ischimic heart disease

Question 1

acute coronory syndrome aetiology

Answer 1

Spectrum of conditions relating to lack of blood to the heart.

rarely due to emboli, coronery spasm, vasculitis.

Ischaemia => blood flow is obstructed/ lack of blood supply ± cell death
Infarction => cellular response to lack of blood supply, definite cell death

Atypical causes
Vasculitis
Cocaine
COVID
Endocarditis
SCAD => spontaneous coronary aortic dissection
Young women
You would see STEMI/ NSTEMI + raised troponin

Question 2

ACS pathophysiology

Answer 2

Risk factors => atherosclerosis formation => plaque rupture => thrombosis => partial or total occlusion of CA (often accompanied by marked spasm of the vessel)

NB that ACS is sometimes (rarely) due to emboli, coronary spasm, vasculitis

Question 3

ACS signs and symptoms,

Answer 3

Acute central chest pain lasting more than 20 mins, radiation to left arm
Nausea
Sweatiness
Dyspnoea
Palpitations
ACS without chest pain => silent MI => mostly seen in elderly, diabetic females
Syncope
Pulmonary oedema
Epigastric pain
Vomiting
Acute confusion

raised troponin (greater than a 7 jump over 3 hr period.
neutrophils over 8 (indicated inflamation)

Question 4

ACS investigation

Answer 4

Question 5

ACS Diagnostic criteria/classification

Answer 5

based of the investigation and treatment

Question 6

ACS first line management

Answer 6

aspirin (300 mg) and heparin bolus and intravenous (IV) heparin infusion Antiplatelet therapy with ticagrelor or clopidogrel

Question 7

ACS emergency management. STEMI

Answer 7

ECG, IV access. Hx+Ex are there any contraindications to PCI.

MONARCH
Morphine- IV (2 puff GTN if allergic)
Oxygen- if less than 94% sats. no high doses, avoid reperfusion damage.
Nitrates- avoid if systolic <100. use for hypertensive crisis in ACS.

Aspirin- 300mg
Re-perfusion- PCI within 120 mins. if lnger fibrinolysis (absolute contraindication prev Intercerebran hemorage)
C- clopidogrel however this is not used any more use prasugrel (plt inhib)
Heprain infusion (or DOAC) give after PCI for obvious resons.

Question 8

ACS acute management of an NSETMI

Answer 8

Question 9

Angina definition of anginal pain

Answer 9

Constricting discomfort in the front of the chest, or in the neck, shoulders, jaw or arms
Precipitated by physical exertion
Relieved by rest of GTN in about 5 minutes

Question 10

classification of angina

Answer 10

stable angina CAN be caused by hypertrophic cardiomyopathy or increaced afterload (haert has to work greater)

Question 11

Rx of angina

Answer 11

Question 12

investigation of angina

Answer 12

Question 13

what two beta blockers are allowed for heart faliure

what are flozins

Answer 13

bisporlol
carvedilol

sglt2 inhibitors.