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Cardio History

Ischaemic Heart Disease



  • 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


    • 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 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 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

    • 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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