Ischaemic heart disease

Question 1

Risk factors for IHD

Answer 1

(CODFISH CHASM):

• Cholesterol
• Obesity
• DM
• FHx
• Illicit drug use
• Smoking
• Hypertension
• CKD
• High-fat, energy-rich diet
• Alcohol
• Sedentary lifestyle
• Male sex

Question 2

3 characteristics of stable angina

Answer 2

1. Retrosternal pressure/squeezing, radiating to left arm
2. Triggered by exercise or stress, lasting several minutes
3. Relieved by rest or GTN

Question 3

3 characteristics of unstable angina

Answer 3

1. Occurs at rest and lasts >20 minutes
2. Is severe and new-onset
3. Occurs with a crescendo pattern (becomes much more severe, prolonged or frequent)

Question 4

Management of stable angina

Answer 4

• Drugs (SAAB+NN):
  
  • Statins
  • Antiplatelets (aspirin, clopidogrel)
  • ACE inhibitors
  • Beta blockers
  • Nitrates (GTN patch, isosorbide mononitrate/dinitrate)
  • New anti-anginals (nicorandil, ivabradine)
• Revascularisation:
  
  • PCI/CABG

Question 5

Management of acute unstable angina

Answer 5

(MONASH):

• Morphine
• Oxygen
• Nitrates
• Aspirin
• Statin
• Heparin

Revascularisation:

• PCI/CABG

Question 6

Management of chronic unstable angina

Answer 6

(SAAB):

• Statins
• Antiplatelets
• ACE inhibitors
• Beta blockers

Question 7

Management of NSTEMI

Answer 7

• Antiplatelets (aspirin, clopidogrel)
• Anticoagulants (enoxaparin)
• Beta blockers (atenolol/metoprolol)
• PCI/CABG

Question 8

Management of STEMI

Answer 8

• PCI
• Fibrinolytics (alteplase)
• Antiplatelets (aspirin, clopidogrel/ticagrelor)
• Adjuvant anticoagulants (enoxaparin, UF heparin)
• CABG