T3 L7: Ischaemic heart disease

Question 1

What is the Framingham heart study?

Answer 1

Started in 1948, it’s a longitudinal study over 3 generation of participants now. Before the study, risk factors for IHD were not clear

Question 2

Describe some major findings of the Framingham heart study

Answer 2

1957: High cholesterol and high BP linked to CHD
1961: Risk factors introduced
1962: Smoking linked to CHD
1967: obesity and inactivity linked to CHD
1972: diabetes linked to CHD

Question 3

What is atherosclerosis?

Answer 3

Fatty deposit build up in arteries (hardening of arteries)

Question 4

Name 3 acute coronary syndromes

Answer 4

Unstable angina, NSTEMI, STEMI. They are characterised by the development of a thrombosis. Are not relieved with sublingual GTN

Question 5

What is the difference between stable and unstable angina?

Answer 5

Stable angina is caused by a fixed atheromatous stenosis but unstable angina is caused by a dynamic obstruction due to plaque rupture

Question 6

What are the 3 characteristics of typical angina?

Answer 6

Substernal chest discomfort of characteristic quality and duration, provoked by exertion or emotional stress, relieved by rest or nitrites within minutes

Question 7

How do beta-blockers treat angina?

Answer 7

They slow heart rate so reduce the oxygen demand of the heart

Question 8

How do Ca2+ blockers treat angina?

Answer 8

Causes less Ca2+ to enter vessels which causes them to relax and allows the heart to get more oxygen

Question 9

What is Ivabradine and how does it work?

Answer 9

A hyperpolarization-activated cyclic nucleotide-gated (HCN) channel blockers. It works by slowing the heart rate so the heart can pump more blood through the body each time it beats

Question 10

What is Nicorandril and how does it work?

Answer 10

A potassium-channel activator. It works by relaxing and widening your blood vessels, which increases the supply of blood and oxygen to your heart

Question 11

What is Ranolazine and how does it work?

Answer 11

Reduces the flow of sodium ions into the heart muscle cells. This interferes with the sodium-dependent calcium channels through which calcium ions normally enter the cells therefore improving blood flow

Question 12

What is Trimetazidine and how does it work?

Answer 12

A cytoprotective drug that normalizes metabolic disturbances in low-flow ischemia by inhibiting fatty acid oxidation

Question 13

What are long-acting nitrites and how do they work?

Answer 13

They widen your blood vessels to increase blood flow to the heart. Long acting-nitrates are in tablet form and are different to GTN spray.

Question 14

What is GTN spray?

Answer 14

Glyceryl trinitrate (GTN) is a spray used to relieve angina. It’s a long-acting nitrite

Question 15

What is the clinical significance of Troponin in the blood?

Answer 15

It’s released following injury to the heart and is used a diagnostic marker for MI. It can remain in the blood stream for 2 weeks

Question 16

What type of angina doesn’t cause elevated Troponin levels?

Answer 16

Unstable angina

Question 17

How are MI, STEMI, and NSTEMI differentiated?

Answer 17

By their characteristic abnormalities on an ECG

Question 18

What does an ST elevation on an ECG indicate about the occlusion?

Answer 18

That it’s a complete coronary occlusion

Question 19

What does an ST depression and variable T wave on an ECG indicate about the coronary occlusion?

Answer 19

An incomplete occlusion

Question 20

What are the 3 steps of platelet activation?

Answer 20

Adherence, activation, and aggregation

Question 21

What is the function of thrombin?

Answer 21

It causes platelet aggregation

Question 22

What are the symptoms of the elderly and diabetic with acute coronary syndromes?

Answer 22

Breathlessness, Nausea or vomiting, sweating and clamminess

Question 23

What is the dosage of Aspirin given for management of acute coronary syndromes?

Answer 23

300mg at first and then a 75mg maintenance dose

Question 24

What is Clopidogrel and how does it work?

Answer 24

A P2Y2 receptor antagonist. It makes platelets less ‘sticky’ by decreasing the amount of tissue factor produced so the coagulation cascade can’t happen

Question 25

What is prasugrel and how does it work?

Answer 25

A P2Y2 receptor antagonist that prevents coagulation

Question 26

What is Ticagrelor and how does it work?

Answer 26

A P2Y2 receptor antagonist that prevents coagulation

Question 27

What are secondary prevention tharapies?

Answer 27

It’s what the patient leaves the hospital with. includes medication like statins and life style changes

Question 28

Which is more of an emergency, a STEMI or an NSTEMI?

Answer 28

A STEMI because it’s a complete occlusion

Question 29

Why is a coronary artery bypass surgery never performed on those with ST elevation?

Answer 29

Because they’re not stable enough

Question 30

Which 2 vessels can be used for a coronary artery bypass surgery?

Answer 30

The internal mammary artery from chest or the saphenous vein from the leg