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Ischemic heart disease (IHD) (Aetiology (Endocrine Thyrotoxicosis,…
Ischemic heart disease (IHD)
Definition
Imbalance between supply and demand
of the heart for oxygen, resulting in
hypoxic damage to the heart
Epidemiology
Largest cause of death in UK
Common
Elderly
Pathophysiology
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
Types
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
Risk factors
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
Examination
Cardio
General colour/BMI, CRT, HR, JVP, apex, heart sounds, murmurs, peripheral oedema, lung oedema
Investigations
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)
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
Management
Conservative
Information and advice
Lifestyle measures
Medical
Secondary prevention
Per cause