Ischaemic Heart Disease

Ed and Rashmi discuss all you need to know about one of the most important topics in medicine - ischaemic heart disease.

 

Lecture by

Video Duration: 16 minutes

  • Unstable Angina
    Created by oliviaimpey
    General
    Epidemiology

    Chest pain at rest due to myocardial ischaemia

    Pathology

    Cardiac muscle oxygen supply insufficient for myocardial demand

    Ischaemia is insufficient to cause myocardial damage

    Top three causes
    • Coronary artery atheroma
    • Thyrotoxicosis
    • Aortic stenosis
    Clinical Features
    Symptoms
    • Central, crushing, retrosternal chest pain
    • Present on exertion and not relieved on rest
    • Pain may radiate to L arm and/or jaw
    Signs

    May be none

    Signs of risk factors (e.g. hypertension)

    Chest pain

    Investigations
    Cultures

    None

    Bloods

    Troponin - normal

    FBC, U&Es, Lipids

    Imaging

    Angiography

    Scopic/Biopsy

    None

    Functional

    ECG - may show non-specific ST changes

    Treatment
    Conservative

    Modify risk factors (as for unstable angina)

      Medical
      • Pain relief (e.g. Morphine + Metoclopramide)
      • Oxygen
      • 300mg Aspirin
      • 300mg Clopidogrel
      • Enoxaparin

      Discharge medication

      • Clopidogrel (for 12 months)
      • Beta-blockers or CCBs - secondary MI prevention
      • ACEi - plaque stabilisation
      • Statins - plaque stabilisation
      Surgical

      May require PCI

    • Stable Angina
      Created by oliviaimpey
      General
      Epidemiology

      Chest pain on exertion due to myocardial ischaemia

      Pathology

      Imbalance between cardiac oxygen supply and myocardial demand

      Top three causes

      Coronary artery atheroma

      Aortic stenosis

      Thyrotoxicosis

      Clinical Features
      Symptoms

      Central, crushing, retrosternal chest pain

      Occurs on exertion, relieved by rest

      May radiate to L arm and jaw

      Signs

      Sometimes no signs

      Non-specific ST depression

      Signs of risk factors (e.g. hypertension)

      Investigations
      Cultures

      None

      Bloods

      None

      Imaging

      None

      Scopic/Biopsy

      None

      Functional

      ECG - may show non-specific ST depression

      Exercise Tolerance Test - if no change on ECG at rest

      Coronary angiography

      Treatment
      Conservative

      Modify lifestyle to reduce risk factors

      • Optimise weight
      • Adequate glucose control
      • Smoking cessation
      • Reduce stress
      • Increase exercise and eat healthy diet
      Medical

      Sublingual GTN spray - relieves acute symptoms

      Beta-Blocker or CCB - reduces myocardial demand

      Aspirin - secondary prevention of MI

      Drugs to modify risk factors (e.g. Statins)

      Surgical

      Rarely PCI