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CORONARY HEART DISEASE heart_beating_0, MECHANISM OF ACTION, SIDE EFFECTS …

- - - - ACE inhibitor
        
        Aspirin
        
        Nicorandil
        
        Ivabradine
        
        Trimetazadine
        
        Ranolazine
        
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        Inhibit long-chain 3-ketoacyl CoA thiolase activity
        
        Reduction of fatty acid oxidation and a stimulation of glucose oxidation
        
        Reduce sodium and calcium overload in the heart as well as reducing oxygen consumption
        
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        Decrease pacemaker activity in the SA node
        
        Reduce the heart rate and oxygen demand of the heart
        
        Dizziness and fatigue
        
        Inactivation of cyclic guanosine-3’,-5’-monophosphate (cGMP) signaling pathways
        
        Increase the opening of ATP‐gated K+ channels causes smooth muscle relaxation and contributing to coronary vasodilatation
        
        Headache, dizziness, flushing, malaise and gastrointestinal upse
        
        Reduce the ability of blood to clot, making it easier for blood to flow through narrowed heart arteries
        
        Dizziness, increased bleeding, nausea, and abdominal pain
        
        Interfering with the body’s renin-angiotensin-aldosterone system (RAAS).
        
        Loss of taste
        
        Hyperkalaemia
        
        Dry cough
      - Inhibit Ca 2+ influx through L type Ca 2+ channel (smooth muscle of arterial wall and myocardium)
        smooth muscle relaxation and reduce myocardial contractility
        
        constipation
        
        palpitation
        
        dizziness
  - - - Coronary angioplasty (CA)
        
        Def : Medical procedure that opens up a blocked or narrowed artery around the heart
        
        Process
        
        Inserts a tube into an artery in the groin or wrist and thread the tube towards the affected artery around the heart
        
        Insert a balloon or stent (metal tube) to open the artery
        
        Monitor the progress of the catheter tip by using imaging technique
        
        Types of CA
        
        Stent angioplasty
        
        balloon angioplasty
      - Types of coronary by pass
        
        Minimally Invasive Direct Coronary Artery Bypass Grafting
        
        Off-Pump Coronary Artery Bypass Grafting
        
        Traditional Coronary Artery Bypass Grafting
      - Process
        
        Take healthy blood vessel from other part of body and connecting to the blocked coronary artery
        
        The grafted artery or vein bypasses the blocked portion of the coronary artery
        
        Creates a new passage routed around the blockage to the heart muscle
- - - - Large arteries narrowed by plaque, but not as much as obstructive
    - - Affects tiny arteries in the heart muscle
    - - 50% of arteries blocked
  - - - Risk factor
        
        Hypertension
        
        Diabetes Mellitus
        
        Dyslipidemia
        
        Cigarette smoking
        
        Family history of premature CHD
        
        Metabolic Syndrome
        
        High Lipoprotein a
- - - - Gender
        
        Family history and genetic
        
        If first degree relatives (mother and father) had CHD it increase the risk of developing CHD
        
        Men tend to get higher risk compared to women
      - Risk increases as getting older
  - - - High blood cholesterol level
        
        Diabetes
        
        Cigarette smoking
        
        Obesity
        
        Sedentary lifestyle
- - - - ECG
        
        Exercise stress test
        
        Echocardiogram
        
        Coronary angiography
        
        Nuclear stress test
        
        Similar as regular stress test but include imaging of heart and radioactive dye in veins
        
        Results :
        -at rest
        -during exercise
        
        Chest X-ray
        
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        Computed tomography technique used to visualize arterial and venous vessels throughout the body.
        
        Receives IV contrasting dye
        
        Result : displays the anatomical detail of blood vessels
        
        Observe heart muscle function through ultrasound
        
        Perform physical exercise that increase demand of heart muscle to pump
        
        Examine the heart functions and rhythm to identify any abnormalities by using electrocardiogram
      - Examine level of LDL, HDL, Lipoprotein A, Triglycerides