Ischemic Heart Disease PDF

ISCHAEMIC HEART DISEASE I - IHD  Ischaemic heart disease Definition myocardial ischaemia occurs when there is imbalance between the supply of oxygen (and other essential myocardial nutrients ) and the myocardial demand for these substances The coronary blood flow may be reduced b...

ISCHAEMIC HEART DISEASE I - IHD  Ischaemic heart disease Definition myocardial ischaemia occurs when there is imbalance between the supply of oxygen (and other essential myocardial nutrients ) and the myocardial demand for these substances The coronary blood flow may be reduced by a mechanical obstruction - atheroma - thrombosis - embolus - -DISSECTING AORTIC ANEURYSM coronary ostial stenosis -VASCULITIS- coronary arteritis- BEHCHET S - KAWASKI  ANGINA DUE TO DECREASE BLOOD SUPPLY- HYPOXIA- ANEMIA-slow coronray flow ANGINA DUE TO INCREASE DEMAND -tachycardia- thyrotoxicosis- LVH-HNT-AS- heavy exertion. IHD- NON-OBSTRACTIVE CORONARY- prevalence 7%- MI- F>M- cor.spasm- cocain- microvascular disease thromboembolic-ECTASIA-slow blood flow Coronary artery disease CAD it is the most common cause of ischaemic heart disease. CAD is the largest single cause of death in the UK. the main pathological lesion in CAD is (coronary atheroseclerosis)- PLAGUE ULCERATION- FISSUREING- RUPTURE- plat.aggregation- CAD presents clinically as:- Stable angina pectoris –chronic cor.syn Acute coronary Syndrome- unstable angina - Myocardial infarction CAD risk factors Fixed Age, gender, family history, Changeable Hyperlipidaemia Homocysteineaemia Smoking Personality Hypertention lack of exercise- Obesity Diabetes mellitus Gout IMPOTANCE Alcohol AIRPOLLOUTION microalbumin urea Drugs-COCAIN -CVA- CKD Angina pectoris It is the most important cause of recurrent chest discomfort it is characterized by:- - central chest pain, which may radiate to left, right or both arms, throat or jaw and rarely to the back or epigastrium - short duration usually lasting less than 10 min. - pain is described as tightness and is usually not sever -- aggravated by exertion- heavy exercise walking against cold air- heavy meal - relieved by GTN OR by REST Types Decubitus angina :- occurs on lying down -ANGINA EQUIVALENT –SOB after exertion Nocturnal angina :- occurs at night Variant (prinzmetal`s) angina :- occurs at rest Unstable angina :- refer to angina of recent onset, worsening angina or post-infarction angina- or angina at rest On examination - usually NO finding - may have 4th. Heart sound - signs of associated factors Investigations - Resting ECG is usually normal between attacks may show ST depression or T inversion during attack - Exercise ECG ST segment depression of > 1 mm. is positive NON-INVASIVE Cardiac scintigraphy (myocardial perfusion scan) EX- ECG- TREADMEL TEST -Echocardiography –STRESS-ECHO CT coronary angiography Cardiovascular magnetic resonance (C-MRA) INVASIVE Coronary angiography  Treatment of angina General management -- Assurance and education –life style -- Treat underlying problems such as anaemia, hypertension, hyper –and hypo-thyroidism and diabetes-alcohol stop - Stop smoking -- Treat hypercholesterolaemia -- Weight reduction -- Regular exercise Medical treatment Symptomatic treatment Glyceryl trinitrate (GTN) used sublingual tablet or spray, action peaks 4-8 minutes and last 20-30 minutes, transdermal GTN last up to 24 hours Beta- blockers duo to their negative inotropic and chronotropic effect Atenolol, 50 -100 mg. daily Metoprolol 25-50 mg. twice daily Bisoprolol- Nibevolol IVABRADINE- SA- NODE Long acting nitrates ( e.g. isosorbide mononitrate) Calcium channel blockers DIHYDROPYRIDINE nifedipine amlodipine NONDIHYDROPYRINE VERAPAMINE- DELTIAZEM Prophylactic medication Aspirin is used in all patients with angina75 mg.daily Lipid lowering therapy- 1mmol cholesterol = 39mg- --statin-INCLISIRAN- PCSK9- inhibitor HIGH risk LDL- < 1OOmg/dl-