Ischemic heart disease (IHD)

Definition

Epidemiology

Pathophysiology

Types

Risk factors

Imbalance between supply and demand
of the heart for oxygen, resulting in
hypoxic damage to the heart

Largest cause of death in UK

Common

Elderly

Increased demand
Thyrotoxicosis, anaemia
Hypertrophy

Atherosclerosis
Endothelial cell damage from turbulent blood flow and inflammation, plus hyperlipidemia
Lipids, macrophages and smooth muscle accumulation in intima of the coronary arteries, forming a plaque
Arteries narrow, leading to ischemia on exertion then rest
Plaque rupture, thrombosis and inflammation

Reduced supply
Atheroma (commonest)
Thrombosis/spasm/arteritis

Acute coronary syndromes
Unstable angina - unstable plaque, partial blockage
Myocardial infarction - sudden thrombosis and partial blockage with ischemia (NSTEMI) complete blockage of artery; ischemia and necrosis

Stable angina (angina pectoris)
Partial occlusion, reduced supply on exertion

Modifiable
HTN
Hyperlipidemia
Obesity
Smoking
Sedentary lifestyle
T2DM
Cocaine
Stress

Non-modifiable
Age
Male gender
FH

Aetiology

Endocrine
Thyrotoxicosis

Haematological
Coagulation disorder

Idiopathic
Spasm of coronaries

Drugs
Cocaine

Vascular
Atherosclerosis (commonest)
Thrombosis
Cardiomyopathy/hypertrophy

Infection
Severe sepsis

Autoimmune
CA arteritis

Metabolic
Severe anaemia

Clinical
presentation

Breathlessness

Syncope

Chest pain

Diagnosis

Management

Examination

Investigations

History

DH
Medications, allergies

FH
MI, PVD, stroke

PMH
Cardiovascular disease
anaemia, endocrine disorder

SH
Work/life stress, alcohol, smoking

PC/HPC
Pain (socrates), breathlessness, syncope,
palpitations, fatigue, fever, weight loss

Cardio
General colour/BMI, CRT, HR, JVP, apex, heart sounds, murmurs, peripheral oedema, lung oedema

Bloods
FBC (anaemia), U+E, LFT,
glucose, lipids, TFTs

Imaging
ECHO - structural disease
Stress tests - angina

Bedside
Obs (HR, BP, RR, sats, temp)
ECG (arrhythmia, MI, strain pattern)

Conservative
Information and advice
Lifestyle measures

Medical
Secondary prevention
Per cause