11 chronic ischemic heart disease

Question 1

what are the chronic ischemic heart disease ?

Answer 1

stable angina pectoris
silent myocardial ischemia
causes atleast 7 percent of lumen obstruction
has not ruptured artheroscleroti plaque

only as world increases the blood flow becomes not sufficient anymore leading to angina

patent take rest or nitroglycerin the workload f the heart decreases

Question 2

what is the clinical presentation of chronic ischemic heart disease ?

Answer 2

duration 5-15 mins- same every time , same intensity , radiates to same location

Question 3

what can be diagnosis of chronic ischemic heart disease ?

Answer 3

ST segment depression
at j point beginning of affected area

T wave negative symmetrically ascending and descending limbs

egg after attack normal - because only causes reversible damage

echcardiogram ultrasound - during attach
segemntal kinetic diturbances
impaired left ventricular relaxation
outside attack normal

an attack of stable angina is provoked - treadmill stress with simultaneous egg recordings

perfusion myocardial scintography

invasive testing - selective coronary artery angiography
inserted into femoral artery the catheter
introduce contrast die to coronary artery - x ray

Question 4

what is the treatment of patient with stable angina attacks ?

Answer 4

anti platelet drugs
aspirin - gi ulcerations and bleeding
contraindicated - peptic ulcers,
Reye’s syndrome, a rare but severe illness characterized by acute encephalopathy and fatty liver

clopidrogel if aspirin allergy
thrombotic thrmobocytopnic purpura

lipid lowering

statin
permanent duration again - because of rebound phenomena esp in statins
fluvastatin
rabhdomyolysis , myaligia
no interaction with CYP3A4 - but simvastatin does

fibrates (fenofibrate) with nicotonic acid
fenofibrate - nephro and hepatotoxicity

ACE-I
—————–
betablockers

symptom reducing

symtoms are relieved by reduced oxygen demand
preload reduction
after load rduction
heart rate and contractility reduction

preload reduction
short acting nsublingual nitrates

long acting - mononitrate , denigrates

causes headaches - due to increased intrcranila pressure
contraindicated when increased intraocular pressure

after load reduction -
ACE-I
calcium channel blockers

heart rate reduction
B 1 selective blockers

STENT - only done when persisting symptoms

mediteranian diet