IHD

Question 1

What are the core features of typical angina?

Answer 1

1. Heavy discomfort in the chest, jaw, shoulders, neck or arms
2. Brought on by exertion
3. Symptoms relieved within 5 mins by rest or with GTN

Question 2

What symptoms are included in atypical angina?

Answer 2

-GI discomfort
-SOB
-Nausea

Question 3

What management would you consider for a patient with angina?

Answer 3

-Address any exacerbating factors eg tachycardia, anaemia
-Secondary prevention of CVD eg lifestyle advice, aspirin, treat hyperlipidaemia
-Symptoms relief (GTN)
-Anti-anginal medication:
–Beta blocker or CCB (1st line)
–Long-acting nitrates eg isosorbide mononitrate
–Anti-anginals eg ivabradine, ranolazine, nicorandil

Question 4

How would you manage a patient with ACS?

Answer 4

-If STEMI or high-risk N-STEMI then revascularisation
-Symptom control with PRN GTN / opiates
-Cardioprotective meds:
–Antiplatelet (aspirin, clopidogrel)
–Anticoagulants (fondaparinux until discharge)
–Beta blockers
–ACEis if LV dysfunction present on echo
–High-dose statin

Question 5

What is primordial prevention?

Answer 5

-Risk factor reduction
-Large population focus on social and environmental factors

Question 6

What is primary prevention?

Answer 6

-Measures aimed at a susceptible group but that are still healthy
-Aim to prevent a disease ever occurring

Question 7

What is secondary prevention?

Answer 7

-Emphasis on early disease detection
-Aims to detect disease in subclinical disease in asymptomatic patients eg screening

Question 8

What is tertiary prevention?

Answer 8

-Aims to reduce severity of established disease and any direct effects from it

Question 9

What is quaternary prevention?

Answer 9

-Aimed at reducing iatrogenic harm or ‘over-medicalisation’