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Ischaemic heart disease

Definition
  • Ischaemic Heart Disease: A condition characterised by reduced blood supply to the heart muscle, usually due to coronary artery disease (CAD).
Etiology
  • Most commonly caused by atherosclerosis of the coronary arteries.
  • Risk factors: Hypertension, hyperlipidaemia, smoking, diabetes, family history, age, gender, and obesity.
Pathophysiology
  • Narrowing or blockage of coronary arteries reduces oxygen supply to myocardium.
  • Prolonged ischaemia can lead to myocardial infarction (heart attack).
Clinical Features
  • Angina pectoris: Chest pain or discomfort, often radiating to the left arm, neck, or jaw. Triggered by exertion or stress.
  • Myocardial infarction: Severe, prolonged chest pain; associated with nausea, sweating, and shortness of breath.
  • Silent ischaemia: Asymptomatic episodes of myocardial ischaemia.
Investigations
  • Electrocardiogram (ECG): Detects ST-segment changes, T-wave inversions, and Q waves suggestive of ischaemia or infarction.
  • Blood tests: Cardiac enzymes (troponin, CK-MB) rise after myocardial infarction.
  • Coronary angiography: Gold standard for visualising coronary artery blockages.
  • Stress testing and myocardial perfusion imaging to evaluate the functional significance of coronary lesions.
Management
  • Pharmacological: Antiplatelets (aspirin, clopidogrel), statins, beta-blockers, ACE inhibitors, and nitrates.
  • Revascularisation: Percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) for significant obstruction or uncontrolled symptoms.
  • Lifestyle modifications: Smoking cessation, diet, exercise, and weight management.
Prognosis
  • Early detection and treatment improve outcomes.
  • Complications: Heart failure, arrhythmias, sudden cardiac death, and recurrent myocardial infarction.

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