SIHD & Angina 1

Question 1

Describe angina pectoris.

Answer 1

Angina pectoris is chest discomfort or pain caused by myocardial ischemia without myocardial necrosis.

Question 2

Define myocardial ischemia.

Answer 2

Myocardial ischemia is the inadequate blood supply to the heart muscle, leading to a mismatch between oxygen and metabolite delivery and demand.

Question 3

How does coronary atheroma contribute to angina symptoms?

Answer 3

Coronary atheroma, a buildup of cholesterol deposits in the coronary arteries, can lead to obstruction of blood flow, causing stable angina symptoms.

Question 4

Do emotional stress and anxiety play a role in triggering angina symptoms?

Answer 4

Yes, emotional stress and anxiety can increase myocardial oxygen demand, potentially leading to myocardial ischemia and angina symptoms.

Question 5

Describe left ventricle hypertrophy and its association with angina.

Answer 5

Left ventricle hypertrophy can result from conditions like systemic hypertension or aortic stenosis, leading to increased myocardial oxygen demand and potentially causing angina symptoms.

Question 6

How can atheroma progression lead to acute coronary syndromes?

Answer 6

Progression of atheroma can cause disruptions in coronary plaques, leading to thrombotic reactions and potentially resulting in acute coronary syndromes with myocardial ischemic symptoms at rest.

Question 7

Describe the cardinal feature of symptoms in myocardial ischemia.

Answer 7

Symptoms worsen during times of increased myocardial oxygen demand, such as physical activity emotional stress, and ease rapidly when the demand stops.

Question 8

Define stable angina and unstable angina.

Answer 8

Stable angina occurs on activity and is relieved by rest, while unstable angina involves chest pain that worsens over time, leading to decreased exertional capacity.

Question 9

How can the severity of angina symptoms be assessed using the Canadian Classification of Angina Score (CCS)?

Answer 9

CCS ranges from 1 (least symptoms) to 4 (most symptoms), with class 1 experiencing angina only on significant activity and class 4 having symptoms even during minimal activities like washing and dressing.

Question 10

Do myocardial ischemic angina symptoms typically include sharp stabbing pain or tenderness over the chest wall?

Answer 10

No, these symptoms are not typical of myocardial ischemia; instead, symptoms worsen with increased myocardial oxygen demand and are relieved with rest or GTN spray.

Question 11

Describe the characteristics of chest pain associated with pericarditis and aortic dissection.

Answer 11

Pericardial pain worsens with deep inspiration and sitting forward but is relieved by lying back, while aortic dissection pain is intense, prolonged, and described as tearing or intra-scapular back pain.

Question 12

How can symptoms from the upper GI tract mimic myocardial ischemic angina?

Answer 12

Symptoms like epigastric discomfort and gastroesophageal reflux, often associated with food or drink, can mimic chest pain but are not related to exertion and point to alternative causes when present.

Question 13

Describe the symptoms of stable angina.

Answer 13

Symptoms occur on activity and include chest pain.

Question 14

Define modifiable cardiovascular risk factors.

Answer 14

Factors like smoking, poor diet, sedentary lifestyle, diabetes, hyperlipidemia, and hypertension that can be changed or controlled.

Question 15

How can a healthcare provider assess a patient’s cardiovascular risk profile?

Answer 15

By considering non-modifiable factors like age, gender, and ethnicity, as well as modifiable factors like lifestyle habits and medical conditions.

Question 16

Do patients with stable angina always show abnormal findings on examination?

Answer 16

No, many patients with stable angina may have a normal physical examination.

Question 17

Describe the importance of a baseline 12 lead ECG in evaluating stable angina.

Answer 17

It is essential to perform a 12 lead ECG as a baseline investigation, even though it may be normal in over 50% of cases with confirmed angina, as it can provide additional information.

Question 18

How can the diagnosis of angina be confirmed non-invasively?

Answer 18

Through methods like exercise tests, myocardial perfusion scans, and CT scans.

Question 19

Define the purpose of an exercise test in diagnosing angina.

Answer 19

To reproduce symptoms during physical activity, evaluate ECG changes, and provoke chest pain to assess for myocardial ischemia.

Question 20

Describe the role of invasive angiography in diagnosing angina.

Answer 20

Invasive angiography involves inserting a catheter to visualize the coronary arteries and assess for blockages or narrowing.

Question 21

Do patients with stable angina always require a chest x-ray for evaluation?

Answer 21

No, a chest x-ray is generally not required for evaluating stable angina, but a baseline 12 lead ECG is essential.

Question 22

Describe the process of a treadmill exercise test.

Answer 22

Patients are hooked up to an ECG while exercising on a treadmill to evaluate heart function, but it may not be suitable for all patients.

Question 23

How does myocardial perfusion imaging work?

Answer 23

It involves taking pictures of the heart at rest and during stress after injecting a tracer to detect areas with reduced blood flow, indicating ischemia.

Question 24

Do stress echocardiograms help diagnose heart conditions?

Answer 24

Yes, by using ultrasound to create images of the heart before and after exercise or medication-induced stress to detect abnormalities.

Question 25

Describe the limitations of a treadmill test for diagnosing heart conditions.

Answer 25

It may not be sensitive or specific enough, leading to false positives or negatives, especially in certain patient groups like women or those with hypertension.

Question 26

What are some alternative non-invasive tests for diagnosing heart conditions?

Answer 26

Myocardial perfusion imaging, CT scan of coronary arteries, and stress echocardiogram are more accurate options compared to a treadmill test.

Question 27

Describe myocardial ischemia detection using imaging techniques.

Answer 27

Myocardial ischemia can be detected through imaging techniques like stress echocardiogram, CT scan of coronary arteries, and nuclear imaging, which help localize the affected area of the heart.

Question 28

Define CT scan of coronary arteries.

Answer 28

A CT scan of coronary arteries is a non-invasive imaging test that uses x-rays and contrast material to visualize the inside of the coronary arteries, aiding in the diagnosis of coronary artery disease.

Question 29

How does stress echocardiogram help in diagnosing myocardial ischemia?

Answer 29

Stress echocardiogram assesses the consequences of reduced blood flow by evaluating the contractility of the myocardium under stress, indicating myocardial ischemia if there is reduced contractility.

Question 30

Do invasive angiograms carry risks?

Answer 30

Yes, invasive angiograms involve going inside the body to assess coronary artery disease and carry small risks compared to non-invasive tests, requiring a high degree of sophistication in execution.

Question 31

Describe the procedure of an invasive angiogram.

Answer 31

During an invasive angiogram, a catheter is inserted into an artery, usually through the radial or femoral artery, to visualize the coronary arteries using x-ray imaging and contrast material.

Question 32

How are diagnostic studies typically conducted in modern practice?

Answer 32

Most diagnostic studies are performed under local anesthesia, with catheters inserted through the radial or femoral artery, allowing detailed imaging of the arterial system using x-ray technology.

Question 33

Describe the process of an invasive coronary angiogram.

Answer 33

An invasive coronary angiogram involves inserting a coronary catheter filled with x-ray contrast into the coronary arteries to visualize blood flow and detect any blockages.

Question 34

What is the purpose of iodine in an x-ray contrast fluid during a coronary angiogram?

Answer 34

Iodine absorbs x-rays, making the fluid appear black under x-ray and helps visualize the coronary arteries.

Question 35

Define coronary artery disease.

Answer 35

Coronary artery disease is a condition where the blood vessels supplying the heart muscle become narrowed or blocked, leading to reduced blood flow and potential heart complications.

Question 36

How is eccentric coronary artery disease detected during an angiogram?

Answer 36

Eccentric coronary artery disease is detected by taking multiple pictures from different angles to observe variations in the appearance of the coronary arteries.

Question 37

Describe the treatment strategies for stable angina.

Answer 37

Treatment strategies for stable angina include addressing cardiovascular risk factors, specific medical treatments like statins and antianginals, and potentially coronary revascularization.

Question 38

What lifestyle changes are important for patients with stable angina?

Answer 38

Lifestyle changes such as smoking cessation and increasing physical activity are crucial for managing stable angina and reducing cardiovascular risk factors.

Question 39

Describe the essential therapy for patients with proven atheromatous disease and severe symptoms associated with it.

Answer 39

Modifying cholesterol and cholesterol deposition in the arteries, typically through the use of statins.

Question 40

What is the primary function of statins in patients with atheromatous disease?

Answer 40

Lowering cholesterol, protecting coronary arteries, stabilizing coronary plaques, and reducing acute coronary events.

Question 41

How do antiplatelet agents like aspirin and clopidogrel benefit patients with atheromatous disease?

Answer 41

They reduce acute coronary events by inhibiting platelet activation during plaque rupture events.

Question 42

Define the role of beta blockers in the medical treatment of angina.

Answer 42

Beta blockers reduce myocardial oxygen demand by lowering heart rates and blood pressure, making them a cornerstone treatment for angina.

Question 43

Describe the alternative medications used for angina in patients intolerant to beta blockers, such as those with significant asthma or obstructive airways disease.

Answer 43

Central acting calcium channel blockers like diltiazem and verapamil, or IK channel blockers, can be used to lower heart rates without affecting blood pressure.

Question 44

What is the mechanism of action of nitrate medications in the treatment of angina?

Answer 44

Nitrates produce vasodilation, particularly in the coronary arteries, to alleviate angina symptoms.

Question 45

Describe percutaneous coronary intervention (PCI)

Answer 45

Percutaneous coronary intervention involves inserting a balloon or stent through a needle puncture in the radial artery to crush atheromatous material in the coronary artery, leaving a stent to maintain lumen size.

Question 46

What are the risks associated with PCI?

Answer 46

Risks of PCI include small risks of mortality, heart attack during the procedure, and a 5% risk of narrowing returning within contemporary drug-eluting stents.

Question 47

Define stent in the context of PCI

Answer 47

A stent is a metal brace left in the coronary artery during PCI to maintain lumen size and improve blood flow.

Question 48

How does PCI differ from coronary artery bypass grafting (CABG) as a revascularization option for stable angina?

Answer 48

PCI is less intensive upfront compared to CABG, involves inserting a balloon or stent to improve blood flow, and is used for patients with less complex coronary artery disease.

Question 49

Describe the post-procedure medication regimen for patients undergoing PCI

Answer 49

Patients typically need to take aspirin and clopidogrel for a period, which can increase the risk of bleeding, along with staying on statins for long-term management.

Question 50

What is the purpose of antiplatelet medication in PCI patients?

Answer 50

Antiplatelet medication is crucial post-PCI to prevent arterial thrombosis and maintain blood flow through the stented coronary artery.

Question 51

Describe the difference between percutaneous coronary intervention and coronary artery bypass grafting in terms of treatment effects and longevity.

Answer 51

Percutaneous coronary intervention helps with symptoms but doesn’t necessarily improve lifespan or reduce heart attack risk, while coronary artery bypass grafting can improve longevity in certain patients with severe coronary disease.

Question 52

Define saphenous vein graft and its role in coronary artery bypass grafting.

Answer 52

A saphenous vein graft is a vein, often from the leg, that is used in coronary artery bypass surgery to create new pathways for blood flow around blocked coronary arteries.

Question 53

How does the left internal mammary artery (LIMA) play a role in coronary artery bypass grafting?

Answer 53

The LIMA is often used as a graft in bypass surgery, where it is redirected to attach to coronary arteries downstream to bypass blockages and restore blood flow.

Question 54

Describe the types of bypass grafts used in coronary artery bypass grafting.

Answer 54

There are free grafts, often using saphenous veins, and fixed arterial grafts like the left internal mammary artery (LIMA) used in coronary artery bypass surgery.

Question 55

Do saphenous vein grafts in coronary artery bypass grafting last a lifetime?

Answer 55

Saphenous vein grafts typically last around 5 to 10 years before deteriorating, leading to potential recurrence of symptoms and the need for further intervention.

Question 56

Define angiogram and its role in coronary artery bypass grafting.

Answer 56

An angiogram is a medical imaging technique used to visualize blood vessels, including those in the heart, to help guide surgeons in identifying blockages and planning bypass grafting procedures.