B.4 Manifestations and Evaluation of Ischemic Heart Disease

Question 1

B.4 Manifestations and Evaluation of Ischemic Heart Disease

Defintions

Answer 1

Ischemic Heart Disease refers to the condition caused by plaque accumulation in the coronary arteries. Generally, this leads to an inadequate blood supply to the heart muscle.

• Coronary artery disease (CAD): A common cause of Ischemic Heart Disease (IHD) is the narrowing or blockage of coronary arteries, which results in a mismatch between the oxygen supply and demand of the myocardium.
• Angina: Chest pain caused by myocardial ischemia (tissue death from insufficient blood flow) due to narrowing (from thrombus or spasms, known as Prinzmetal angina) of the coronary artery.
• Stable angina: A type of angina that typically occurs during physical activity, emotional stress, or exposure to cold and usually subsides within 20 minutes after taking nitroglycerin.

Question 2

B.4 Manifestations and Evaluation of Ischemic Heart Disease

Clinical

Answer 2

Asymptomatic or silent myocardial infarction (MI) in diabetes mellitus (DM)

Angina: Radiating pain that may include paresthesia (tingling, tickling, or burning sensation) and numbness in the skin, with accompanying loss of sensation in the arms, shoulders, or wrists

Dyspnea (shortness of breath)

Anxiety

Response to sublingual nitrates (complete, partial, or no response)

Ischemic ECG changes at rest; if none are present, stress or exercise ECG may be necessary

Arrhythmia

Sudden cardiac death

Question 3

B.4 Manifestations and Evaluation of Ischemic Heart Disease

DX

Answer 3

Family history, medical history, and physical examination

Assessment of risk factors and predisposing causes (e.g., hyperlipidemia, diabetes mellitus, anemia, thyrotoxicosis)

Electrocardiogram (ECG): ST depression, flat/inverted T waves, signs of previous myocardial infarction; Holter monitoring may be utilized

Exercise ECG (stress test), echocardiogram/echo stress test

Chest X-ray (CXR)

Exercise radioisotope test for myocardial scintigraphy

Percutaneous coronary intervention (PCI) and intravascular ultrasound (IVUS)

Magnetic Resonance Imaging (MRI) / Computed Tomography (CT)