IHD symposium

Question 1

Heart attack process

Answer 1

Heart disease develops over time as fatty deposits narrow coronary arteries, restricting blood flow to the heart
Coronary artery blocks – usually by a clot resulting from ruptured atherosclerotic plaque
Blood flow is restricted and a heart attack begins
If blockage continues, parts of the heart muscle start to die
Heart may stop beating, leading to cardiac arrest

Question 2

Stopping a heart attack

Answer 2

Quick action and medical treatment

Dead muscle cannot be restored

Question 3

Rapid treatment of STEMI

Answer 3

Antiplatelet agents (aspirin + clopidogrel)

AND

“Clot-busting” drug (thrombolysis): pharmacologically break up clots, restoring blood flow

‘Primary’ angioplasty (balloons, stents): artery is mechanically reopened, restoring blood flow

Question 4

Revascularisation therapies - PCI

Answer 4

Clinical evidence to suggest the superiority of primary PCI over thrombolysis1
The NIAP* suggests that PPCI is most effective if delivered within 150mins of the patient’s call for help (‘call-to-balloon’ time)1

Question 5

Revascularisation therapies - Thrombolysis

Answer 5

Treatment of choice in STEMI when primary PCI cannot be performed
Aim to initiate within 90mins of patient calling for help (‘call-to-needle’) or within 30mins of arrival at hospital (‘door-to-needle’)

Question 6

Thrombolysis limitations

Answer 6

Despite therapeutic advances in thrombolytics only 50% restore normal coronary flow after 90 minutes
Increased bleeding risks with thrombolysis (haemorrhagic stroke)
Lack of reliable non-invasive methods for assessing patency of infarct related artery

Question 7

Therapeutic goals in STEMI

Answer 7

restore epicardial vessel patency
limit myocardial necrosis
control symptoms

Anti-platelelet therapy
anti-ischaemic therapy
secondary prevention

Question 8

IHD 2nd prevention

Answer 8

Antiplatelet therapy
aspirin
clopidogrel /prasugrel /ticagrelor

Statin
ACE inhibitors
Beta blockers
Smoking cessation 
Lifestyle modification