Ischaemic Heart Disease

Question 1

Pathophysiology of angina

Answer 1

Atheromatous plaque builds up in coronary vessels, occludes the lumen, reduces blood supply to the myocardium, causes ischaemia.
Brought on by exertion as the O2 demand of the heart increases, and diastole shortens

Question 2

Difference between stable and unstable angina

Answer 2

Stable = pain in exertion, relieved by GTN spray
Unstable = pain at rest, not relieved by GTN spray

Question 3

Pathophysiology of MI

Answer 3

Plaque/thrombus completely occludes vessel, leading to an infarct in the myocardium

Question 4

Difference between NSTEMI and STEMI

Answer 4

NSTEMI: infarct not full thickness of myocardium, not ST elevation
STEMI: infarct is full thickness of myocardium

Question 5

Investigations of angina

Answer 5

Exercise stress test

ECG shows ST depression

Question 6

Investigation of an MI

Answer 6

ECG changes: ST elevation, T wave inversion, pathological q-wave
Biochemical markers in blood: troponin and creative kinase

Question 7

Management of angina

Answer 7

Lifestyle advice: stop smoking, increase exercise, diet and weight control
Symptom relief: GTN spray
Reduce number of attacks: beta-blocker/ca channel blocker eg. Diltiazem
Prevention of CVS event: aspirin, statins, ACE-inhibitors

Consider re vascularisation surgery

Question 8

Mechanism of action of GTN spray

Answer 8

A fast acting organic nitrate. Causes venodilation, reduces workload of heart

Question 9

Angina differential diagnosis

Answer 9

Pericarditis
GORD
PE

Question 10

Symptoms of angina

Answer 10

Central/left sided crushing/aching chest pain - brought on by exertion, can radiate to neck/shoulder/arm
Breathlessness
Dizziness

Question 11

Risk factors for IHD

Answer 11

Age, male, family history, smoking, BP, high cholesterol, diabetes, obesity, little exercise