Ischaemic Heart Disease

Question 1

What is ischaemic heart disease?

Answer 1

Inadequate blood supply to the cardiac muscles due to narrowing or blockages in the coronary artery, leading to a mismatch between the supply and demand.

Question 2

What are the 4 main clinical presentations of an ischaemic heart disease?

Answer 2

Angina
Breathless
Nausea
Sweating

Question 3

SOCRATES of ischaemic heart disease pain:

Answer 3

Site: central chest
Onset: exertion or in severe situations rest
Characteristics: dull ache, tight, squeeze
Radiation: neck, arms, back
Associated features: SOB, sweaty, clammy, nauseous
Time: less than 5 minutes in angina, hours in acute coronary syndrome (ACS)
Exacerbating and relieving factors: worse on walking or exercise; improves with nitrate spray
Severity: mild to moderate for angina, severe for ACS

Question 4

Risk factors of ischaemic heart disease

Answer 4

Male
Age
Family History
Racial group
Smoker
Diabetes Mellitus
Hypertension
Other lifestyle choices

Question 5

Investigations to diagnose ischaemic heart disease

Answer 5

Electrocardiogram (ECG)
Exercise ECG
CT scan
Cardiac MRI
Myocardial perfusion scan (MPS)

Question 6

Possible treatment options of ischaemic heart disease

Answer 6

Medicine (ABCNO)
Percutaneous coronary intervention (PCI)
Surgery eg coronary artery bypass graft

Question 7

What are the medicinal treatments available for ischaemic heart disease?

Answer 7

1. Antiplatelet & anticoagulation: aspirin, clopidogrel, prasugrel, ticagrelor, apixaban, rivaroxaban, dabigatran, warfarin
2. Beta-blocker: bisoprolol, atenolol, carvedilol, metoprolol. nebivolol
3. Calcium channel blockers: amlodipine, diltiazem, verapamil
4. Nitrates: short acting GTN spray, long acting isosorbide, long acting mononitrate (ISMN)
5. Others: ranolazine, nicorandil, ivabradine, atorvastatin, pravastatin, simvastatin

Question 8

Adrenaline in the local anaesthetic used can stimulate ________

Answer 8

Angina

Question 9

What is the most common stenosis in the world?

Answer 9

Aortic stenosis

Question 10

What are the two main categories of valvular heart disease?

Answer 10

Stenosis - tight/narrow valves
Regurgitant - leaky valves

Question 11

What are the clinical presentations of valvular heart disease?

Answer 11

Chest tightness
Syncope
Dizzy
Shortness of breath

Question 12

Investigations to diagnose valvular heart disease

Answer 12

Transthoracic echocardiography
Transoesophageal echocardiography

Question 13

What are the medicines available for treating valvular heart disease? (5 points)

Answer 13

1. Anticoagulants: apixaban, rivaroxaban, dabigatran, warfarin, edoxaban
2. Beta-blockers: bisoprolol, carvedilol, nebivolol
3. Calcium channel blockers: verapamil, diltiazem
4. Digoxin
5. Diuretics: furosemide

Question 14

What are the surgical treatment options for valvular heart disease?

Answer 14

1. Transcatheter aortic valve implantation (TAVI)
2. Transcatheter edge-to-edge repair (TEER)
3. Artificial mechanical valve sewn in place of tissue valve