L 38

Question 1

How is angina usually diagnosed?

Answer 1

With a clinical picture and a cardiac stress test (+ECG)

Question 2

What is the purpose of the treadmill test?

Answer 2

It is a stress test to put the heart under stress to identify signs of ischaemia or AF

Question 3

ACS signs and symptoms?

Answer 3

• 20+ mins of substernal chest pain, often at rest. Pain can radiate to shoulder, down left arm, back, and jaw
• Increased cardiac enzymes
• Thrombus visualised during angiography
• ECG may show ST segment elevation or depression, T wave inversion and maybe STEMI

Question 4

ACS may also be accompanied by

Answer 4

Dyspnoea, nausea, vomiting, diaphoresis

Arrhythmias, tachycardia, bradycardia, heart block

Question 5

What is an example of a cardiac enzyme increased in the plasma during a cardiovascular event?

Answer 5

Troponin

Question 6

Non-pharmacological treatments for IHD

Answer 6

Nutritional advice
- Increase fruit/vege/grains/low fat dairy/fish/legumes, poultry etc
- Reduce salt if BP elevated and sugar
Regular physical activity/weight loss
Moderation of alcohol consumption
Smoking cessation!!!!

Question 7

5x treatment goals of angina

Answer 7

1. Alleviate acute symptoms of angina
2. Prevent recurrent symptoms of angina
3. Prevent progression of the disease (e.g ACS)
4. Reduce complications of IHD
5. Avoid or minimise adverse treatment effects.

Question 8

Treatment strategy of angina:

Is a 5 step loop:

Answer 8

Angina symptoms

• -> diagnostic workup (history, stress test, angiogram)
• -> control risk factors
• -> primary and secondary prevention (lifestyle modifications, anti-platelet therapy, B-blocker, statins)
• -> Anti-anginal therapy (B blocker, CCB, nitrates)
• -> And if angina symptoms reoccur, do the loop again.

Question 9

Short term treatment goals of ACS x4

Answer 9

• Early restoration of blood flow to prevent MI
• Prevention of coronary artery re-occlusion death and other MI complications
• Ischaemic discomfort relief
• resolution of ST segment and T-wave changes on ECG

Question 10

Long term treatment goals of ACS x3

Answer 10

• Control of CV risk factors
• Prevention of additional CV events
• Improvement in QoL

Question 11

ACS short term treatment strategy x4 steps

Answer 11

1. Oxygen, morphine, nitrates (IV/inhaled)
2. Revascularisation (e.g PCI, emergency CABG, fibrinolytics. TIME IS MUSCLE)
3. Antiplatelets (aspirin +/- clopidogrel or ticagrelor)
4. Anticoagulants (UFH or enoxaparin)

Question 12

What does “time is muscle” mean

Answer 12

The more time spent before treating the patient for ACS (wasted time), the more muscle that will die in the heart. This increases complications.

Question 13

ACS long term treatment strategy x2 steps

Answer 13

1. Control of CV risk factors
2. Aspirin (+clopidogrel/ticagrelor for 6-12months) +B blocker +statin +potentially ARB/ACEI (to prevent left ventricular hypertrophy)

Question 14

What is a CABG?

What does it allow for?

Answer 14

Coronary artery bypass graft.
It is a surgical procedure whereby a blood vessel is grafted between the aorta (the main artery leading from the heart) and the coronary artery, or arteries leading to the heart muscle.
This allows the blood to divert/bypass blocked arteries and restores blood flow to the heart muscle.

Question 15

What are the mainstays for pharmacological angina treatment?

Answer 15

Aspirin + B-blocker + vasodilator (nitrate +/- CCB) + statin
Mainstays of short term ACS treatment
Morphine, revascularisation (PCI/fibrinolytics/CABG), antiplatelets, anticoagulants and vasodilators.

Question 16

Mainstays of long term ACS treatment?

Answer 16

Aspirin (+ clopidogrel/ticagrelor for 6-12months), B blocker, statin, and ACEI
If angina symptoms, add a vasodilator (nitrate
+/- CCB)

Question 17

Why is an ACEI used in ACS long-term treatment?

Answer 17

To prevent left ventricular hypertrophy from the heart working too hard.