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CVS > IHD > Flashcards

IHD Flashcards

1
Q

cause of angina

A

mostly atheroma

mismatch of o2 demand and supply

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2
Q

environmental exacerbating factors

A

cold weather, heavy meals, emotional stress

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3
Q

supply/demand exacerbating factors for angina

A

impairment of blood flow e.g. arterial stenosis
increased distal resistance e.g. LV hypertrophy
reduced o2-carrying capacity: anaemia

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4
Q

typical angina presenting patient

A

older male, FH, smoker

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5
Q

stable angina definition

A

induced by effort, relieved by rest

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6
Q

angina ECG

A

mainly normal

may show ST depression, flat or inverted T waves, signs of past MI

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7
Q

what Ix to show how much plaque someone with angina has?

A

CT calcium scoring

CT coronary angiography

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8
Q

surgical options for angina

A

percutaneous coronary intervention (PCI)

coronary artery bypass graft (CABG)

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9
Q

why are cold fingers a side effect of beta blockers?

A

they dilate coronary arteries but constrict skin and muscle ones –> cold fingers

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10
Q

what does negatively chronotropic mean?

A

decrease in heart rate

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11
Q

what does negatively inotropic mean?

A

decrease in LV contractility (force of contraction)

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12
Q

Side effects of beta blockers

A

erectile dysfunction, cold hands + feet, bradycardia

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13
Q

How do nitrates work?

A

they are ventilators

increase venous capacity –> reduction in preload

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14
Q

how does aspirin work?

A

cyclo-oxygenase inhibitor
reduces prostaglandin synthesis, results in decreased platelet aggregation.
Is antipyretic, anti-inflammatory, analgesic

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15
Q

what do statins do?

A

reduce the amount of cholesterol produced by the liver

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16
Q

what does angiotensin II do?

A

increased sympathetic activity
release of aldosterone
vasoconstriction

17
Q

what do ACE inhibitors block?

A

the conversion of angiotensin I to angiotensin II

18
Q

underlying pathology of unstable angina and evolving MI?

A

plaque rupture, thrombosis and inflammation

19
Q

what do we call acute MI?

A

STEMI - diagnosed by ECG on presentation

20
Q

How is a N-STEMI diagnosed?

A

Its retrospective

Made after troponin/other results

21
Q

modifiable risk factors?

A

age, male, family history

22
Q

presentation of acute coronary syndrome?

A

acute central chest pain lasting >20 mins

often associated with nausea, sweatiness, dyspnoea

23
Q

what would you look for on a CXR for acute coronary syndrome

A

cardiomegaly
pulmonary oedema
widened mediastinum?

24
Q

what are the most sensitive + specific markers of MI?

A

cardiac troponin levels (T and I)

25
Q

what is troponin?

A

protein complex that regulates actin:myosin contraction

helps level with risk stratification

26
Q

what is CK-MB

A

one of 3 isosomes of creatine kinase.

CK-MB is mainly in the heart

27
Q

Why use opiates with caution for ACS?

A

they can delay absorption of PY12 inhibitors

28
Q

1st line management for ACS (pre-hospital)

A

MONA

morphine, oxygen, nitrate, aspirin

29
Q

What is clopidogrel and its metabolism?

A

a P2Y12 inhibitor. has to be metabolised to its active form by 2 steps in the liver

great target due to its amplification role

30
Q

Side effects of anti platelet drugs

A

increased risk of bleeding, rash, GI disturbance

31
Q

what do anticoagulants target?

A

formation and/or activity of thrombin

32
Q

Complications of MI

A

cardiac arrest
cariogenic shock
unstable angina
bradycardia, tachyarrhythmias or heart block

33
Q

pathology of NSTEMI

A

occluding thrombus causes myocardial damage –> elevation of myocardial damage markers: troponin & creatinine kinase

34
Q

STEMI

A

complete occlusion of artery by thrombus
more severe symptoms
ST elevation on ECG
elevated troponin & creatinine kinase

35
Q

what would normal serum troponin at 12 hrs suggest?

A

unstable angina (instead of NSTEMI/STEMI)

36
Q

Medical treatment after MI

A 
primary angioplasty/thrombolysis
BBs (atenolol)
ACE-i (lisinopril) or ARB (candesartan)
Statin
Dual anti platelet therapy: aspirin and a P2Y12 inhibitor (clopidogrel)
37
Q

What is cardiac tamponade?

A

pericardial effusion: fluid accumulation in pericardium –> reduced ventricular filling –> haemodynamic compromise

38
Q

LT rx angina

A

CCB/B-blocker/long acting nitrate e.g. amlodipine, atenolol, nicorandil

39
Q

Post MI what should pts do

What is contraindicated

A

Attend cardiac rehab – advice on activity etc.
Lifestyle changes
NSAIDS absolute CI for 2/12 post STEMI

CVS (14 decks)

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