6a IHD PDF

Ischemic heart disease (IHD) Introduction also called coronary heart disease (CHD) or coronary artery disease (CAD) What is an Angina? Angina Pectoris is the main manifestation sudden, severe, pressing chest pain radiating to the back, jaw, neck, and arms. A characteristic: Myocardial oxygen...

Ischemic heart disease (IHD) Introduction also called coronary heart disease (CHD) or coronary artery disease (CAD) What is an Angina? Angina Pectoris is the main manifestation sudden, severe, pressing chest pain radiating to the back, jaw, neck, and arms. A characteristic: Myocardial oxygen Supply & Demand Classical angina Any other names? ……. ……. a burning, heavy, or squeezing feeling in the chest Stable angina or typical angina Relieved by rest or GTN (nitroglycerin) ……. Any other names? ……. Occurs at rest Unstable angina Not relieved by rest or GTN Must do (Coronary Angiography) Acute Coronary Symptoms To visualize the coronary artery occurs at rest and is due to coronary artery spasm Variant (Prinzmetal angina) Relieved promptly by GTN and CCBs Types of (Angina Pectoris) Cocaine What can increase the risk factors of having any type of AP? Amphetamine Drug addicts Tryptophan Visuals: Epidemiology IHD rate is higher in middleaged men compared with women. However, increases 2-3 times in women after menopause. Chronic stable angina is the initial manifestation of IHD in about 50% of patients, whereas ACS is the first sign of IHD in other patients. > 45 years old for male; • > 55 years old for female Increased age: Male gender Post-menopausal females Risk Factors (unmodifiable) Family history of premature CVD: First degree relatives Competitive, hostile and aggressive Type A personality: 2-4 times more risk than nonsmokers Smoking: Diabetes mellitus Primary Modifiable Hypertension Dyslipidaemia > LDL and < HDL Obesity: Risk Factors (Modifiable) BMI ≥ 30 kg/m2 Sedentary lifestyles > 0.9 for male Abdominal obesity: WHR Secondary Modifiable > 0.7 for female Less fresh fruits/ vegetables Stress and anxiety Alcohol overconsumption >21 units per week Exertion Trigger Factors (for stable angina) 6a : IHD Emotions Cold weather ( increases peripheral resistance) Heavy meals ( due to increased GI blow flow) Factors affecting myocardial oxygen demand and oxygen supply Panel A cross-section of a CA. CA with a stable atherosclerotic plaque. Panel B Lipid core is small and the fibrous cap is made up of: several layers of SMs cells. unstable atherosclerotic plaque. Panel C Larger lipid core, thin fibrous cap. Single layer of SM cells Panel D with a fissure or rupture. platelet adhesion in response to the fissured plaque Platelet activation, aggregation and fibrinogen binds platelets. Panel E It forms a mesh-like occlusion in the CA lumen. Symptoms of acute coronary syndrome If endogenous anticoagulant proteins fail, platelet aggregation continues fibrinogen is converted to fibrin, Pathophysiology of chronic stable angina versus acute coronary syndromes. Panel F resulting in an occlusive thrombus. Symptoms of acute coronary syndrome Visuals: How long does each stage take? 10 years Cholesterol and fatty substances deposits Endothelial lining - damaged. Time Scale of Atherosclerosis Coronary endothelial dysfunction → Coronary artery disease → form Foam cells + Growth factors to promote smooth muscle cell from middle wall (media) to intima. attracts macrophages → Acute Coronary Syndrome (ACS) Visuals: Males: 0 -10 Females: (troponin I or troponin T): 0-14 nanograms/L 0 - 14 What does increase in the number mean? In which phase it happening? Cardiac Troponin: How long does it last? Most sensitive biomarker myocardial damage • ↑ in MI but typically normal in SIHD and UA. Laboratory Tests Assessing CVS risk factors and differential diagnosis. Hemoglobin Fasting glucose Fasting lipid profile ECG, Treadmill or bicycle exercise ECG, Other Diagnostic Tests cardiac magnetic resonance (MR), Coronary angiography Most confirming test Myoglobin FEBB CKNB Computed Tomography Check calcium ions Means the disease is progressing Late phase / late phase marker 2 hr to 2 days Then calcium deposits → hardened plaques k/a atheromas.