Ischemic Heart Disease

Clinical Description

Condition in which there is inadequate blood and oxygen supply to any portion of the myocardium, Can be stable angina, unstable angina, or myocardial infarction (acute coronary syndrome). Risk factors: Hypertension, Diabetes mellitus, smoking, alcohol, old age, hyperlipidemia, family history of ischemic heart disease.

Signs and Symptoms

• Central crashing chest pain (worse on exertion) +/-radiation to left arm/jaw/neck + nausea/vomiting
• Heaviness feeling on the chest
• Shortness of breath and palpitations
• Sweating
• -/+ signs of pulmonary edema if LVF

Note: old and diabetic patients may have silent myocardial infarction (with no chest pain)

Sub-lingual nifedipine (10 mg) should be avoided due to the unpredictable response of the blood pressure. If parenteral drugs are unavailable, then slow release nifedipine 20mg orally can be used.

Investigations

• FBC, Cardiac enzymes (CK, CK-MB, Troponin, AST, LDH), U+E+Creatinine, RBS, Lipogram, ECG, CXR, Echocardiogram

Treatment

General measures

Minimize risk factors by:

• Weight reduction (if obese)
• Control of hypertension
• Control of diabetes
• Stop smoking

Address other factors such as:

• High blood cholesterol
• Stressful lifestyle
• Excessive alcohol intake
• Encourage monitored regular moderate exercise