Ischaemic heart disease revision notes

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Ischaemic heart disease revision notes

Ischaemic heart disease Pathophysiology

• Fatty streak-> lipid deposition-> monocytes become -> macrophages become foam cells-> smooth muscle proliferation + collagen deposition-> Intimal hypertrophy
  
• narrowed artery: o2 supply demand mismatch-> angina
  
• Fibrous plaque formation-> crack in fribrous plaque-> platelet aggregation-> vessel occlusion-> myocardial infarction
  

Ischaemic heart disease Investigations

ECG: ST elevation / depression in MI
Stress test:

• Exercise Tolerance Test: treadmill
  
• Stress echocardiography
  
• Radionucleotide 
  
• MRI

Angiography

Ischaemic heart disease clinical features

• Chest pain: dull ache, radiates neck + arms + back
  
• Associated nausea + vomit + short of breath
  
• Exertional, relieved by rest + GTN

• MI: pain at rest, arrhthmias, heart failure
  

Ischaemic heart disease management

Angina

• Angina symptom relief: beta-blockers, calcium channel blockers, nitrates, nicorandil, ranolazine
  
• Primary prevention: aspirin, statin

MI: 

• dual anti-platelet, glycoprotein IIB/IIIA inhibitor, IV GTN, morpine, O2
  
• Angiography- PCI (balloon angioplasty + stent)
• Secondary prevention: statin, ACEi/ARB, BB, eplerenone

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