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Gen Med (Cardio) > Ischaemic Heart Disease > Flashcards

Ischaemic Heart Disease Flashcards

1
Q

How soon after an MI can patients return to sexual activity?

A

4 weeks

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2
Q

What are the driving rules after an MI?

A

Car drivers can return to driving after 4 weeks and do not have to inform the DVLA. HGV/bus drivers can return to driving after 6 weeks and must inform the DVLA.

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3
Q

As a result of VSD or sub-mitral valve papillary muscle rupture, what murmur may develop after an MI? How does it sound?

A

Mitral regurgitation / pansystolic murmur

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4
Q

What is Dressler’s syndrome?

A

Autoimmune pericarditis occurring 2-10 weeks after an MI

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5
Q

Describe what is involved in the MONA acronym for the initial treatment of STEMI?

A

Morphine (+ anti-emetic), oxygen (only if hypoxic), nitrates, anti-platelets (aspirin + ticagrelor)

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6
Q

What are the interventional management options for STEMI?

A

Primary PCI or thrombolysis

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7
Q

What anti-emetic should be given alongside IV morphine when treating NSTEMI?

A

IV metoclopramide

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8
Q

How can GTN be given in a STEMI?

A

Sublingual, oral or IV

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9
Q

Which patients should be given nitrates when treating a STEMI?

A

If systolic BP > 90mmHg

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10
Q

What dose of aspirin, clopidogrel and ticagrelor should be given in the acute treatment of a STEMI?

A

300mg aspirin + clopidogrel, 180mg ticagrelor

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11
Q

What are some potential interventions for the primary prevention of ACS?

A

Smoking cessation, cholesterol reduction, tight control of hypertension/diabetes

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12
Q

In addition to chest pain and dyspnoea, what are some other potential symptoms of ACS?

A

Sweating, nausea/vomiting

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13
Q

Which acute coronary syndrome(s) will cause chest pain that is relieved by GTN spray?

A

Unstable angina

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14
Q

Which acute coronary syndrome(s) may cause an abnormal ECG?

A

NSTEMI and STEMI (NSTEMI may or may not be abnormal, STEMI will always be abnormal)

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15
Q

Which acute coronary syndrome(s) will cause a rise in troponins?

A

NSTEMI and STEMI

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16
Q

Which ECG leads, and which artery, correspond to the anteroseptal territory of the heart?

A

V1-V4, left anterior descending artery

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17
Q

Which ECG leads, and which artery, correspond to the lateral territory of the heart?

A

I, aVL, V5 & V6, left circumflex artery

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18
Q

Which ECG leads, and which artery, correspond to the inferior territory of the heart?

A

II, III & aVF, right coronary artery

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19
Q

What ECG change can be seen in a posterior STEMI?

A

ST depression in the anterior leads V1-V4

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20
Q

When a patient presents with a possible ACS, what 3 basic investigations should be done ASAP?

A

ECG, CXR, bloods (FBC, U&E, lipid profile, troponins)

21
Q

What is the gold standard investigation for ACS?

A

Coronary angiography

22
Q

For best results, when should a measurement of troponin be taken?

A

12 hours after the onset of pain

23
Q

What medical management is required for cases of NSTEMI and unstable angina?

A

Dual anti-platelet therapy and an anti-coagulant

24
Q

What can be used for pain control in cases of NSTEMI/unstable angina? What should be co-prescribed?

A

IV opiates and nitrates / co-prescribe an anti-emetic

25
Q

In which group of patients should anticoagulation not be given, when presenting with NSTEMI/unstable angina?

A

If cardiac catheterisation is scheduled for the same day

26
Q

What interventional management options may be offered to patients with NSTEMI/unstable angina?

A

PCI or CABG

27
Q

Describe the typical clinical feature of angina?

A

Chest pain which is worse on exertion and relieved by rest and the use of GTN spray

28
Q

What are some non-modifiable risk factors for the development of ischaemic heart disease?

A

Increasing age, male gender, family history

29
Q

What are the four main modifiable risk factors for the development of ischaemic heart disease?

A

Smoking, diabetes, high cholesterol, hypertension

30
Q

What are some potentially exacerbating factors for chest pain caused by ischaemic heart disease?

A

Exertion, stress, large meals

31
Q

Chest pain caused by angina will most likely last for how long?

A

< 10 minutes

32
Q

What are some features which may suggest that stable angina has developed into ACS?

A

An increase in the severity/duration of symptoms, a reduction in the threshold for symptoms

33
Q

Aside from chest pain, what is another common feature of ischaemic heart disease?

A

Dyspnoea

34
Q

All patients with suspected angina undergo which investigation?

A

ECG

35
Q

What investigation can be done to identify inducible ischaemia in patients with suspected angina?

A

Exercise ECG

36
Q

What is the gold standard investigation for ischaemic heart disease, and may be done if inducible ischaemia is found in a patient with angina?

A

Coronary angiography

37
Q

What does an ECG usually show in patients with angina?

A

Nothing (unless there has been a previous MI)

38
Q

What are some signs of current ischaemia that could potentially be seen on an ECG?

A

ST segment depression, T wave inversion, LBBB

39
Q

Symptomatic therapies for the treatment of angina usually have what effect?

A

Vasodilation of systemic and coronary vessels

40
Q

What drugs (group and specific examples) are used in the symptomatic treatment of angina?

A

Nitrates (GTN, isosorbide mononitrate), Ca channel blockers (amlodipine), K channel blockers (nicorandil)

41
Q

What is the difference between GTN and isosorbide mononitrate?

A

GTN is short-acting, isosorbide mononitrate is long-acting

42
Q

What drugs are used in the prognostic treatment of angina?

A

Cardioselective beta blockers, aspirin and statins

43
Q

Give two examples of cardioselective beta blockers?

A

Bisoprolol and atenolol

44
Q

What are the two surgical interventions that can be used in the treatment of stable angina? To which patients would these treatments be offered?

A

PCI or CABG: these can be offered to patients with severe symptoms or those who are deemed high risk of ACS

45
Q

Primary PCI is the first line treatment for ACS. To achieve maximum benefit, when should this be done?

A

Within 120 minutes of the onset of chest pain

46
Q

What are the criteria for patients to receive primary PCI?

A

Chest pain < 12 hours duration AND ST elevation of > 1mm in two contiguous limb leads or > 2mm in two contiguous chest leads

47
Q

If primary PCI cannot be performed in patients with a STEMI, what is the next line treatment and what timeframe can it be used in?

A

Thrombolysis with IV streptokinase: given < 12 hours from the onset of pain

48
Q

What medications are used for secondary prevention following an NSTEMI or unstable angina?

A

Statin, ACE inhibitor, beta blocker (lifelong)

49
Q

What medications are used for secondary prevention following a STEMI?

A

Statin, ACE inhibitor, beta blocker, aspirin (all lifelong) and a second anti-platelet agent for around 1 year

Gen Med (Cardio) (8 decks)

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