Ischaemic Heart Disease

Question 1

Name four pathologies that can lead to cardiac arrest

Answer 1

• stable plaque
• acute occlusion
• chronic closure
• ischaemic cardiomyopathy

Question 2

Describe the results of the study which investigated cardiac arrest in long distance runners

Answer 2

• higher mortality in half marathons compared to marathons
• survivors were older than non-survivors
• non-survivors were more likely to smoke & have higher CVD risk factors

Question 3

Describe the epidemiology of CVD

Answer 3

death rate is decreasing but still highest in scotland

Question 4

What has been introduced to avoid waiting times for the cardiologist?

Answer 4

Rapid assess chest pain clinics

Question 5

How will angina present?

Answer 5

Visceral pain from myocardial hypoxia, hard to describe, squeezing/pressure gesture is a good marker. If the patient can point to an exact location, it is not CHD

Question 6

What are the characteristics of an angina presentation?

Answer 6

• provovation, relief, timing (on exercise relieved by rest)

- CVD risk factors (smoker, hyperlipidaemic)

Question 7

What are some differential diagnoses for chest pain in the GI tract?

Answer 7

• Reflux
• Peptic Ulcer Pain
• Oesophageal spasm
• Biliary Colic

Question 8

What are some musculoskeletal differential diagnoses for chest pain?

Answer 8

Injury & nerve root pain

Question 9

Name four investigations that can be done on someone with suspected coronary heart disease

Answer 9

• exercise testing
• perfusion imaging
• CT angiogram
• Angiography

Question 10

Describe the pros and cons of exercise testing

Answer 10

Pros; cheap, reproducible, risk stratification

Cons; poor diagnostic accuracy, sub maximal test

Question 11

Describe the pros and cons of perfusion imaging

Answer 11

Pros; non-invasive, more precise, risk stratification, increased heart rate in response to pharmacological stress
Cons; radiation & false -ve/+ve’s

Question 12

Describe the pros and cons of CT angiogram

Answer 12

Pros; non-invasive & anatomical data/risk stratification
Cons; radiation, less precise than angiography, cost

Question 13

What are the pros and cons of angiography?

Answer 13

Pros; gold standard, anatomical data/risk stratification & allows angioplasty to follow
Cons; risk of death or stroke, radiation, side effects of contrast

Question 14

What is the aim of management of coronary heart disease?

Answer 14

• reduce risk of death

- disable symptoms

Question 15

What type of drugs are given to manage ischaemic heart disease?

Answer 15

• aspirin (anti platelet)
• ACE inhibitor (decrease blood pressure)
• beta blocker (decrease heart rate)
• statin (reduce cholesterol)

Question 16

What are the two types of revascularisation?

Answer 16

• CABG

- PCI

Question 17

Name some complications of CABG

Answer 17

Death, stroke, MI, AF, Infection, Renal failure, Cognitive impairment & sternal malunion

Question 18

Describe PCI

Answer 18

Angioplasty with a stent, the patient is on anti platelets. Stent is inserted then balloon inflated to widen the artery

Question 19

Name some complications of PCI

Answer 19

Death, stroke, MI, renal failure, vascular complications (stent thrombosis/ stent restenosis)

Question 20

When is CABG the chosen procedure?

Answer 20

Patients with three vessel or left main coronary artery disease

Question 21

What are the problems with IHD treatment?

Answer 21

• Stroke, contrast neuropathy, bleeding

- failure of stent to deliver, expand, remain patent, treat atherosclerosis & prevent future events

Question 22

Why the radial artery used?

Answer 22

Because it is dual supply to the hand, superficial and there are no adjacent nerves/veins

Question 23

What is the problem with the radial artery?

Answer 23

It is small and prone to spasm.

Question 24

What are treatments are used for STEMI, ACS & Chronic stable angina?

Answer 24

STEMI - PPCI
ACS - angiography with view to revascularisation
Chronic stable angina - CABG or PCI