Ischaemic Heart Disease Flashcards
what is ischaemic heart disease?
a group of syndromes, which are related pathophysiologically, which result from myocardial ischaemia
examples of IHD
- myocardial infarction
- angina pectoris
- chronic IHD with heart failure
- sudden cardiac death
what causes ischaemic heart disease?
an imbalance between the myocardial blood flow and the metabolic demand of the myocardium
what does coronary artery perfusion depend on?
- the pressure difference between the ostia and the coronary sinus
- inversely on heart rate
what reduces coronary perfusion?
- decreased aortic diastolic pressure
- increased intraventricular pressure and myocardial contraction
- coronary artery stenosis (artherosclerosis, vasoconstriction)
- aortic valve stenosis and regurgitation
- increased right atrial pressure
how can risk factors be classified?
- genetic vs acquired
- modifiable vs non-modifiable
risk factors for IHD
- hypertension
- high cholesterol (high LDL; low HDL)
- hypertriglyceraemia
- diabetes mellitus
- obesity (waist-to-hip ratio)
- smoking (duration and no of cigs per day; incl passive smoking)
- male gender (for MI/SCD); female gender (for AP)
- physical inactivity
- family history of CAD
- influenza (this brings on an acute inflammatory and vasoconstrictive episode)
- oral contraceptive
properties of lipoprotein A
- proatherogenic
- proinflammatory
- prothrombotic
risk factors for metabolic syndrome
- abdominal obesity
- triglycerides
- HDL cholesterol
- hypertension
- hyperglycaemia/diabetes
how does alcohol consumption affect IHD risk?
- light to moderate drinking decrease the risk for mortality, CAD, DM, HF and stroke
- heavy drinking increases the risk of death and CVD
how do the genders differ in CAD risk?
- men present earlier with symptoms of CAD etc
- the risk of women developing IHD increases after menopause
- oestrogen is cardioprotective because it has a lower atherogenic profile and more healthy fat distribution
how does age contribute to IHD?
- independent risk factor
- linked to the lack of modification of other more prominent risk factors
- the risk decrease over the age of 50yo as there are more competiting causes to kill you
what are the pathological components of atherosclerosis?
- central lipid core
- fibrous cap
- covered by endothelium
what is atherosclerosis?
progressive disease characterised by focal accumulation of lipid with inflammatory response
where does atherosclerosis hap[pen?
medium to large arteries
