Ischaemic Heart Disease

BASIC KNOWLEDGE
Anatomy of Coronary artery system
Physiology related to cardiac ischaemia
Pathology of atherosclerosis
HISTORY TAKING AND OBSERVATIONS
Definition of Angina
Differentiation between stable and acute coronary syndromes
Risk factors
Observing the patient with acute angina
MANAGEMENT
Diagnostic investigations
Drugs used in treatment
Risk factor modification
PCI and CABG
CLINICAL SCENARIOS
Chest pain
Preoperative risk assessment of patient with IHD
Anatomy of Coronary artery system
Physiology related to cardiac ischaemia
Pathology of atherosclerosis
Physiology related to cardiac ischaemia
OXYGEN DEMAND
HEART RATE
CONTRACTILITY
LV WALL TENSION
OXYGEN SUPPLY
Coronary artery diameter
HR and BP
pO2
Hb
CORONARY ARTERY DISEASE: CLINICAL SYNDROMES
Stable angina
Acute coronary syndrome
Unstable Angina
Myocardial Infarction
• ST Elevation MI (STEMI)
• Non ST Elevation MI (NSTEMI)
HISTORY TAKING AND OBSERVATIONS
 Definition of Angina
 Differentiation between stable and acute coronary syndromes
 Risk factors
 Observing the patient with acute angina
Angina
 CENTRAL
 COMPRESSIVE
 RADIATES TO ARMS, JAW
Stable Angina and Acute coronary syndromes
 STABLE
o Short lived
o On exertion
o Relieved by rest / SL GTN
 UNSTABLE ANGINA (ACS)
o Prolonged
o At rest
o Not responding to GTN

Coronary Artery disease

 Risk factors of accelerated atherosclerosis
o DIABETES
o HYPERTENSION
o HYPERLIPIDAEMIA
o SMOKING
o FAMILY HISTORY

Observing the patient with acute angina

 Distressed
 Sweaty
 Fast HR
 Short of breath
MANAGEMENT
 Diagnostic investigations
 Risk factor modification
 Drugs used in treatment
 PCI and CABG