Course Content
Management of Ischaemic Heart Disease
0/5
Pathophysiology & Clinical Presentation
13:40
Pharmacological Management
14:35
Non-Pharmacological Interventions
05:25
Patient Education & Adherence Strategies
05:17
End of Topic Quiz
00:20:00
Anticoagulants & Antiplatelet Therapy
0/4
Mechanisms of Action of Anticoagulants & Antiplatelets
05:30
Indications, Dosing, & Monitoring of Anticoagulation Therapy
06:27
Management of Bleeding Risks & Reversal Strategies
03:49
End of Topic Quiz
00:20:00
Management of Diabetes Mellitus
0/5
Overview of Type 1 & Type 2 Diabetes Management
03:45
Pharmacological Treatments
08:05
Monitoring of Blood Glucose & HbA1c
05:22
Managing Complications
09:20
End of Topic Quiz
00:20:00
Hormone Replacement Therapy
0/4
Indications for Hormone Replacement
09:47
Risks & Benefits of Hormone Therapy
08:15
Monitoring & Adjusting Hormone Therapy
End of Topic Quiz
Asthma & COPD Management
0/5
Pathophysiology of Asthma & COPD
07:26
Pharmacological Treatments
Inhaler Technique & Patient Education
05:03
Acute Management
06:56
End of Topic Quiz
00:20:00
Immunotherapy in Respiratory Diseases
0/4
Role of Immunotherapy in Allergic Asthma
01:00
Mechanisms & Types of Immunotherapy
13:50
Monitoring Response and Adverse Effects to Immunotherapy
End of Topic Quiz
00:20:00
Heart & Respiratory Disease Management
About Lesson

Introduction

  • Ischaemic Heart Disease (IHD), also known as coronary heart disease (CHD) or coronary artery disease, is characterised by inadequate blood and oxygen supply to the myocardium.
  • IHD is the leading cause of death globally.
  • Deaths from IHD peaked in the mid-1960s, and while they have decreased since, they remain a significant health concern.

Pathophysiology

  • Atherosclerosis: The most common cause of IHD, where cholesterol deposits within the artery wall cause endothelial dysfunction and plaque formation.
    • Begins as a fatty streak and can progress to an unstable atherosclerotic plaque, disrupting blood flow and leading to ischaemia.
  • Plaque Activation: Atherosclerosis alone doesn’t account for all IHD cases; inflammation, thrombosis, and coronary microvascular dysfunction (CMD) are also important factors.
  • Coronary Microvascular Dysfunction (CMD):
    • CMD affects the coronary microcirculation and accounts for about 60% of coronary resistance, contributing significantly to IHD.
    • It can result from ischaemia-reperfusion injury, distal embolisation, and individual susceptibility, impacting both acute coronary syndrome (ACS) development and prognosis.

Clinical Presentation

  • IHD can present as stable ischaemic heart disease (SIHD) or acute coronary syndrome (ACS).
  • Key Symptoms include:
    • Chest Pain (Angina): Often triggered by exertion, radiating to the jaw, neck, or left arm.
    • Dyspnoea: Shortness of breath, worsened by activity.
    • Other symptoms: Syncope, palpitations, tachypnea, oedema, orthopnea, and reduced exercise capacity.
  • Classification:
    • SIHD: Predictable chest pain relieved by rest or nitroglycerin.
    • ACS: Includes unstable angina, NSTEMI, and STEMI; caused by the rupture of an atherosclerotic plaque, leading to thrombus formation and restricted blood flow.
  • Diagnosis: Involves a combination of history, physical examination, and laboratory tests, including:
    • Cardiac enzymes (CK and troponin) for ischaemic events.
    • Electrocardiogram (ECG) to identify ischaemic patterns.

Management and Treatment

  • Lifestyle Modifications:
    • Smoking cessation, weight loss, exercise, and dietary changes (e.g., Oslo Diet).
  • Pharmacological Therapy:
    • Antiplatelet agents (e.g., aspirin, ticagrelor, clopidogrel) to prevent thrombus formation.
    • Statins to lower cholesterol.
    • Beta-blockers to reduce heart rate and myocardial oxygen demand.
    • ACE inhibitors to improve cardiac function.
    • Nitrates (e.g., nitroglycerin) to improve blood flow.
    • Ranolazine to improve ischaemic threshold and reduce angina.
  • Revascularisation Procedures:
    • Percutaneous Coronary Intervention (PCI) with stent placement.
    • Coronary Artery Bypass Graft (CABG) surgery to bypass blocked arteries.

Complications

  • Arrhythmias, ACS, congestive heart failure (CHF), mitral regurgitation, ventricular free wall rupture, pericarditis, aneurysm formation, and mural thrombi are possible complications of IHD.

Deterrence and Patient Education

  • Modifiable Risk Factor Management:
    • Control diabetes, hypertension, lipid levels, weight, and smoking cessation.
  • Public Health Initiatives: Increasing awareness through education programs and media campaigns is key for primary prevention.

References

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