Clinical Symposium 7 - Ischaemic Heart Disease& Heart Failure

Question 1

What is ischemic heart disease?

Answer 1

Cardiac muscle dysfunction due to inadequate blood supply to the myocardium, caused by:

Cardiac artery permanent obstruction (by thrombus), or
Cardiac artery lumen transient or permanent narrowing (by atheroma or
myocardial hypertrophy

Question 2

Significance of IHD?

Answer 2

Leading cause of death globally
Trend: fewer IHD deaths in UK and USA
IHD mortality has reduced thanks to:
Prevention (risk modification)
Improved diagnosis and treatment

Question 3

Prevention of HD?

Answer 3

No smoking
Lose/manage weight
Lower blood pressure
Encourage exercise
Calculate risk and ?prescribe

Question 4

What does the NIH Framingham risk score involved in its calculation?

Answer 4

Age
Gender
Total cholesterol
HDL cholesterol
Smoker
Systolic blood pressure

Question 5

What are some other risk calculations used?

Answer 5

SCORE
QRISK3

Question 6

Myocardial necrosis pathogenesis?

Answer 6

Myocardial necrosis (of coagulative type) begins at approximately 30 minutes after coronary occlusion with classical features of an MI (which we’ll discuss) seen after reduced perfusion for an extended interval of 2-4 hours…important to know that if you reperfusion the myocardium after a brief period of reduced perfusion (usually taken as <20 minutes0 then you can prevent cell loss…basis for early detection and rapid treatment of MI to reperfusion where possible, reduce the area at risk and limit the infarct size in a bid to retain function.

Question 7

Types of Ischaemic heart disease syndromes?

Answer 7

Angina pectoris
Typical/stable
Crescendo/unstable
Variant/Prinzmetal
Acute coronary syndrome
Acute myocardial infarction (+/- ECG ST elevation)
Crescendo/unstable angina
Sudden cardiac death
Chronic ischaemic heart disease

Question 8

Acute ischaemia characteristics?

Answer 8

Atheroma + acute thrombosis/haemorrhage
Lipid rich plaques at most risk
Regional transmural myocardial infarction (STEMI)