Pages Below:
Angina Pectoris
Blood Supply to Heart
Cardiac Enzymes
Chest Pain
Myocardial Infarction
Myocardial Infarction Pathology
Risk factors for atherosclerosis
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- Ischemic heart disease is the state in which coronary blood flow to a
region of the myocardium is insufficient to supply the required oxygen and
nutrients
- most commonly seen as a result of obstructive coronary disease
- single biggest cause of death in the UK
- Main disease process atherosclerosis
- Produces
Causes
- Reduction in coronary blood flow
- Atheroma
- Thrombus/Embolism
- Spasm
- Coronary arteritis (eg SLE)
- Decrease in flow of oxygenated blood
- Anaemia
- Hypotension reducing coronary perfusion pressure
- Increase in oxygen demand
- Increased cardiac output (eg thyrotoxicosis)
- Myocardial hypertrophy
Risk Factors
- as for atherosclerosis
- fixed
- age
- family history
- male sex
- ACE mutations
Strong association
- cigarette smoking
- hyperlipidaemia
- including familial dyslipidaemias
- primary prevention
- total cholesterol and LDL fraction important
- secondary prevention
- whole lipid profile
- triglycerides
- needs fibrates rather than statins
- diabetes mellitus
- hypertension
- ethnicity
- Increased in Asian, Afro-Caribbean
Weak association
- personality / behavioural / stress
- obesity
- hypertension
- gout
- soft water
- lack of excercise
- contraceptive pill
- heavy alcohol consumption
Recent discoveries
- plasma homocysteine
- blood coagulation factors
- fibrinogen
- C-reactive protein
- Chlamydia pneumoniae
Investigation
- ECG
- CXR
- Treadmill exercise test
- Echo
- Bloods
- cholesterol
- ? cardiac enzymes
- Radionuclide perfusion scanning
- Stress echo
- Coronary angiography
Treatment
- symptoms
- statins / fibrates
- aspirin
- beta-blockers
- ACE inhibitors
General Management Of Ischaemic Heart Disease
This aims to treat the risk factors for coronary atherosclerosis and to
reduce myocardial oxygen consumption. A variety of therapies are used including:
lipid lowering drugs, aspirin, antihypertensive drugs, and drugs that reduce
cardiac work.
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