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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
In which group of patients should anticoagulation not be given, when presenting with NSTEMI/unstable angina?
If cardiac catheterisation is scheduled for the same day
26
What interventional management options may be offered to patients with NSTEMI/unstable angina?
PCI or CABG
27
Describe the typical clinical feature of angina?
Chest pain which is worse on exertion and relieved by rest and the use of GTN spray
28
What are some non-modifiable risk factors for the development of ischaemic heart disease?
Increasing age, male gender, family history
29
What are the four main modifiable risk factors for the development of ischaemic heart disease?
Smoking, diabetes, high cholesterol, hypertension
30
What are some potentially exacerbating factors for chest pain caused by ischaemic heart disease?
Exertion, stress, large meals
31
Chest pain caused by angina will most likely last for how long?
< 10 minutes
32
What are some features which may suggest that stable angina has developed into ACS?
An increase in the severity/duration of symptoms, a reduction in the threshold for symptoms
33
Aside from chest pain, what is another common feature of ischaemic heart disease?
Dyspnoea
34
All patients with suspected angina undergo which investigation?
ECG
35
What investigation can be done to identify inducible ischaemia in patients with suspected angina?
Exercise ECG
36
What is the gold standard investigation for ischaemic heart disease, and may be done if inducible ischaemia is found in a patient with angina?
Coronary angiography
37
What does an ECG usually show in patients with angina?
Nothing (unless there has been a previous MI)
38
What are some signs of current ischaemia that could potentially be seen on an ECG?
ST segment depression, T wave inversion, LBBB
39
Symptomatic therapies for the treatment of angina usually have what effect?
Vasodilation of systemic and coronary vessels
40
What drugs (group and specific examples) are used in the symptomatic treatment of angina?
Nitrates (GTN, isosorbide mononitrate), Ca channel blockers (amlodipine), K channel blockers (nicorandil)
41
What is the difference between GTN and isosorbide mononitrate?
GTN is short-acting, isosorbide mononitrate is long-acting
42
What drugs are used in the prognostic treatment of angina?
Cardioselective beta blockers, aspirin and statins
43
Give two examples of cardioselective beta blockers?
Bisoprolol and atenolol
44
What are the two surgical interventions that can be used in the treatment of stable angina? To which patients would these treatments be offered?
PCI or CABG: these can be offered to patients with severe symptoms or those who are deemed high risk of ACS
45
Primary PCI is the first line treatment for ACS. To achieve maximum benefit, when should this be done?
Within 120 minutes of the onset of chest pain
46
What are the criteria for patients to receive primary PCI?
Chest pain < 12 hours duration AND ST elevation of > 1mm in two contiguous limb leads or > 2mm in two contiguous chest leads
47
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?
Thrombolysis with IV streptokinase: given < 12 hours from the onset of pain
48
What medications are used for secondary prevention following an NSTEMI or unstable angina?
Statin, ACE inhibitor, beta blocker (lifelong)
49
What medications are used for secondary prevention following a STEMI?
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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