Coronary heart disease: Investigations and Management

Question 1

pros and cons of exercise test

Answer 1

pros: cheap, reproducible, positive test at a low workload implies poor prognosis (so can stratify risk)
cons: submaximal tests (won’t see problems which occur at full-on exercise), poor diagnostic accuracy in some groups of people

Question 2

pros and cons of perfusion imaging?

Answer 2

pros: non-invasive, more precision than exercise test, risk stratification
cons: radiation, false positives and negatives

Question 3

pros and cons of CT angiography?

Answer 3

pros: non-invasive, anatomical data and risk stratification
cons: radiation, cost, less precise than angiography

Question 4

describe angiography?

Answer 4

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

Question 5

pros and cons of angiography?

Answer 5

pros: gold standard!, anatomical and risk stratification, follow-on angioplasty possible
cons: risk 1:1000 of stroke, radiation, contrast can cause renal dysfunction/ rash/ nausea

Question 6

describe CABG?

Answer 6

stenotic arteries are bypassed by grafting vessels from elsewhere in the body.

Question 7

describe percutaneous coronary intervention?

Answer 7

non-surgical procedure used to treat stenosis of the coronary arteries. Bloodstream accessed through radial/ femoral artery. Process uses coronary catheterisation to visualise the blood vessels on x-ray. Then, coronary angioplasty can be performed (using balloon catheter). PCI is urgent in acute MI.

Question 8

which drugs can be used in coronary heart disease?

Answer 8

• aspirin (antiplatelet)
• B-blockers (slows heart, reduces O2 demand)
• statin (reduced cholesterol)
• ACE inhibitor (reduces BP)

Question 9

lifestyle advice?

Answer 9

stop smoking (smokers present about 15 years earlier, when you stop smoking - the extra risk goes away)
exercise
eat a good diet