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Stage 4: CSIM 2 > Week 5: Coronary disease > Flashcards

Week 5: Coronary disease Flashcards

1
Q

Which GI conditions presents very similarly to MI

A

Reflux oesophagitis

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2
Q

Why do NSAIDs reduce the anti-platelet effects of aspirin

A

They are competitive inhibitors at the same binding site on COX-1.

But ibuprofen binds reversibly so has shortlived effects.
Aspirin binds irreversibly.

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3
Q

What are the 3 features of typical angina

A
  1. Tight chest pain, may radiate to neck, shoulders, jaw, arms
  2. Precipitated by exercise
  3. Relieved by rest/ GTN in 5min
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4
Q

Diagnostic features of myocardial infarction

A

Troponin >99th percentile +

  1. Ischaemia symptoms
  2. ECG indicating ischaemia
  3. ECG indicating necrosis
  4. New myocardium loss/ regional wall abnormalities in imaging
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5
Q

When should troponin be measured in hospital

A
  1. On admission

2. 6-9h later

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6
Q

What troponin levels indicate an MI

A

Troponin >99th percentile +

Rise/ fall of >20% on second blood test

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7
Q

Describe the pathophysiology of atherosclerosis

A
  1. Lipid is deposited in vascular wall
  2. Macrophages enter vascular wall and take up lipid, turn into foam cells
  3. Break down of foam cells releases lipids into vascular wall
  4. Fibrin, platelets, RBC attracted to site
  5. Fibroblasts and smooth muscle cells wall off the lipid core
  6. Plaque grows bigger
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8
Q

How would a cardiac event involving an OCCLUSIVE thrombus show on ECG

A
  • pathological Q waves

- ST elevation

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9
Q

How would a cardiac event involving a SUB-OCCLUSIVE thrombus show on ECG

A

-ST depression

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10
Q

1st line test used to diagnose angina

A

CT coronary angiography

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11
Q

How does CT coronary angiography pick up plaques in vessels

A

Detects the calcium content in the plaques

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12
Q

1st line drugs used to manage angina

A

Beta blocker or CCB

+GTN spray for episodes of angina

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13
Q

CABG and PCI have pros and cons in different situations. In which situations is CABG preferred?

A

CABG better for:

  • diabetics
  • > 60yo
  • complex 3 vessel disease
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14
Q

How should a STEMI be managed in the cath lab

A
  1. PCI (if eligible)

2. Fibrinolytic drug if PCI cannot be done within 2h

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15
Q

Name some examples of fibrinolytic drugs

A

Streptokinase/

Alteplase

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16
Q

When not to give a patient a fibrinolytic drug

A
  1. If planned PCI

2. If they already had 1 previous dose of fibrinolytic

17
Q

When to do coronary angiography (with follow on PCI if indicated)

A
  • Presenting after >12h of continuing myocardial ischaemia

- intermediate/high risk of CVD found on GRACE score

18
Q

How quickly should coronary angiography be done within admission to hospital

A

Within 96h

19
Q

What changes on an ECG can indicate ischaemia

A

New ST changes/

New LBBB

20
Q

What changes on an ECG can indicate necrosis (death of heart tissue)

A

Pathological Q waves

21
Q

Causes of a raised troponin apart from MI

A
  • PE
  • Sepsis
  • AF
  • LV hypertrophy
  • Post-operation
22
Q

What drugs are given within hospital for unstable angina/ NSTEMI

A
  • Aspirin
  • Fondaparinux (similar to LMWH)
  • Clopidogrel
23
Q

What does the GRACE score predict

A

6 month mortality + risk of future CVS events

24
Q

What is considered a low risk on the GRACE score

A

less than 3%

25
Q

What does the CHADVASC score predict

A

Ischaemic stroke risk

26
Q

What does the HASBLED score predict

A

Bleeding risk

27
Q

What 4 types drugs should a patient be discharged with after an MI

A
  1. ACE inhibitor
  2. Antiplatelets (aspirin + something else)
  3. Beta blocker
  4. Statin
28
Q

Complications post MI

A

DARTH VADER

Death
Arrhythmia
Rupture (ventricular free wall/ septum/ papillary muscles)
Tamponade
Heart failure
Valve disease
Aneurysm of ventricle
Dressler's syndrome (pericarditis)
Embolism
Regurgitation of mitral valve
29
Q

What does it mean if:

Troponin on admission <99th percentile + pain >6h

A

Not an ACS

30
Q

What does it mean if:

Troponin on admission <99th percentile + pain <6h

A

Uncertain

Do another troponin after 3h

31
Q

What does it mean if:

Troponin on admission >99th percentile +
second troponin shows change <3ng/L

A

Not an ACS

32
Q

What does it mean if:

Troponin on admission >99th percentile +
second troponin shows change 3-10ng/L or <20%

A

Uncertain

Do another troponin after 6h

33
Q

What does it mean if:

Troponin on admission >99th percentile +
second troponin shows change >10ng/L and >20%

A

ACS

Stage 4: CSIM 2 (47 decks)

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