Coronary Heart Disease

Question 1

describe plaque progression in reference to CVS disease

Answer 1

primary prevention - ASSIGN score

secondary prevention - blood comes into contact with fatty plaque (we already know patient has the disease)

Question 2

STEMI

Answer 2

MI with ST elevation

urgent

Question 3

NSTEMI

Answer 3

plaque rupture not related to occlusion, pain comes and goes

Question 4

describe cardiogenic shock

Answer 4

inadequate systemic perfusion as a result of cardiac dysfunction
acute MI;
multivessel disease, particularly occluded LAD
delayed presentation
mechanical complications - VSD, MR, rupture

Question 5

describe symptoms and sign of angina

Answer 5

visceral pain from myocardial hypoxia;
hard to describe
gestures from patient

characteristic patterns;
provocation
relief
timing
e.g. patient exerts themselves, experiences pain. Patient then stops, pain is alleviated (angina will only last a few minutes)

characteristic background;
risk factors

Question 6

differential diagnosis of chest pain

Answer 6

GI;
reflux
peptic ulcer pain
oesophageal spasm
biliary colic

musculoskeletal;
injury
nerve root pain

pericarditis

pleuritic pain

Question 7

describe exercise testing

Answer 7

used in suspected coronary heart disease

pros;
cheap
reproducible
risk stratification - positive test at low workload implies poor prognosis

cons;
poor diagnostic accuracy in important sub-groups
submaximal tests

Question 8

describe perfusion scanning

Answer 8

pros;
non invasive
pharmacological stress in less mobile patients 
more precision than exercise testing 
risk stratification 

cons;
radiation
false positives and negatives

Question 9

describe CT angiography

Answer 9

pros;
non-invasive
anatomical data and risk stratification
well established as a good test

cons;
radiation
less precise than angiography, particularly when calcium present (blocks view)
cost

Question 10

describe angiogrpahy

Answer 10

sheath inserted into artery
catheter advanced from wrist/groin to coronary ostium
x-ray contrast agent injected to outline coronaries
video fluoroscopy recorded images in multiple views

pros;
gold standard
anatomical and risk stratification
follow-on angioplasty

cons;
risk 1:1000 death, stroke
radiation
contrast; rena; dysfunction, rash, nausea

Question 11

drugs for treatment in coronary heart disease

Answer 11

aspirin
beta blocker - slows heart rate, reducing oxygen demand
statin
ACE inhibitor