Notes in Ischaemic Heart Disease LECTURE 35

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Published	01/07/2025	ischaemic heart diseasegroup of clinical syndromes usually due to {{c1::atherosclerosis}} of coronary arteries
Published	01/07/2025	incidence = {{c1::new cases of disease presenting in individual year}}prevalence = {{c1::number of people living with disease at any on time…
Published	01/07/2025	angina symptoms3 main symptoms - {{c1::chest pain/discomfort/ache}}exertion or not? {{c1::exertional}}settles within {{c1::2-10 mins}}type of chest pa…
Published	01/07/2025	when are angina symptoms worse?upon {{c1::exertion}}in the {{c1::cold}}after a large {{c1::meal}}
Published	01/07/2025	what type of ischaemia is angina?{{c1::demand}} ischaemia
Published	01/07/2025	what is demand ischaemia?due to a {{c1::fixed}} obstruction (e.g.narrowing of coronary artery)inadequate blood flow when {{c1::demand}} incr…
Published	01/07/2025	cardiac pain is a {{c1::referred}} pain of visceral origin
Published	01/07/2025	when is cardiac pain a referred pain?referred pain to {{c1::T1-5}} (chest) and {{c1::C5-6}} (shoulder)
Published	01/07/2025	describe journey of cardiac pain through nervous systemcarried via cardiac sympathetic {{c1::afferent}} nervesto {{c1::spinothalamic}} tractto {{…
Published	01/07/2025	myocardial infarctionmain symptom? {{c1::chest pain/discomfort}}type of pain? {{c1::severe and persistent}}type of pain? {{c1::tight/dull/squeezing/he…
Published	01/07/2025	myocardial infarction associated symptomsm{{c1::alaise}}n{{c1::ausea}}b{{c1::reathlessness}}s{{c1::weating (like all of you)}}
Published	01/07/2025	what type of ischaemia is myocardial infarction?{{c1::supply}} ischaemia
Published	01/07/2025	what is supply ischaemia?acute coronary artery {{c1::occlusion}}inadequate blood flow even to cover {{c1::basal requirements}}
Published	01/07/2025	atherosclerosis consist of:lipid rich {{c1::necrotic}} core{{c1::fibromuscular}} cap
Published	01/07/2025	coronary thrombosis{{c1::plaque}} rupture because cap is thin (vulnerable plaque){{c1::collagen/lipid}} exposed = very thrombogenic{{c1::pla…
Published	01/07/2025	ischaemic cascade{{c1::}}
Published	01/07/2025	heart failuredue to low {{c1::cardiac output}} - fatiguedue to {{c1::fluid}} retentionsymptoms (4):- leg {{c2::swelling}}- b{{c2::reathlessn…
Published	01/07/2025	silent ischaemiafirst sign of {{c1::IHD}} may be sudden death (may be due to acute occlusion of non-obstructive plaques/obstructive disease)What …
Published	01/07/2025	principles of managementfor all IHD patients:l{{c1::ifestyle}} changer{{c1::isk}} factor managementa{{c1::nti-thrombotic}} therapy{{c1:…
Published	01/07/2025	how to manage risk factor: hypertensionlose {{c1::weight}}, reduce {{c1::salt}} intakedrugs: {{c1::Ramipril}} (ACE inhibitor)
Published	01/07/2025	how to manage risk factor: hyperlipidaemiadiet: reduce saturated {{c1::fat}} intakedrugs: {{c1::atorvastatin}} (statin)
Published	01/07/2025	how to manage risk factor: diabetesoptimise {{c1::glycaemic}} control, reduce refined sugar intakedrugs: {{c1::metformin, insulin}}
Published	01/07/2025	anti-platelet drugs:cyclooxygenase inhibitor: {{c1::aspirin}}ADP receptor antagonist: {{c1::clopidogrel}}Gp2b3a antagonist: {{c1::tirofiban}…
Published	01/07/2025	acute MI treatment: {{c1::low molecular weight heparin}}: fondaparinux
Published	01/07/2025	anti-anginal medication - beta blockersexample - how do they work?block {{c1::beta-1}} receptors to:- reduce force of contraction- reduce heart r…
Published	01/07/2025	anti-anginal medication - calcium channel antagonistsWhat medications? How do they work?{{c1::diltiazem}}: reduces calcium entry into myocyte and vasc…
Published	01/07/2025	amlodipine: only dilates {{c1::arteries}} (by reducing calcium entry)diltiazem: also reduces calcium entry into {{c1::myocyte}}
Published	01/07/2025	anti-anginal drugs - nitratesHow do anti-anginal nitrates work?mimic {{c1::NO}} = vaso{{c1::dilation}} (of coronary arteries)dilate {{c1::ve…
Published	01/07/2025	right coronary artery supplies blood to {{c1::25-30}}% of the heartleft coronary artery supplies blood via:- LAD to {{c1::45}}% of the heart- Circumfl…
Published	01/07/2025	disease of which coronary arteries is high risk?{{c1::left main stem (LMS)}}{{c1::left anterior descending (LAD)}}
Published	01/07/2025	revascularistion methods:{{c1::CABG - Coronary Artery Bypass Grafting}}{{c1::percutaneous coronary intervention}}
Published	01/07/2025	CABG - coronary artery bypass graftingWhat is it?{{c1::open}} heart surgery via {{c1::sternotomy}}How does it work?uses {{c1::conduits}} to …
Published	01/07/2025	percutaneous coronary intervention{{c1::catheter}} to coronary artery{{c1::wire}} through narrowingdilated with a {{c1::balloon}} and stent …
Published	01/07/2025	percutaneous coronary intervention used:when narrowing is at a {{c1::focal}} pointCABG used:when patients have {{c1::extensive}} arterial di…
Published	01/07/2025	how long after coronary occlusion can myocardium be salvaged?up to {{c1::12}} hours
Published	01/07/2025	acute MI: necrosisnecrosis detectable after {{c1::15}} minsBUT - it is not {{c1::uniform}} within an ischaemic territory:{{c1::subendocardia…
Published	01/07/2025	acute reperfusion treatment for ST-elevation MI (mortality rates)-pre intervention-thrombolysis/aspirin-balloon only PCI-Balloon + stenting PCI%s{{c1:…
Published	01/07/2025	MIs are usually due tocoronary artery {{c1::thrombosis}}
Published	01/07/2025	Which is the most appropriate immediate treatment for a patient with an anterior ST elevation MI?primary {{c1::angioplasty and stenting}}
Published	01/07/2025	IHD epidemiology- need to knowhigh in {{c1::deprived}} areas (scotland, wales, north england)high in {{c1::coastal}} areas and inner citiesh…
Published	01/07/2025	When are the symptoms of heart failure worse?when lying {{c1::flat}}
Published	01/07/2025	When do we use percutaneous coronary intervention?Narrowing is at a {{c1::focal}} pointWhen do we use Coronary artery bypass grafting?Patients ha…
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