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Cardio History
 
 

Ischaemic Heart Disease

 
 
 
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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.
  • Ask About

  • 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

  • Ask About

  • 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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