CVS 10 (Ischaemic Heart Disease 1)

Question 1

What could cause central tightening chest pain?

Answer 1

Myocardial ischaemia

Question 2

What could cause central sharp chest pain?

Answer 2

Pericarditis

Question 3

What could cause tearing pain, which begins in central back and descends down back?

Answer 3

Aortic dissection

Question 4

What could cause lateral sharp stabbing chest pain, often worsening on inhalation and coughing?

Answer 4

Respiratory causes ie:

• Pneumonia
• Pneumothorax
• Pulmonary embolism

Question 5

What could cause chest and epigastric burning pain?

Answer 5

GI causes ie:
- GORD
- Gastric band
(many more)

Question 6

What could cause localised, tender chest pain?

Answer 6

MSK causes:

• Trauma ie cracked ribs
• Muscle pain
• Bone metastases

Question 7

What usually relieves pericardial pain?

Answer 7

Leaning forward

Question 8

Name the non-modifiable risk factors for coronary artery disease:

Answer 8

• Increasing age
• Male > Female
• Family history
• South Asian / African-Caribbean Ethnicity

Question 9

Name the modifiable risk factors for coronary artery disease:

Answer 9

• Hyperlipidaemia
• Smoking
• Hypertension
• Diabetes
• Lack of exercise
• Obesity
• Low intake of Fruit/Veg

Question 10

Describe the plaque which causes stable angina:

Answer 10

Stable/Simple plaque
Small necrotic core
Thick fibrous cap

Question 11

What is the presentation of stable angina?

Answer 11

Hx of moderate central tightening pain on exertion, relieved by rest

Question 12

What are the possible ECG signs of stable angina?

Answer 12

• Normal
• ST depression
• T wave inversion

Question 13

Which serum biomarkers are associated with stable angina?

Answer 13

No associated serum biomarkers.

Question 14

What is the short-term treatment of stable angina? How do they improve symptoms?

Answer 14

Sublingual organic nitrates ie Glycerol trinitrate
- Increase production of NO
= venodilation, decreases pre-load of heart

Question 15

What is Glycerol trinitrate, and what is it used to treat?

Answer 15

Sublingual organic nitrate

Treats angina attack (stable angina)

Question 16

Name some of the long-term treatments for stable angina:

Answer 16

• Modify risk factors (lower cholesterol, increase exercise, stop smoking, lose weight etc)
• Long-acting nitrates
• Beta-blockers
• Ca2+ Channel blockers
• Statins
• Aspirin
• Revascularisation (1) Percutaneous angioplasty and stenting, 2) Coronary artery bypass grafting)

Question 17

Name the 2 types of surgery interventions used to treat stable angina:

Answer 17

1) Percutaneous angioplasty + stenting

2) Coronary Artery Bypass Grafting

Question 18

Name 3 vessels that can be used for a Coronary Artery Bypass Graft:

Answer 18

1) Radial artery
2) Internal mammary artery
3) Saphenous vein (reversed due to valves)

Question 19

Describe the plaque which causes unstable angina:

Answer 19

Unstable/complicated plaque
Large necrotic core
Thin fibrous cap

Question 20

Which type of angina is not relieved by sublingual nitrates?

Answer 20

Unstable angina

Question 21

What are the possible ECG findings in unstable angina?

Answer 21

• Normal
• ST depression
• T wave inversion

Question 22

Name some of the treatments for unstable angina:

Answer 22

• IV opioids
• Oxygen (if sats<94%)
• Antithrombotics
• P2Y12 receptor antagonist
• IV nitrates
• IV beta-blockers
• Statins
• Revascularisation (1) Percutaneous angioplasty and stenting, 2) Coronary artery bypass grafting)

Question 23

What is the difference between an NSTEMI and a STEMI?

Answer 23

NSTEMI = incomplete obstruction to blood flow to myocytes
STEMI = complete obstruction to blood flow to myocyes

Question 24

Name the 2 types of acute myocardial infarction:

Answer 24

1) NSTEMI

2) STEMI

Question 25

List some of the symptoms of an acute MI:

Answer 25

• Severe persistent central crushing chest pain
  (with or without radiation, commonly to left arm/neck)
• Sweating, pallor
• Nausea, vomiting
• Anxious, breathless, faint

Question 26

What are the possible ECG findings in an NSTEMI?

Answer 26

• Normal
• ST depression
• T wave inversion

Question 27

What are the posisble ECG findings in a STEMI?

Answer 27

• Pathological Q wave
• ST elevation
• T wave inversion

Question 28

Which ECG finding in a STEMI indicates transmural necrosis?

Answer 28

Pathological Q wave

Question 29

Why are P2Y12 receptor antagonists used in the treatment of an acute MI?

Answer 29

P2Y12 binds to Gq coupled receptor, inducing platelet aggregation
P2Y12 antagonist reduces platelet aggregation

Question 30

If an acute MI shows abnormal ECG findings in leads II, II and aVF, what artery is blocked?

Answer 30

Right coronary

Question 31

If an acute MI shows abnormal ECG findings in leads V1 - V4, what artery is blocked?

Answer 31

LAD (Left Anterior Descending)

Question 32

If an acute MI shows abnormal ECG findings in leads V5-V6, I and aVL, what artery is blocked?

Answer 32

Circumflex

Question 33

If an acute MI shows abnormal ECG findings in leads V1-V6, I and aVL, what artery is blocked?

Answer 33

Proximal Left Coronary artery

Question 34

If an acute MI shows tall R wave in leads V1-V2 in an ECG, which leads are blocked?

Answer 34

Right coronary artery

Question 35

Name the artery which supplies the right atrium and right ventricle:

Answer 35

Right coronary artery

Question 36

Name the artery which supplies the right ventricle, left ventricle and AV septum:

Answer 36

LAD (Left anterior descending)

Question 37

Name the artery which supplies the Left atrium and Left ventricle:

Answer 37

Circumflex artery

Question 38

Name the artery which supplies the Left atrium, left ventricle and AV septum:

Answer 38

Proximal left coronary artery