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A condition characterised by reduced blood supply to the heart muscle, usually due to coronary artery disease (CAD).
Epidemiology
IHD is a leading cause of death worldwide, however, due to population-wide primary prevention initiatives, the number of deaths globally are falling.
Pathophysiology
Narrowing or blockage of coronary arteriesΒ reduces oxygen supplyΒ to the myocardium.
Prolonged ischaemia can lead to myocardial infarction.
Aetiology/Risk Factors
Most commonly caused by atherosclerosis of the coronary arteries.
Risk factors:
Hypertension
Hyperlipidaemia
Smoking
Diabetes
Family history
Age
Gender
Obesity
Clinical Features π‘οΈ
Symptoms
Angina pectoris:Chest pain or discomfort, often radiating to the left arm, neck, or jaw. Symptoms are triggered by exertion or stress.
Myocardial infarction: Severe, prolongedchest pain; associated with nausea, sweating, and shortness of breath.
Silent ischaemia:Asymptomatic episodes of myocardial ischaemia.
Patients with diabetes mellitus are more susceptible to silent episodes.
Investigations π§ͺ
Initial Tests
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.
Diagnostic Tests
Coronary angiography:Gold standard for visualising coronary artery blockages.
Stress testing and myocardial perfusion imaging to evaluate the functional significance of coronary lesions.
Management π₯Ό
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 treatmentΒ improve outcomes.
Complications
Heart failure
Arrhythmias
Sudden cardiac death
Recurrent myocardial infarction
Key Points
IHD is characterised by an imbalance between blood oxygen supplyΒ and metabolic demand of the myocardium.
Coronary angiography is the gold standard diagnostic test.
Management includes both pharmacological and revascularisation interventions in addition to lifestyle modifications.
References
Office for National Statistics (2021). Ischaemic heart diseases deaths including comorbidities, England and Wales – Office for National Statistics. [online] www.ons.gov.uk. Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/ischaemicheartdiseasesdeathsincludingcomorbiditiesenglandandwales/2019registrations.