SIHD & Angina 2 Flashcards
Describe the process of arterial grafting in coronary artery bypass surgery.
Arterial grafting involves taking a healthy artery, like the left internal mammary artery (LIMA), and attaching it to the coronary artery downstream from a blockage to improve blood flow.
What is the advantage of using an arterial graft, such as LIMA, in bypass surgery?
Arterial grafts, like LIMA, are more durable and less prone to atherosclerosis compared to vein grafts, potentially lasting a lifetime.
Define the term ‘free graft’ in the context of coronary artery bypass surgery.
A free graft refers to a graft taken from a healthy artery, like the aorta, and attached downstream to bypass a blockage in a coronary artery.
How does the structure of veins differ from arteries in the context of grafting for bypass surgery?
Veins have a different structure and pressure differential compared to arteries, making them less ideal for long-term grafting as they are more prone to deterioration.
Describe the role of the left internal mammary artery (LIMA) in arterial grafting for coronary artery bypass surgery.
LIMA is often used as an arterial graft in bypass surgery, as it is durable, less prone to atherosclerosis, and can significantly improve symptoms for patients.
Describe the therapeutic options mentioned for patients with coronary artery disease.
Therapeutic options include medical therapy like statins, antiplatelets, and beta blockers, as well as coronary revascularization procedures like percutaneous coronary intervention and coronary artery bypass grafting.
What are some examples of disease-modifying therapies discussed in the content?
Examples of disease-modifying therapies include statins, antiplatelets, antianginals, beta blockers, and calcium antagonists.
How is coronary revascularization used in managing patients with coronary artery disease?
Coronary revascularization procedures like percutaneous coronary intervention and coronary artery bypass grafting are used to minimize symptoms and improve outcomes in patients with severe disease.
Define stable angina and its key characteristics as mentioned in the content.
Stable angina, also known as angina pectoris, refers to myocardial ischemia without myocardial necrosis, presenting as chest pain that can be managed with detailed history-taking and appropriate treatment.
What is the significance of taking a full detailed history for patients presenting with chest pain, according to the content?
Taking a detailed history is essential to rule in or rule out symptoms associated with angina, aiding in the diagnosis and management of patients with chest pain.
Describe the symptoms associated with stable angina.
Exertional symptoms like heaviness and tightness that improve with rest and GTN, more common in patients with high atherosclerotic cardiovascular risk.
What is the recommended approach for patients with ongoing symptoms of stable angina after medical therapy?
Revascularization to improve coronary blood flow, with options like coronary artery bypass grafting over balloon and stents for some individuals.
Define the diagnostic evaluation process for stable angina.
Includes non-invasive tests to look for symptoms reproduction or myocardial ischemia, and invasive angiography if ongoing symptoms or concerns persist.
How does medical therapy help in managing stable angina symptoms?
It helps alleviate symptoms, but for patients with persistent symptoms, revascularization may be offered to improve coronary blood flow.
Describe the potential benefits of coronary artery bypass grafting over balloon and stents for some patients with stable angina.
A small group may benefit prognostically from a lifespan perspective, although there are small risks and no lifetime guarantee.
Describe the cornerstone features of stable angina symptoms.
Symptoms occur on exertion, are relieved by rest reproducibly, and respond rapidly within seconds to minutes to GTA.
What is an essential part of evaluating someone for stable angina?
A 12 Lead ECG, which needs to be studied and reported.
How can investigations for stable angina be categorized?
Into those that reproduce symptoms (like an exercise test), show myocardial ischemia, or show consequences of ischemia.
Define disease modifying therapy for atheromatous coronary artery disease.
It involves treatments like statins and antiplatelet agents to modify the progression of the disease.
Do patients with high cardiovascular risk factors have a higher likelihood of stable angina?
Yes, patients with excess cardiovascular risk or high cardiovascular risk are more likely to have stable angina.
Describe the treatment approach for patients with symptoms requiring antiantinals.
Patients may need more than one antianginal medication to control their symptoms, typically focusing on those that reduce arterial blood pressure.
What are the two main methods for coronary revascularization mentioned in the content?
Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG).
Define the purpose of coronary revascularization in patients with ongoing symptoms.
It aims to alter coronary blood flow to restore it to normal, improving symptoms and potentially prognosis.
How is coronary artery bypass grafting (CABG) typically reserved in clinical practice?
It is often reserved for patients with multivessel or severe coronary disease.
