SIHD & Angina 2

Question 1

Describe the process of arterial grafting in coronary artery bypass surgery.

Answer 1

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.

Question 2

What is the advantage of using an arterial graft, such as LIMA, in bypass surgery?

Answer 2

Arterial grafts, like LIMA, are more durable and less prone to atherosclerosis compared to vein grafts, potentially lasting a lifetime.

Question 3

Define the term ‘free graft’ in the context of coronary artery bypass surgery.

Answer 3

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.

Question 4

How does the structure of veins differ from arteries in the context of grafting for bypass surgery?

Answer 4

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.

Question 5

Describe the role of the left internal mammary artery (LIMA) in arterial grafting for coronary artery bypass surgery.

Answer 5

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.

Question 6

Describe the therapeutic options mentioned for patients with coronary artery disease.

Answer 6

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.

Question 7

What are some examples of disease-modifying therapies discussed in the content?

Answer 7

Examples of disease-modifying therapies include statins, antiplatelets, antianginals, beta blockers, and calcium antagonists.

Question 8

How is coronary revascularization used in managing patients with coronary artery disease?

Answer 8

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.

Question 9

Define stable angina and its key characteristics as mentioned in the content.

Answer 9

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.

Question 10

What is the significance of taking a full detailed history for patients presenting with chest pain, according to the content?

Answer 10

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.

Question 11

Describe the symptoms associated with stable angina.

Answer 11

Exertional symptoms like heaviness and tightness that improve with rest and GTN, more common in patients with high atherosclerotic cardiovascular risk.

Question 12

What is the recommended approach for patients with ongoing symptoms of stable angina after medical therapy?

Answer 12

Revascularization to improve coronary blood flow, with options like coronary artery bypass grafting over balloon and stents for some individuals.

Question 13

Define the diagnostic evaluation process for stable angina.

Answer 13

Includes non-invasive tests to look for symptoms reproduction or myocardial ischemia, and invasive angiography if ongoing symptoms or concerns persist.

Question 14

How does medical therapy help in managing stable angina symptoms?

Answer 14

It helps alleviate symptoms, but for patients with persistent symptoms, revascularization may be offered to improve coronary blood flow.

Question 15

Describe the potential benefits of coronary artery bypass grafting over balloon and stents for some patients with stable angina.

Answer 15

A small group may benefit prognostically from a lifespan perspective, although there are small risks and no lifetime guarantee.

Question 16

Describe the cornerstone features of stable angina symptoms.

Answer 16

Symptoms occur on exertion, are relieved by rest reproducibly, and respond rapidly within seconds to minutes to GTA.

Question 17

What is an essential part of evaluating someone for stable angina?

Answer 17

A 12 Lead ECG, which needs to be studied and reported.

Question 18

How can investigations for stable angina be categorized?

Answer 18

Into those that reproduce symptoms (like an exercise test), show myocardial ischemia, or show consequences of ischemia.

Question 19

Define disease modifying therapy for atheromatous coronary artery disease.

Answer 19

It involves treatments like statins and antiplatelet agents to modify the progression of the disease.

Question 20

Do patients with high cardiovascular risk factors have a higher likelihood of stable angina?

Answer 20

Yes, patients with excess cardiovascular risk or high cardiovascular risk are more likely to have stable angina.

Question 21

Describe the treatment approach for patients with symptoms requiring antiantinals.

Answer 21

Patients may need more than one antianginal medication to control their symptoms, typically focusing on those that reduce arterial blood pressure.

Question 22

What are the two main methods for coronary revascularization mentioned in the content?

Answer 22

Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG).

Question 23

Define the purpose of coronary revascularization in patients with ongoing symptoms.

Answer 23

It aims to alter coronary blood flow to restore it to normal, improving symptoms and potentially prognosis.

Question 24

How is coronary artery bypass grafting (CABG) typically reserved in clinical practice?

Answer 24

It is often reserved for patients with multivessel or severe coronary disease.

Question 25

Describe the potential outcomes and considerations associated with coronary artery bypass grafting (CABG) mentioned in the content.

Answer 25

CABG can improve symptoms and has a small evidence base for improving prognosis, but may require additional medications and pose risks like increased bleeding.