Coronary Artery Disease

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Questions and Answers

Which statement correctly describes the characteristics of a stable plaque in coronary artery disease?

It causes chronic fixed narrowing of the coronary lumen. (correct)

It consists primarily of inflammatory cells and platelets.

It is likely to rupture, leading to acute coronary syndrome.

It has a thin cap and a large lipid core.

Which of the following is NOT considered a modifiable risk factor for developing coronary artery disease?

Old age (correct)

Hypertension

Diabetes mellitus

Smoking

What primarily contributes to the formation of coronary artery plaques?

Nutritional deficiencies.

Excessive blood flow to the coronary arteries.

Deposition of lipids and haemodynamic shear stress. (correct)

Increased physical activity.

What is the primary clinical presentation associated with unstable plaques in coronary artery disease?

Rupture leading to acute coronary syndromes. Signup and view all the answers

Which statement is true regarding the differences between stable and unstable coronary plaques?

Unstable plaques have a thin cap and are more likely to cause acute events. Signup and view all the answers

What mechanism is primarily responsible for myocardial ischemia in coronary artery disease?

Coronary artery atherosclerosis. Signup and view all the answers

Which of the following is a common mechanism by which acute coronary syndromes can occur?

Plaque rupture and thrombosis. Signup and view all the answers

Which of the following conditions is associated with stable angina due to chronic coronary artery disease?

Chronic fixed narrowing of the coronary lumen. Signup and view all the answers

Which of the following is NOT considered a high-risk feature in the assessment of acute coronary syndrome?

Normal ejection fraction Signup and view all the answers

What is the primary aim of treatment for STEMI?

To restore coronary blood flow to the occluded artery Signup and view all the answers

Which adjunctive therapy is specifically recommended for all ACS patients?

Beta-blockers Signup and view all the answers

For patients who present to medical contact after the reperfusion window for STEMI, which option is the LEAST relevant?

Lifestyle modification Signup and view all the answers

Which specific loading dose of clopidogrel is indicated prior to PCI in STEMI management?

600 mg orally Signup and view all the answers

Which condition is NOT an indication for the use of ACE inhibitors in ACS patients?

Premature ventricular contractions Signup and view all the answers

Which of the following is a contraindication for performing Primary Percutaneous Coronary Intervention (PPCI)?

Active peptic ulcer Signup and view all the answers

What is the recommended management for a patient with STEMI who cannot receive PPCI within 120 minutes?

Thrombolytic therapy Signup and view all the answers

What primary symptom characterizes angina pectoris?

Chest pain due to myocardial ischemia Signup and view all the answers

Which of the following descriptions best fits the character of angina discomfort?

Pressure, tightness, or heaviness in the chest area Signup and view all the answers

What is the typical duration of angina discomfort?

Brief, no more than 10 minutes Signup and view all the answers

Which scenario is most likely to trigger an episode of angina?

Walking up an incline or in cold weather Signup and view all the answers

Which classification of angina severity describes a situation where ordinary activity does not cause angina?

Class I Signup and view all the answers

What differentiates typical angina from atypical angina?

Typical angina meets all three specific characteristics Signup and view all the answers

In what situation may shortness of breath occur concerning angina?

As a sole symptom of Spontaneous Coronary Artery Dissection (SCAD) Signup and view all the answers

Which of these conditions would be considered non-anginal chest pain?

Chest pain that lacks most of the typical characteristics Signup and view all the answers

What is a characteristic feature of stable angina?

The provoking effort remains constant. Signup and view all the answers

Which of the following is NOT a type of myocardial infarction (MI)?

Type 3 MI Signup and view all the answers

Which factor would most likely indicate unstable angina rather than stable angina?

Chest pain occurring at rest. Signup and view all the answers

What is a common trigger for Type 2 myocardial infarction?

Severe tachyarrhythmias. Signup and view all the answers

Which symptom is least likely to be associated with angina?

Sharp stabbing pain in the stomach. Signup and view all the answers

Which condition could lead to reduced myocardial perfusion resulting in Type 2 MI?

Coronary artery spasm. Signup and view all the answers

During a clinical examination for acute coronary syndrome (ACS), which statement is true?

Vital signs should be assessed quickly. Signup and view all the answers

What is a typical relieving factor for stable angina?

Use of SLG nitrates. Signup and view all the answers

What is the main mechanism of action of nitrates in managing angina?

Coronary arteriolar and venous vasodilation. Signup and view all the answers

Which class of drug acts directly on the heart to reduce heart rate and contractility?

B-blockers. Signup and view all the answers

In patients with stable coronary artery disease, which medication is recommended for primary prevention of further cardiovascular events?

Low-dose aspirin. Signup and view all the answers

What is the primary role of calcium channel blockers in the pharmacological management of stable coronary artery disease?

Reduce peripheral vascular resistance and induce vasodilation. Signup and view all the answers

Which of the following statements best describes the effect of ivabradine?

Lowers heart rate without affecting blood pressure. Signup and view all the answers

Statins are recommended for which group of patients with stable coronary artery disease?

All patients with established stable coronary artery disease. Signup and view all the answers

Which drug class is effective in preventing formation of coronary thrombus?

Antiplatelet agents. Signup and view all the answers

ACE inhibitors are particularly indicated in patients with SCAD who also have which condition?

Co-existing hypertension, LVEF ≤ 40%, diabetes, or CKD. Signup and view all the answers

Study Notes

Overview of Coronary Artery Disease (CAD)

CAD primarily results from coronary artery atherosclerosis, causing myocardial ischemia.
Acute coronary syndromes (ACS) arise from unstable plaques, which can rupture and form thrombus.

Risk Factors for CAD

Non-modifiable:
- Age: Increased risk with older age.
- Gender: Males at higher risk until age 50.
- Genetics: Family history of coronary artery disease.
Modifiable:
- Hypertension: Major contributor to CAD.
- Dyslipidaemia: Abnormal lipid levels increase risk.
- Diabetes: Significant risk factor for CAD development.
- Obesity: Associated with various cardiovascular risks.
- Smoking: Directly impacts cardiovascular health.
- Mental stress: Can trigger or exacerbate heart conditions.
- Sedentary lifestyle: Inactivity leads to increased risk.

Pathophysiology of Atherosclerosis

Plaque formation in arteries involves shear stress and lipid deposition.
Plaque structure:
- Stable plaques: Thick caps, small lipid cores, lead to stable angina due to chronic narrowing.
- Unstable plaques: Thin caps, prone to rupture, associated with ACS.

Types of Angina

Stable Angina: Characterized by predictable chest pain with exertion that resolves with rest or nitrates; typically brief.
Unstable Angina:
- Crescendo angina: Increased frequency, duration, and severity.
- Angina at rest, post-ACS, and de novo angina.

Myocardial Infarction (MI)

Type 1 MI: Plaque rupture leading to thrombus formation and arterial occlusion.
Type 2 MI: Results from an imbalance in myocardial oxygen demand vs. supply, influenced by various conditions (e.g., coronary spasm, hypotension).

Clinical Examination

Physical exams may be unremarkable; vital signs assessments are crucial.
High-risk features:
- Low systolic blood pressure (<100 mm Hg).
- Elevated jugular venous pressure.
- Abnormal heart sounds.
- Rales or crackles in lungs.

Management of Acute Coronary Syndromes (ACS)

STEMI Treatment Objectives:
- Rapid restoration of coronary blood flow within 12-24 hours.
- Primary Percutaneous Coronary Intervention (PPCI) is preferred.
Adjunctive Therapy:
- Dual antiplatelet therapy (DAPT): Aspirin combined with a P₂Y₁₂ inhibitor for 12 months.
- Anticoagulants: Unfractionated heparin or enoxaparin.
Additional Drug Therapy:
- Beta-blockers for patients, especially with reduced ejection fraction.
- High-intensity statin therapy to lower LDL cholesterol.
- ACE inhibitors or ARBs for high-risk patients (heart failure, diabetes).

Treatment of Chronic Coronary Syndromes

Goals: Alleviate angina and reduce adverse cardiovascular events.
Pharmacological Management:
- Nitrates: For acute and long-term angina relief.
- Beta-blockers: Decrease heart rate and myocardial oxygen demand.
- Calcium Channel Blockers: Primarily for vasodilation.
- Ivabradine: Selectively lowers heart rate without affecting blood pressure.
Event Prevention:
- Antiplatelet Agents: Aspirin and alternatives if allergic.
- Statins: Recommended for all patients with established SCAD.
- ACE inhibitors: For patients with hypertension or diabetes, unless contraindicated.

Angina Characteristics

Typical Angina: Specific location (retrosternal), pressure-like pain, triggered by exertion, relieved by rest/nitrates.
Atypical Angina: Meets two criteria of typical angina.
Non-anginal Chest Pain: Lacks typical characteristics.

Classification of Angina Severity

Class I: No angina with ordinary activity.
Class II: Slight limitation during ordinary activities.

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Description

This quiz focuses on the pharmacological approaches for managing stable coronary artery disease, particularly the use of anti-ischaemic drugs like nitrates. Participants will learn the mechanisms by which these medications relieve angina pain and prevent further cardiovascular events. Understanding these interventions is crucial for effective patient care in cardiovascular health.