2. IHD Flashcards
Ischaemia
is a restriction of blood supply to tissues, causing a shortage of oxygen that is needed for cellular metabolism (to keep tissue alive).
diagnosing IHD
Ischaemic heart disease is usually diagnosed after a risk
assessment and some further tests
Medical history, family history and your lifestyle will be recorded.
Followed by a blood test to check the cholesterol level.
Further tests may include:
Treadmill test
Radionuclide scan - Imaging CT scan - Imaging MRI scan - Imaging Coronary angiography ECG X-Rays Echocardiogram
Rapid access chest pain clinic
The rapid access chest pain clinic (RACPC)
provides a quick and early specialist cardiology
assessment for patients with new onset of exertional
chest pain thought likely to be angina, and for
patients not currently under a cardiologist who have
known ischaemic heart disease and worsening
symptoms, who need urgent assessment.
A healthcare assistant/nurse will measure your
blood pressure, pulse, height and weight. You will
then have an electrocardiogram followed by a range
of tests
You will see the cardiologist who will discuss your medical history and examine you. Blood tests Chest X-ray CT coronary angiogram Echocardiogram Stress echocardiogram Myocardial perfusion scan ( a special heart X ray) 24hr ECG also called a Holter monitor Coronary angiogram Cardiac MRI An Exercise ECG test which involves walking on a
treadmill at increasing speed while your pulse, blood
pressure and heart trac are monitored
drugs used to treat someone with IHD
Antiplatelet drugs Statins Nitrates Beta blockers Calcium channel blockers ACE inhibitors
how IHD develops
Cholesterol particles build up on the walls of the artery leading to deposits known as plaque or atheroma in a process of atherosclerosis. This plaque leads to the narrowing of the arteries. This can take place anywhere in the body and start to happen as early as your 30’s.
Atherosclerosis is a potentially serious condition where arteries become clogged with fatty substances called plaques, or atheroma. These plaques cause the arteries to harden and narrow, restricting the blood flow and oxygen supply to vital organs, and increasing the risk of blood clots that could potentially block the flow of blood to the heart or brain.
Cholesterol may be LDL or HDL - low-density or high-density lipoprotein. LDL is bad as it takes your cholesterol to your arteries where it may collect in the vessel walls. HDL is taken to the liver where it is removed from the blood. HDL is good.
risk factors how IHD
Smoking (increase formation of plaque and makes it more likely for blood to clot, nicotine also increases heart rate), hypertension, high cholesterol, diabetes, physical inactivity, stress, menopause (mostly related back to cholesterol levels, heart health and hypertension).
symptoms of IHD
IHD develops slowly over time and the symptoms can be different for everyone. Some people don't know they have IHD before they have a heart attack. Angina is the term used to describe the most common symptoms. These include: chest pain shortness of breath pain travelling through the body feeling faint nausea. Some other symptoms include: Oedema in legs and feet Pain in neck or jaw Cough – caused by fluid in lungs
primary vs secondary prevention
primary - lifestyle changes
secondary - drug treatments
What does GTN stand for?
Glyceryl trinitrate
How is GTN administered to a patient (give two routes)?
- Sublingual (sl)
* Transdermal (top)
Why is GTN not used orally?
- After a drug is swallowed it is absorbed by the GI tract and enters the hepatic portal system
- It would be metabolised by the liver which can substantially reduce the bioavaiability.
- Drugs absorbed through the mucosa of the mouth or through the skin directly enter the systemic circulation, hence sublingual and transdermal routes are preferred.
What is ‘PRN’ when written on a prescription?
‘pro Re Nata’ which means as needed, so is used as and when needed by the patient up to the maximum advised limit
