Ischaemic Heart Disease

Dr CS Mutiti-Masona

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Definations
 IHD-Caused by atherosclerotic plaque formation
that leads to an imbalance between oxygen
supply and demand resulting in myocardial
ischaemia
 Atherosclerosis-Accumulation of white cells and
lipids(plaque) in the artery lumen eventually
causing clogging of the vessel
 Ischaemia-Reduction in blood supply to tissues
causing shortage of oxygen and glucose
 Infarction-Tissue death due to lack of oxygen
due to obstruction of the tissues blood supply.

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Atherosclerosis

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Infarction

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Types of Ischaemic heart Disease
 1.ACUTE (Acute Coronary Syndrome)
 i)Unstable angina
 ii)Non ST Elevation Myocardial Infarction
 Iii)ST Elevation Myocardial infarction
 2.CHRONIC (Coronary Artery Disease)
 i)Stable Angina

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Risk Factors

 Dyslipidaemia
 Smoking
 Diabetes Mellitus-Poor control
 Hypertension
 Obesity
 Family History of heart failure and coronary

artery disease
 Old Ischaemic heart disease condition

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Symptoms
 Chest pain-usually central or left
sided,radiating to left shoulder or Jaw
 Chest pain relieved by Nitrates and worsened

by Exercise,stress etc
 Shortness of breath-dysponea
 Sweating

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Investigations
 Electrocardiography-Records the electrical
activity of the heart
 Main Diagnostic tool

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Normal ECG

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ST ELEVATION MI

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Stress ECG

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Other investigations-Cardiac enzymes

 Cardiac enzymes-biomakers used to evaluate

heart function
 Troponin-A protein released by myocytes

when irreversible myocardial damage

occurs,most specific
 Creatine kinase-MB also released by skeletal

muscle
 Myoglobin-Released by cardiac and skeletal

muscle
 Glycogen phophorylase BB

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Cardiac enzymes

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Management-Non Pharmacological
 Stop smoking
 Lipid control-reduce fats and cholesterol in

diet
 Strict diabetic control
 Exercise
 Stop alcohol

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Pharmacological management

 Sublingual Nitroglycerine ,
 Aspirin,
 Thrombolitic agents
 Long acting nitrates
 Calcium channel blockers
 Beta Blockers

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QUESTION 1
 Patient and Setting: AD, a 60-year-old
woman presents for follow-up at cardiology
clinic

 Chief Complaint: Follow-up appointment for

coronary artery disease/post-myocardial
infarction care; presents with increasing chest
pain, shortness of breath, and leg swelling

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History of present illness
 Presents to cardiology clinic complaining of
increased chest pain after climbing two flights of
stairs or walking three blocks. All episodes of chest
pain are relieved by sublingual nitroglycerin. AD
reports that “they occur a bit more often” than
before her myocardial infarction (MI); also complains
of occasional shortness of breath, mainly when
climbing stairs or walking, swelling in her ankles and
lower legs, and having to get up several times during
the night to go to the bathroom; she claims that the
shortness of breath and leg swelling are new and
have been occurring over the past several weeks

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 Medical History: Came to the emergency
department 6 months ago with an anterior-
wall MI; received fibrinolytic therapy for the
MI; has a long history of uncontrolled
hypertension.

 Surgical History: Tonsillectomy and

adenoidectomy, age 9; appendectomy,

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 Family/Social History: Family History: Mother
died at age 55 of lung cancer; father died at
age 61 of heart failure

 Social History: Married with three children, all

alive and well; active smoker, has smoked
approximately one and a half packs of
cigarettes per day for 40 years; drinks alcohol
occasionally (~ 1–2 drinks per day, 5 × a
week)

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 Which of the following is a sign or symptom
of left-sided heart failure?
 a. Bilateral rales
 b. Raised Jugular venous pressure
 c. Hepatomegaly
 d. Splenomegaly

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 . Which of the following is the most likely
etiology of AD's heart failure?
 a. Coronary artery disease
 b. Renal insufficiency
 c. Estrogen replacement therapy
 d. Hypertension

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