CW2 atherosclerosis and vascular disease (karim meeran)

Question 1

What is the first bedside investigation for someone who comes in with chest pain?

Answer 1

ECG

Question 2

What specifically is a stress test?

Answer 2

An exercise tolerance ECG- the patient is made to walk/do exercise and an ECG is recorded during this

Question 3

Where on an ECG can you look to see if its an exercise tolerance ECG?

Answer 3

In the top right look at the speed and grade (incline) and if its above 0 for either it shows they are exercising

Question 4

What is chronic stable angina?

Answer 4

Partly blocked coronary artery

Question 5

What rises in chronic stable angina?

Answer 5

Lactate

Question 6

What ECG change is seen in chronic stable angina?

Answer 6

ST depression

Question 7

What happens on ECG when there is acidosis/ischaemia in the heart?

Answer 7

ST depression

Question 8

What 4 drugs should you give someone with chronic stable angina?

Answer 8

Aspirin
Beta blocker- atenolol
GTN spray
Statin- simvastatin

Question 9

What is isosorbide mononitrate?

Answer 9

A sublingual nitrate

Question 10

How is chronic stable angina managed

Answer 10

Unblock the blocked artery:
CABG
Angiogram- to see where the block is
Angioplasty- much easier, put a wire in and blow up a balloon to open up the artery

Question 11

Describe the progressive stages of atherosclerosis

Answer 11

Fatty streak
Plaque
Obstructive atherosclerotic plaque
Ruptured plaque

Question 12

Why is there long term heart failure after a heart attack?

Answer 12

There is death of the muscle, therefore that muscle will no longer contract even after the heart attack is over cardiac output will fall

Question 13

How do you manage a heart attack?

Answer 13

Unblock coronary artery
PCI
Angioplasty: if not available thrombolysis with tPA like alteplase or streptokinase, until then aspirin and nitrates
Beta blockers
Statin

Question 14

Why are beta blockers given in heart attack?

Answer 14

Slowing the heart rate down will stop the ischaemia

Question 15

How do you manage cardiovasular risk?

Answer 15

Diet and exercise
Stop smoking
Reduce blood pressure- low salt diet
Drug treatments for high BP
Reduces dyslipidaemia- statins

Question 16

What is first line antihypertensive for age under 55 and then over 55 or black?

Answer 16

under 55= ace inhib or ARB

over 55 or black= CCB

Question 17

What is second line antihypertensive medication?

Answer 17

Ace inhib/ARB PLUS CCB

Question 18

What is third line antihypertensive?

Answer 18

ACE inhib/ARB PLUS CCB PLUS thiazide like diuretic

Question 19

What does intensive lifestyle modification for cardiovascular patients consist of?

Answer 19

Aspirin
High dose statin (atorvastatin 40-80mg OD)
Optimal BP control
Assessment for probable T2DM

Question 20

What is PCSK9 inhibitor?

Answer 20

It reduces cholesterol further than a statin

Question 21

What drug can be used to further reduce cholesterol other than statins?

Answer 21

PCSK9 inhibitor

Question 22

What is the same as PCI?

Answer 22

Angioplasty

Question 23

Why is beta blocker not used long term in stemi?

Answer 23

It is only needed to reduce cardiac output when the artery is blocked
Once the artery is unblocked you dont need to keep the patient on it