Stable Ischaemic Heart Disease Flashcards

1
Q

What is the difference between angina and a heart attack?

A

Myocardiac ischaemia without myocardial necrosis

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2
Q

What is the pathophysiology of myocardial ischaemia and anginal symptoms?

A

Mismatch between supply of O2 and metabolites to myocardium, and the demand.

Most commonly due to reduction in coronary blood flow caused by:

  • obstructive coronary atheroma (common)
  • coronary artery spasm (uncommon)
  • coronary inflammation/arteritis (rare)

Uncommonly due to pathologically increased myocardial O2 demand such as in LVH and hypertension, aortic stenosis

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3
Q

What percentage of the lumen is usually obstructed in stable angina?

A

> 70%

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4
Q

What are is the typical presentation in SIHD?

A
Retrosternal pain
Tight band/crushing chest pain
Radiates to neck and/or jaw, down arms
Worse on exertion
Rest helps
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5
Q

What features may make angina a less likely diagnosis?

A
Sharp/stabbing pain
Associated with body movements or respiration
Very localised pain
Superficial pain
No pattern to pain
Begins some time after exercise
Lasts for hours
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6
Q

What are risk factors in SIHD/coronary artery disease?

A

Non modifiable:

  • age
  • sex
  • family history/genetics

Modifiable:

  • smoking
  • exercise/diet
  • diabetes
  • hypertension
  • hyperlipidaemia
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7
Q

What investigations might you do in suspected IHD?

A
ECG
- normal in >50% of cases
CXR
Bloods - FBC, lipid profile, fasting glucose, electrolytes, liver and thyroid tests
ETT
- negative result doesn't exclude
Myocardial perfusion imaging
- superior to ETT, expensive
CT coronary angiogram
Invasive angiogram
- positive ETT
- diagnosis not clear
- young cardiac patients
- lifestyle with risk
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8
Q

How might SIHD be scored?

A

Canadian classification of angina severity (CCS)

I - symptoms only on significant exertion
II - slight limitation of ordinary activity, multiple flights of stairs
III - marked limitation, symptoms on short walks or single flights of stairs
IV - symptoms on any activity e.g. washed/dressed

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9
Q

How might you treat SIHD?

A

Address risk factors

Limit disease progression

  • Statins (total cholesterol >3.5mM/L)
  • ACEi
  • Aspirin

Address symptoms:

  • Beta-blockers (target HR <60)
  • CCB (vasodilatory and rate limiting)
  • Ik channel blockers
  • Nitrates
  • K+ channel blockers

PCI/CABG

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10
Q

If a stent is placed, what medication is taken after?

A

Aspirin

Clopidogrel

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