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INTERNAL MED 3+ conditions > IHD > Flashcards

IHD Flashcards

1
Q

Define IHD

A
  • Reduced blood supply to the heart muscle

- Also known as coronary artery disease (CAD)

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2
Q

Conditions included in IHD

A
  • Angina pectoris
  • Myocardial infarction
  • Silent myocardial ischaemia
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3
Q

Define angina pectoris

A
  • Stable angina

- Chest pain and discomfort due to CAD

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4
Q

Define MI

A

Blood flow to the heart decreases or stops causing damage

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5
Q

Define silent MI

A
  • Evidence of MI in the absence of chest pain or anginal symptoms
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6
Q

IHD is more common in which gender

A

Males (less difference with increase age)

- Note - death is much greater in men (greater %)

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7
Q

Incidence …. with age

A

rises

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8
Q

Mortality rates for CVD and CHD are ……

A

falling (yet still a leading cause of death)

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9
Q

Main aetiology of IHD

A

Atheromatous plaques

  • Obstruct coronary blood flow
  • Damage to arterial wall - inflammatory response - leads to plaques
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10
Q

Risk factors for IHD

A
  • High LDLs
  • Diabetes and glycosylation
  • HTN
  • Smoking
  • Excess adipose tissue
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11
Q

Pathophysiology for angina

A
  • Imbalance between myocardial O2 supply and demand

- Angina can be caused by coronary vasospasm

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12
Q

Conditions that precipitate angina

A
  • Mental and emotional stress
  • Sexual activity
  • Tachycardia
  • Fever
  • Thyrotoxicosis
  • Hypoglycaemia
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13
Q

3 classifications of angina

A

1) Typical angina pain
- substernal, provoked by exercise or stress, relieved at rest or with GTN

2) Atypical angina pain
- 2 of the above

3) Non-anginal pain
- 1 or none of the above

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14
Q

3 principles of UNSTABLE angina

A
  1. Rest angina
  2. New onset angina
  3. Increasing angina
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15
Q

Define STABLE angina

A
  • Chest discomfort occurs predictably and reproducibly at a certain level of exertion
  • Relieved with rest or GTN
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16
Q

Who often has atypical presentations of IHD

A
  • Women (65% of the time)
  • Diabetics
  • Elderly
  • Nausea and vomiting
  • Mid-epigastric discomfort or sharp chest pain
17
Q

Lab investigations for IHD

A
  • Haemoglobin (anaemia possible cause)
  • Metabolic abnormalities
  • Thyrotoxicosis (increased metabolic demands on the heart)
  • Hypothyroidism (dyslipidaemia associated)
18
Q

ECG and IHD

A

> 50% of ECG are normal

Many reveal abnormalities that are risk factors for IHD

ST depression suggestive of sichaemia

19
Q

Diagnosis of stable IHD (SIDH)

A
  • Classic history of angina
  • 1+ risk factors for atherosclerotic CVD
  • Physical exam
  • ECG
  • Stress testing
20
Q

DDx IHD

A
  • Aortic dissection
  • Pericarditis
  • PE
  • Pneumothorax
  • Pneumonia with pleurisy
  • Oesophagitis
  • GORD
21
Q

What is GTN

A

Glyceryl trinitrate

  • sublingual or IV
  • Treat acute episodes of angina
  • Prophylaxis if known cause
  • Works in seconds-minutes
  • Potent vasodilator
  • Increases venous capacity and decreases preload
  • Decreases arterial BP

INDICATIONS

  • ACS with pain
  • Acute cardiogenic pulmonary oedema
  • Autonomic dysreflexia

If failure to relieve symptoms - emergency (unstable or MI)

22
Q

Treatment of IHD

A
  • Lifestyle
    + antiplatelet
    + anti-anginal (1st beta blockers, 2nd ca channel blockers)
    +statin

acute - add GTN

Revasculisation - CABG or PCI

23
Q

Complications of IHD

A
  • Chronic heart failure
  • Stroke
  • MI
  • Depression

INTERNAL MED 3+ conditions (18 decks)

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