IHD

Question 1

What causes IHD?

Answer 1

Atherosclerosis

Question 2

What are the risk factors of IHD?

Answer 2

• Obesity
• Smoking
• Lack of exercise
• Hypertension
• Diabetes
• Hypercholesteraemia
• Poor diet
• Excess alcohol
• Rheumatological disease
  
  • RA
  • SLE
  • Psoriasis
  • Psoriatic arthritis

Question 3

Outline the pathophysiology of IHD

Answer 3

• Atherosclerosis forms from endothelial injury of the vessel
• Proliferation of smooth muscle cells
• This exposes the lipid laden vessel which become oxidised
• This causes macrophage to come and engulf the lipid and become foam cells
• Foam cells accumulate in intima of blood vessel walls to form a fatty streak
• Fatty streaks can evolve into athersclerotic plaque
• Grows and encroaches on the lumen of the artery
• The plaque ruptures
• This triggers acute thrombosis by activating platelets and clotting cascade

Question 4

What are the types of acute coronary syndrome?

Answer 4

Stable angina

Unstable angina

MI

Sudden cardiac death

Question 5

What are the signs and symptoms of IHD?

Answer 5

• Asymptomatic
• Central crushing chest pain
• Radiation of pain to the arm, neck, jaw and back
• Heartburn
• SOB

Question 6

How would you investigate IHD?

Answer 6

• ECG
• Cardiac stress test - exercise tolerance tet
• Cardiac enzymes
• Echo (+stress)
• Coronary angiogram

Question 7

How should IHD be managed?

Answer 7

• Lifestyle changes
  
  • Quit smoking/alcohol
  • Exercise
  • Eat better
  • Optimise HTN and diabetes
• Medication
  
  • Antiplatelets - aspirin and clopidogrel
  • Statins
  • Beta-blockers - HTN
  • GTN
• Surgery
  
  • PCI
  • CABG

Question 8

What are the possible complications of IHD?

Answer 8

• MI
• Heart failure
• Arrythmia