
	Hyperlipidaemia
	Diabetes
	Excessive alcohol intake

Question 4

What is a high risk assign score for CV risk/

Answer 4

20

Question 5

what is angor animi?

Answer 5

fear of impending doom

Question 6

Give some reasons why there can be a decrease in the flow of oxygenated blood to the myocardium?

Answer 6

anaemia
carboxyhaemoglobulinaemia
hypotension, causing decreased coronary perfusion pressure.

Question 7

What is primary prevention defined as?

Answer 7

the prevention of atherosclerotic disease

Question 8

d: secondary prevention

Answer 8

treatment of atherosclerotic disease

Question 9

If a person is suspected of CHD what should be found out?

Answer 9

QRISK
Lipid profile
lifestyle

Question 10

Name some common tests done in suspected CHD?

Answer 10

exercise testing
perfusion scanning
CT angiography
Angiography

Question 11

What does STEMI stand for?

Answer 11

ST elevated MI

Question 12

d: revascularisation

Answer 12

restoration of perfusion to a body part or organ that has suffered ischemia

Question 13

What does PCI stand for?

Answer 13

Percutaneous Coronary Intervention

Question 14

Name some PCI techniques

Answer 14

Vascular access
Anti-platelet drugs, anticoagulation Catheter to ostium of coronary
Guidewire down vessel
Balloons threaded over wire Stent(s) implanted Balloon, catheter, wires removed

Question 15

What sort of forms of heart problems are suitable for revascularisation?

Answer 15

multi-vessel disease
left main disease
diabetes
co-morbities

Question 16

When does a PCI intervention have to be given for STEMI?

Answer 16

<30min

Question 17

What will the ECG look like for Angina?

Answer 17

usually normal between attacks
evidence of old MI may be present (pathological Q waves), LVH or LBBB may be present
during attack will look have a transient ST depression, t wave inversion

Question 18

What will and exercise ECG look like for angina?

Answer 18

St DEPRESSION >1mm suggests MI esp if chest pain occurs at the same time

Question 19

does a normal exercise test exclude CAD?

Answer 19

NO

Question 20

Name the other investigation apart from ECGs for angina?

Answer 20

Myocardial perfusion scans
Echo
CT coronary Angiography
Cardiovascular MR

Question 21

Name some prophylactic treatments for angina?

Answer 21

▪ Aspirin reduces the risk of coronary events in patients with CAD. All patients with angina should take 75mg daily unless contraindicated
▪ Lipid lowering therapy should be used if total cholesterol is above 4.8mmol/L

BB, nitrates Ca2+ channel blockers

Question 22

Name some symptomatic treatments for angina

Answer 22

▪ GTN used sublingually (tablet or spray) gives prompt relief and can be used prior to activities that the patient knows provokes angina
considered for revascularisation
Long acting nitrates isosorbide mononitrate
CCBs
BBs

Question 23

Name some risks associated with PCI?

Answer 23

acute MI and death

Question 24

What other surgery is available for sever angina?

Answer 24

artery bypass grafting