Ischaemic Heart Disease- Angina Pectoris

Question 1

pathophysiology?

Answer 1

atherosclerosis–> myocardial ischaemia

Question 2

aetiology?

Answer 2

• mostly atheroma
• anaemia
• aortic stenosis
• arteritis
  
  • =vasospasm
• tachycardia

Question 3

symptoms?

Answer 3

central chest tightness/ heaviness, relieved by rest

Question 4

classification?

Answer 4

• stable
  
  • when symptoms always relieved by rest or GTN
• unstable
  
  • come on randomly while at rest = ACS
• Decubitus
  
  • induced by lying down
• Prinzmetal’s
  
  • occurs during rest

Question 5

describe cause and treatment of prinzmetal’s

Answer 5

cause- coronary spasm

ST elevation during attack but this resolves as pain subsides

Rx: CCB + long-acting nitrate

Question 6

DDx of angina?

Answer 6

• Aortic stenosis
• Aortic aneurysm
• GI: GORD, spasm
• Costochondritis

Question 7

Ix?

Answer 7

• CT coronary angiography - gold standard

baseline investigations..

• Cardiac examination
• ECG
• Bloods
  
  • FBC, UE, LFT, Lipid profile, TFT, HbA1c & fasting glucose

Question 8

what Ix would you consider?

Answer 8

• ETT
• Myocardial perfusion scan
• Stress echo

Question 9

what is ETT?

Answer 9

ECG recorded whilst pt is exercising

Question 10

describe myocardial perfusion scan

Answer 10

• nuclear imaging scan
• done during ‘stress’ and rest
• shows how well blood flows through heart muscle & how well heart muscle is pumping

Question 11

Principles of Mx? mnemonic

Answer 11

4 principles:

Refer to cardiology

Advise on diagnosis, management & when to phone ambulance

Medical treatment

Procedural or surgical investigations

Question 12

conservative Mx?

Answer 12

• lifestyle modifications
  
  • weight loss
  • quit smoking
  • healthy diet
  • exercise

Question 13

medical Mx

Answer 13

• Immediate symptomatic relief
  
  • GTN- vasodilator; used as required
  • take once and then again after 5 mins
    
    • if still pain after 5 mins, phone ambulance
• Long-term relief
  
  • B blocker or CCB
  • other:
    
    • long acting nitrates ie isosorbide mononitrate
    • ivabridine
    • nicorandil
    • ranolazine

+ secondary prevention of CVD

Question 14

Interventional Mx option?

Answer 14

PCI

Question 15

indications for PCI?

Answer 15

• poor response to medical Mx
• refractory angina but not suitable for CABG

Question 16

complications of PCI

Answer 16

• restenosis
• emergency CABG
• MI
• death

Question 17

what drug reduces risk of re-stenosis?

Answer 17

clopidogrel

Question 18

Surgical Mx?

Answer 18

CABG

Question 19

indications for CABG?

Answer 19

• triple vessel disease
• L main stem disease
• refractory angina
• unsuccessful angioplasty

Question 20

how does CABG work?

Answer 20

harvesting a graft vein from pts leg (usually great saphenous) & sew it onto affected coronary artery to bypass stenosis