Overview
Patients with stable ischaemic heart disease are at great risk of cardiovascular death in the future. By taking a thorough history and understanding the natural history of their disease it is possible to estimate this risk, and identify ways to prevent future complications.
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- Diagnosis - when diagnosed, presentation
- Past myocardial infarction
- Family history of ischaemic heart disease
- Severity - exercise tolerance, stress test results, echo results, angiogram results
- Management - revascularisation, risk factor management, CABG
- Complications - particularly heart failure
Risk Factors for Ischaemic Heart Disease
- Family history of ischaemic heart disease
- Advanced age
- Smoking
- Hypertension
- Hyperlipidaemia
- Diabetes mellitus
- Physical inactivity
- Obesity
Severity
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- Angina - frequency, onset, management
- Heart failure symptoms - exertional dyspnoea, orthopnoea, paroxysmal noctural dyspnoea, peripheral oedema
- Exercise tolerance
- Last stress test results - chest pain, ECG changes
- Last echo results - ejection fraction, regional wall motion abnormalities
- Last angiogram results - degree of stenosis, intervention
Typical Cardiac Chest Pain
- Chest pain radiating to one or both arms
- Associated with exertion, nausea, vomiting or diaphoresis
- Pressure
- Relieved by glyceryl trinitrate
Complications
Complications of Ischaemic Heart Disease
- Atrioventricular (AV) block
- Cardiogenic shock
- Heart failure
- Valvular pathology - e.g. acute mitral regurgitation
- Ventricular rupture - septum / ventricular wall
- Cardiac arrest
Management
Management of Acute Coronary Syndromes
- Initial management (MOAN) - morphine, oxygen, antiplatelet, nitrate
STEMI
- Anticoagulation - heparin / low molecular weight heparin
- Revascularisation - coronary angiography / thrombolysis (depending on timing)
- Secondary prevention - antiplatelets, statin, ACE inhibitor, beta blocker
- Cardiac rehabilitation
NSTEACS
- Anticoagulation - heparin / low molecular weight heparin
- Dual antiplatelets - aspirin + ticagrelor / clopidogrel
- Revascularisation - coronary angiography
- Secondary prevention - antiplatelets, statin, ACE inhibitor, beta blocker
- Cardiac rehabilitation
Management of Stable Ischaemic Heart Disease
Non-Pharmacologic
- Smoking cessation
- Dietary optimisation
- Exercise
Pharmacologic
- Antiplatelet - aspirin
- Manage risk factors - hypertension, hyperlipidaemia, diabetes
Surgical Options
- Surgery - coronary artery bypass graft
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