Ischemic Heart Disease(IHD) Flashcards
Also called:
Coronary Heart Disease(CHD),
Coronary artery disease (CAD)
Atherosclerotic heart disease
Ischemic Heart Disease
condition in which there is an inadequate supply of blood and oxygen to a portion of the myocardium
typically occurs when there is an imbalance between myocardial oxygen supply and demand
Ischemic Heart Disease
blockage or narrowing (stenosis) of the arteries that supply the heart muscle, often due to a buildup of fatty plaque inside the arteries.
Coronary Artery Disease
In majority of patients, it is caused by atherosclerosis
Coronary Artery Disease
rarely may be due to aortitis
Coronary Artery Disease
rarely may be due to vasculitis
Coronary Artery Disease
rarely may be due to autoimmune connective tissue diseases
Coronary Artery Disease
Heart rate
Is a factor influencing
Cardiac work > myocardial O2 demand
Blood pressure
Is a factor influencing
Cardiac work > myocardial O2 demand
Myocardial contractility
Is a factor influencing
Cardiac work > myocardial O2 demand
L. Ventricular hypertrophy
Is a factor influencing
Cardiac work > myocardial O2 demand
Valve disease e.g aortic stenosis
Is a factor influencing
Cardiac work > myocardial O2 demand
Duration of diastole
Is a factor influencing
Coronary blood flow > myocardial O2 supply
Coronary perfusion pressure
Is a factor influencing
Coronary blood flow > myocardial O2 supply
Coronary vasomotor tone
Is a factor influencing
Coronary blood flow > myocardial O2 supply
Oxygenation
- haemoglobin
- O2 saturation
Is a factor influencing
Coronary blood flow > myocardial O2 supply
• Chest pain or heaviness
• Dyspnoea: exertional, orthopnoea,
paroxysmal nocturnal dyspnoea
• Ankle swelling
• Palpitations
• Syncope
• Intermittent claudication
• Fatigue
Are common symptoms of
Ischemic heart disease
Chest pain or heaviness
A common symptom of ischemic heart disease
Dyspnoea: exertional, orthopnoea,
paroxysmal nocturnal dyspnoea
A common symptom of ischemic heart disease
Ankle swelling
A common symptom of ischemic heart disease
Palpitations
A common symptom of ischemic heart disease
Syncope
A common symptom of ischemic heart disease
+ a sign of cardiovascular diseases
Intermittent claudication
A common symptom of ischemic heart disease
Fatigue
A common symptom of ischemic heart disease
Cardiac arrest
A sign of cardiovascular diseases
Abnormal heart sounds/Murmurs
A sign of cardiovascular diseases
Signs of heart failure
A sign of cardiovascular diseases
Cardiac arrhythmias
A sign of cardiovascular diseases
Normal physical exam doesn’t exclude
IHD
usually occurs on exertion and is relieved by the rest
Angina Pectoris
Typically described as a central, squeezing, pressure, heaviness, tightness or pain in the chest.
Angina Pectoris
Pain may radiate to the jaw, neck, or one or both arms and may be associated with shortness of breath
Angina Pectoris
term that encompasses both unstable angina and myocardial infarction
Acute coronary syndrome (ACS)
characterized by
new-onset or rapidly worsening (crescendo ……….)
on minimal exertion or at rest in the absence of myocardial damage
unstable angina
Fixed stenosis
Demand-led ischemia
Related to effort
Predictable
Symptoms over long term
Stable angina
Dynamic stenosis
Supply-led ischemia
Symptoms at rest
Unpredictable
Symptoms over short term
Unstable angina
Mild chest pain for less than 15 minute and occurs with exertion, with rapid relief once the patient rests, or by taking sublingual nitrate
Stable angina
The amount of exertion necessary to produce the pain
Is in
Stable angina
May progress to Unstable Angina
Stable angina
So the change in the pattern ,severity or character of it must be taken very seriously
Chest pain of moderate to severe degree occurs at rest or wakes up a patient from sleep
Stays for more than 15 minutes
Unstable angina
not relieved by rest or sublingual nitrate
Unstable angina
Have to deal with it as seriously as acute MI, patient should be admitted to CCU
Unstable angina
Site: retrosternal, radiates to arm, epigastrium, neck
Precipitated by exercise or emotion
Relieved by rest, nitrates
Mild/moderate severity chest pain
Anxiety absent or mild
No increased sympathetic activity
No nausea or vomiting
Angina
Site: retrosternal, radiates to arm, epigastrium, neck
Often no obvious precipitant
Not relieved by rest, nitrates
Usually severe chest pain(may be ‘silent’)
Severe anxiety
Increased sympathetic activity
Nausea and vomiting are common
MI
Painless or ‘silent’ myocardial infarction is not uncommon, particularly in
diabetic patients and the elderly
A sign of ischemic chest pain
Levine’s sign
Clenching of fist in front of chest while describing chest discomfort
Levine’s sign
Ischaemia due to fixed atheromatous stenosis of one or more coronary arteries
Stable angina
Ischaemia caused by dynamic obstruction of a coronary artery due to plaque rupture or erosion with superimposed thrombosis
Unstable angina
Myocardial necrosis caused by acute occlusion of a coronary artery due to plaque rupture or erosion with superimposed thrombosis
Myocardial infection
Myocardial dysfunction due to infarction or ischaemia
Heart failure
Altered conduction due to ischaemia or infarction
Arrhythmia
Ventricular arrhythmia
asystole
massive mvocardial infarction
Sudden death
DM-insulin resistance
A modifiable risk factor for IHD
Hypertension
A Modifiable Risk factor for IHD
Smoking
A Modifiable Risk factor for IHD
Hyperlipidemia
A Modifiable Risk factor for IHD
Alcohol
A Modifiable Risk factor for IHD
Obesity
A Modifiable Risk factor for IHD
Sedentary lifestyle
A Modifiable Risk factor for IHD
Diet
A Modifiable Risk factor for IHD
Age 45 yrs or more
An Unmodifiable Risk factor IHD
Male gender
An Unmodifiable Risk factor IHD
History of previous IHD
An Unmodifiable Risk factor IHD
Family history of IHD
An Unmodifiable Risk factor IHD
Serial ECGs
Investigation of Acute Coronary Syndromes
Serial cardiac markers
Investigation of Acute Coronary Syndromes
Oxygen
Prehospital care of Acute Coronary Syndromes
aspirin
Prehospital care of Acute Coronary Syndromes
nitrates
Prehospital care of Acute Coronary Syndromes
triage to an appropriate medical center
Prehospital care of Acute Coronary Syndromes
Prehospital care of Acute Coronary Syndromes
Oxygen, aspirin, and nitrates and triage to an appropriate medical center
Drug treatment of Acute Coronary Syndromes
Analgesics,antiplatelet drugs, antianginal drugs, anticoagulants,
Analgesics
Drug treatment of Acute Coronary Syndromes
antiplatelet drugs
Drug treatment of Acute Coronary Syndromes
antianginal drugs
Drug treatment of Acute Coronary Syndromes
anticoagulants
Drug treatment of Acute Coronary Syndromes
Angiography
assess coronary artery anatomy
Reperfusion therapy includes ……
Used for …….
Fibrinolytics, percutaneous coronary intervention or coronary artery bypass
surgery
Used for Management of Acute Coronary Syndromes
Fibrinolytics
Reperfusion therapy
percutaneous coronary intervention
Reperfusion therapy
coronary artery bypass
surgery
Reperfusion therapy
Supportive care includes …….
Used for ……
Post-discharge cardiac rehabilitation and chronic management of coronary artery disease
Management of Acute Coronary Syndromes
Anti-platelet therapy (aspirin +/ clopidogrel)
MI 2ry prevention drug therapy
Beta blocker
MI 2ry prevention drug therapy
ACE inhibitors/ ARB
MI 2ry prevention drug therapy
Statin
MI 2ry prevention drug therapy
Additional therapy for control of diabetes + HT
MI 2ry prevention drug therapy
Mineralocorticoid receptor antagonist
MI 2ry prevention drug therapy
if there is HF or pulmonary congestion
Auscultate Basal crepitations
if R. Ventricular hypertrophy is present
left ventricular heave may feel
