Ischaemic Heart Disease Flashcards
CVD
Compromises CHD, cerebrovascular and peripheral vascular disease
1957: high cholesterol and BP linked to CHD
1962: smoking linked to CHD
1967: obesity and inactivity linked to CHD
1972: diabetes linked to CHD
Clinical Manifestations of IHD
occurs due to atherosclerosis
development of fatty streak, lipid deposition, intimal fibrosis
imbalance between myocardial oxygen supply & demand
asymptomatic/stable angina (long term: heart failure)
Acute Coronary Syndromes
includes unstable angina, acute MIs
all patients who’ve had an acute MI have a rise in troponin (a cardiac enzyme)
STEMI - ST elevation
NSTEMI - incomplete occulsion, ST depression/variable T wave
Progression to Atherosclerosis
Normal artery –> Fatty streat –> Fibrous plaque –> Athersclerotic plaque –> plaque rupture/fissure and thrombosis
- adherence, activation, aggregation
- thrombin and fibrin production - coagulation cascade
- vasoactive molecules from platelets cause vasoconstriction
STEMI
timely diagnosis is key morphine and/or nitrates for pain relief anti-platelet agents emergency primary angioplasty clot-busting drug
NSTEMI
defined as absence of ST elevation on ECG
symptoms of angina and increased cardiac biomarkers
troponin explosion - pneumonia, PE, pericarditis, sepsis, heart failure
ACS - symptoms and risk factors
classical - discomfort/pain, radiation
elderly/diabetic patients - breathlessness, nausea, vomiting, sweating and clamminess
high risk: elevated troponin levels, renal impairment, recurrent chest pain, arrhythmias, ST depression/T wave changes
Medical management for ACS
anti platelet therapy: aspirin, clopidogrel, prasugrel
anti-ischaemic therapy: nitrates
secondary prevention therapy: statin, ACE inhibitors, beta blockers, lifestyle modification
Management of NSTEMI
analgesia, antiplatelet therapy, statins, anti-ischaemic therapy, early coronary angiography
