IHD Flashcards
Define IHD
- Reduced blood supply to the heart muscle
- Also known as coronary artery disease (CAD)
Conditions included in IHD
- Angina pectoris
- Myocardial infarction
- Silent myocardial ischaemia
Define angina pectoris
- Stable angina
- Chest pain and discomfort due to CAD
Define MI
Blood flow to the heart decreases or stops causing damage
Define silent MI
- Evidence of MI in the absence of chest pain or anginal symptoms
IHD is more common in which gender
Males (less difference with increase age)
- Note - death is much greater in men (greater %)
Incidence …. with age
rises
Mortality rates for CVD and CHD are ……
falling (yet still a leading cause of death)
Main aetiology of IHD
Atheromatous plaques
- Obstruct coronary blood flow
- Damage to arterial wall - inflammatory response - leads to plaques
Risk factors for IHD
- High LDLs
- Diabetes and glycosylation
- HTN
- Smoking
- Excess adipose tissue
Pathophysiology for angina
- Imbalance between myocardial O2 supply and demand
- Angina can be caused by coronary vasospasm
Conditions that precipitate angina
- Mental and emotional stress
- Sexual activity
- Tachycardia
- Fever
- Thyrotoxicosis
- Hypoglycaemia
3 classifications of angina
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
3 principles of UNSTABLE angina
- Rest angina
- New onset angina
- Increasing angina
Define STABLE angina
- Chest discomfort occurs predictably and reproducibly at a certain level of exertion
- Relieved with rest or GTN
Who often has atypical presentations of IHD
- Women (65% of the time)
- Diabetics
- Elderly
- Nausea and vomiting
- Mid-epigastric discomfort or sharp chest pain
Lab investigations for IHD
- Haemoglobin (anaemia possible cause)
- Metabolic abnormalities
- Thyrotoxicosis (increased metabolic demands on the heart)
- Hypothyroidism (dyslipidaemia associated)
ECG and IHD
> 50% of ECG are normal
Many reveal abnormalities that are risk factors for IHD
ST depression suggestive of sichaemia
Diagnosis of stable IHD (SIDH)
- Classic history of angina
- 1+ risk factors for atherosclerotic CVD
- Physical exam
- ECG
- Stress testing
DDx IHD
- Aortic dissection
- Pericarditis
- PE
- Pneumothorax
- Pneumonia with pleurisy
- Oesophagitis
- GORD
What is GTN
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)
Treatment of IHD
- Lifestyle
+ antiplatelet
+ anti-anginal (1st beta blockers, 2nd ca channel blockers)
+statin
acute - add GTN
Revasculisation - CABG or PCI
Complications of IHD
- Chronic heart failure
- Stroke
- MI
- Depression
