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Ischaemic Heart Disease 2 (Complications of MI (Arrhythmias…
Ischaemic Heart Disease 2
ECG of MI
Infarct Site
Inferior
ST elevation II,III, AVF
Lateral
I, AVL, V5-V6
Anterior
ST elevation V1-V3
Posterior
ST depression V1-V3, dominant R wave, ST elevation V5-V6
Evolution of a STEMI on ECG
After a few days, the ST segment returns to normal
After weeks/months, the T wave may return upright but Q wave remains
After a few hours, the T waves invert and Q waves develop
After first few minutes, T waves become tall and there is ST elevation
Complications of MI
Persistent pain
- due to progressive myocardial necrosis
Pericarditis
- due to transmural infarct causing inflammation of pericardium. Can progress to Dressler's syndrome = recurrent pericarditis
Right ventricular failure
- presents with low cardiac output and increased jugular venous pressure. Give fluid
Cardiac tamponade
- low cardiac output, Kaussmaul's sign, muffled heart sounds
Arrhythmias
Bradyarrhythmias
1st degree AV block
Mobitz type I and II block
Sinus bradycardia
Complete AV block
Bundle branch block
Tachyarrhythmias
Atrial Fibrillation
Atrial flutter
Sinus tachycardia
Ventricular fibrillation
Mitral regurgitation
- presents with pulmonary oedema
Sudden death, often due to ventricular fibrillation
Systemic embolism
- consider putting patient on anticoagulant for 3 months post MI
Ventricular aneurysm
- due to stretching of newly formed scar tissue
Epidemiology of IHD
Odds Ratio
OR = 1 means the exposure does not affect the odds of the outcome
OR > 1 means the exposure is associated with higher odds of an outcome
Represents the odds that an outcome will occur, given a particular exposure compared to the odds of an outcome occurring in the absence of that exposure
OR < 1 means the exposure is associated with lower odds of an outcome
= A measure of association between an exposure and outcome
The risk factors for an MI create a greater risk in women than in men for having a heart attack
Removing the risk factors (smoking cessation, lower cholesterol) can actually reverse the risk of an MI
Population Attributable Fraction
= The proportion of the incidence of a disease in the exposed and non-exposed population that is due to the exposure
It is the disease incidence in the population that would be eliminated if the exposure were eliminated
Coronary heart disease will manifest in males 10 years earlier than in females
Number Needed to Treat
= A concept that is used to gauge the comparative effect of an intervention e.g. with the intervention of smoking cessation only, 50 people will need to quit smoking to prevent 1 MI
Psychosocial Influences
Psychosocial risk factors
Behaviour traits
Depression
Work
Social support
Depression
Patients with higher depression ratings at baseline had worse CHD and associated mortality
CHD can cause depression + anxiety so it is difficult to determine causation
Measured via MMPI, Beck Depression Inventory, general health questionnaire
Work
Those working >11 hours a day are 67% more likely to have a heart attack
Always ask patient what their occupation is and how many hours they work
Those with high demand and low control jobs are more likely to have an MI
Social Support
People with poorer social relationships are at an increased risk of premature death
Social relationships help people to cope with life events and provide motivation to engage in healthy behaviours
Attachment and social integration is lower in men who contracted CHD