IHD

Question 1

Definition

Answer 1

occurs when there is an imbal. btwn supply of O2 & myocardial demand

Question 2

epidemiology

Answer 2

Men: Women= 4:1 Peak incidence men age 50 – 60 years, female age 60 – 70 years. It‘s the most common, serious, chronic, life-threatening illness in USA. causes > deaths & disability

Question 3

etiology

Answer 3

1. atherosclerosis of the coronary arteries
2. Obstruction : atheroma,thrombosis,spasm,embolus,coronary stenosis,coronary arteritis in SLE
3. ↓ O2 blood to myocardium: anemia, ↓ coronary perfusion, carboxyhaemoglobulinaemia
4. ↑ demand O2 due to ↑ cardiac output ( thyrotoxicosis)/ myocardial hypertrophy (aortic stenosis/HPT)
5. Abnorm constriction/failure of norm dilation of coronary resistance vessels
6. changes in the blood coagulating and anticoagulating systems.

Question 4

risk factors

Answer 4

Risk factors :
- age,
- male sex,
- hyperlipidaemia,
- hypertension,
- excessive alcohol intake,
- obesity,
- lack exercise,
- gout,
- contraceptive pills,
- homocysteinaemia,
- ↑LDL,↓HDL,
- smoking
- fatty food, stress,
- endocrine disturbance
- hereditary predisposition
- heightened coagulability of the blood
- diabetes mellitus
- familial hypercholesterolemia

Question 5

pathogenesis

Answer 5

1. narrowing of coronary arteries by plaque formation (atherosclerosis) → fissuring, thrombosis → obstrucn, coronary b.flow ↓ → reduces myocardial perfusion → myocardial ischemia
2. Disturbances of vascular endothelium func (local ctrl of vascular tone, maintenance of a/coagulant surf, defense against inflamn cells) causes inappropriate constricn, luminal clot formation ,abnorm interacn wit monocytes & platelets
3. ↓ in luminal diameter of arteries causes hemodynamically significant stenosis → smaller distal intramyocardial arteries & arterioles are max dilated → any ↑ in myocardial O2 demand provokes ischemia

Question 6

classifications

acute chronic, location, involve heart muscles, duration

Answer 6

1. Acute : Angina pectoris, Myocardial infarction, Sudden coronary death
   Chronic : Diffuse /post-infarct cardiosclerosis, Arrythmia, Heart failure (CHF)
2. Acc to location : Ant, Post, Lat, Interventricular wall, large(diffuse)
3. Acc to involvement of heart m : Subendocardial, transmural, intramural
4. Acc to duration : Transient ischemia(angina pectoris), Prolonged ischemia ( myocardial necrosis & scarring)
   AP – new onset, stable (I, II, III, IV), progressive exertional, variant / stable, unstable MI - transmural, non transmural

Question 7

primary prophylaxis

Answer 7

• Exercise
• Stop smoking
• Diet: low cholesterol, sugar, unsaturated fat, low salt
• Adequate rest and avoid chronic stress
• Stop using of contraceptive pill
• Stop alcohol consumption
• Always check blood pressure, glucose test. (medical check up frequently)
  Treatment of risk factor / disease eg: oral hypoglycemic agent for DM