Clinical Aspect Of IHD PDF

Clinical Aspect of IHD IHD coronary heart disease (CHD) or coronary artery disease, caused by narrowed heart arteries that supply blood to the heart muscle. Global Importance: Coronary artery disease is a major cause of death and disability worldwide, while angina represents its most common sympt...

Clinical Aspect of IHD IHD coronary heart disease (CHD) or coronary artery disease, caused by narrowed heart arteries that supply blood to the heart muscle. Global Importance: Coronary artery disease is a major cause of death and disability worldwide, while angina represents its most common symptom. positive family history is defined as a first degree relative with Risk Factors CAD diagnosed before the age of 55 1. Age and gender 2. Family history and genetic factors 3. Dyslipidemia: ✓ Low HDL, ✓ High LDL, total cholesterol, triglycerides 4. Smoking 5. Psychosocial factors 6. Obesity and abdominal obesity 7. Diet and Nutrition 8. Hypertension 9. Physical inactivity 10. Diabetes, prediabetes, and insulin resistance Clinical Spectrum of CAD Angina: a) Stable. b) Unstable Myocardial Infarction: a) Non-ST-elevation myocardial infarction (NSTEMI) b) ST-elevation myocardial infarction (STEMI) Clinic pathological correlation  Clinical Aspect of IHD Clinical presentation Traditional clinical classification of chest pain Typical angina : Meets all three of the following characteristics: Substernal chest discomfort of characteristic quality and duration; Provoked by exertion or emotional stress; Relieved by rest and/or nitrates within minutes. Atypical angina (probable) : Meets two of these characteristics. Non-anginal chest pain: Lacks or meets only one of none of the characteristics Symptoms Chest Pain (Ischemic) (Mnemonic, SOCRATES) Other symptoms: 1. Anxiety 2. Pain or discomfort 3. Light headedness 4. Cough 5. Nausea 6. Profuse sweating 7. Shortness of breath 8. Rapid or irregular heart rate 9. Fullness, indigestion Physical Examination: The physical examination is usually not as sensitive or specific for unstable angina. Signs may include the following: a) Systolic blood pressure less than 100 mmHg b) worsening apical systolic murmur due to papillary muscle dysfunction c) Rales or crackles  Clinical Aspect of IHD Diagnosis Laboratory studies imaging studies a. Cardiac biomarker: (Cardiac troponin, (CK), CK-MB) If troponin negative within 6 hours of onset, repeat 8- a) Electrocardiography (ECG) b) Stress ECG: 12 hours later The first line of assessment in unstable angina Troponin is the most sensitive and specific Cardiac should be obtained within 10 minutes myocardial infraction c) Echocardiography (ECHO) d) Stress ECHO. b. Complete blood cell count LV function assessment. c. Serum Glucose level e) Chest radiography f) angiography. g) Computed tomography coronary angiography. h) Magnetic resonance imaging and Magnetic d. Serum Lipid profile resonance i) Diagnostic coronary catheter. Treatment Alteration of lifestyle Medical Treatment 1. Aspirin (75-150mg/24h) reduces mortality by 34%. 2. Beta-blockers. 3. Nitrates: For symptoms, Glyceryl trinitrate (GTN ) sublingual tablets. Prophylaxis: oral mononitrate or nitrate skin patches or buccal pills. 4. Calcium antagonists: amlodipine. 5. ACEI 6. Statins for hypercholesterolemia.  Clinical Aspect of IHD Treatment 3. Treatment of Acute Myocardial Infarction Reperfusion therapy: 1. Thrombolytic therapy Streptokinase Tissue type plasminogen activator t-PA (Actylase) 2. Primary angioplasty and stenting Follow up treatment: a) aspirin & ACEI b) B-blockers, BP c) cholesterol control via statins d) diabetes control, diet ABCs of Secondary Prevention