Ischaemic heart disease

Question 1

Causes of IHD

Answer 1

Mostly atheroma.
Anaemia
Aortic stenosis
Tachyarrhythmias
Arteritis

Question 2

Risk factors for IHD

Answer 2

HTN
DM
Smoking
Hypercholesterolaemia
Obesity
Age
Male
FH of MI <55yrs
Hyperlipidemia

Question 3

Symptoms of IHD

Answer 3

Central chest tightness or heaviness
Brought on by exertion, relieved by rest
May radiate to one/both arms, neck, jaw or teeth

Question 4

Classification of angina

Answer 4

Stable: induced by effort
Unstable: occurs at rest / minimal exertion
Decubitus: induced by lying down
Prinzmetal’s / variant: occurs during rest due to coronary spasm, ST elevation during attack: resolves as pain
subsides.
Syndrome X: angina pain + ST elevation on exercise test but no evidence of coronary atherosclerosis. Probably represents small vessel disease

Question 5

Differentials of angina

Answer 5

Aortic stenosis
Aortic aneurysm
GI: GORD, spasm
Musculoskeletal

Question 6

Secondary prevention of CHD

Answer 6

Aspirin 75mg OD
ACEi (esp. if angina + DM)
Statins
Antihypertensives

Question 7

Anti-anginal medication

Answer 7

GTN + B blocker (atenolol) or Ca channel blocker (verapamil)

Question 8

Percutaneous coronary intervention

Answer 8

Indications:
-Poor response to medical Rx
-Refractory angina but not suitable for CABG Complications:
-Re-stenosis (20-30%) 
-Emergency CABG (<2%)
-MI (<2%)
-Death (<0.5%)
Clopidogrel decreases risk of re-stenosis

Question 9

CABG indications

Answer 9

L main stem disease
Triple vessel disease
Refractory angina
Unsuccessful angioplasty

Question 10

Complications of CABG

Answer 10

MI
Stroke
Pericardial tamponade or haemothorax 
Postperfusion syndrome
Post-op AF
Nonunion of sternum
Graft stenosis