Ischemic Heart Disease in MRCP Part 1

Causes :
Main cause of ischemia to heart muscle is Coronary Artery Disease ( Atherosclerotic or Non Atherosclerotic eg: cocaine abuse, Prinzmetal`s angina, Syndrome X).
Other (non coronary artery) causes are Aortic valve disease, Hypertrophic left ventricle ( eg- HOCM), Anemia etc.

Clinical Presentation and Diagnosis:
Central chest pain is the cardinal symptom but may be atypically breathless (angina equivalent in diabetes or old patient). Moreover there may be additive features of complications (Heart failure/cardiogenic shock, Myocardial rupture/left ventricular aneurysm, DVT and pulmonary embolism, Pericarditis, Dysrhythmias, Mitral regurgitation, Severe depression) of IHD or other cardiac risk factors , comorbidities.

Differential diagnosis of chest pain of IHD is challenging.

Acute MI is defined by several criteria. The commonest is an increase and then a
decrease in cardiac biomarkers (eg troponin) and either: symptoms of ischaemia OR ECG changes of new ischaemia OR development of pathological Q waves OR loss of myocardium on imaging.

Investigations:
ECG, Biomarkers, CXR, Echocardiogram, Coronary angiogram, CBC, Sugar, U/E, Lipids etc

Aims (basic principles) of Investigations in Hypertension
1) To diagnose ischemia
2) To identify causes of ischemia
3) To identify complication
4) To identify associated other cardiac risk factors or co morbidities

Management:
A) Management of Stable angina
B) Management of Acute coronary syndrome (ACS)

                       Immediate management of ACS
Drug
PCI ( if possible)
Thrombolysis (if PCI not is possible and NO contraindication of thrombolysis )

                       Long term management of ACS
Management of causes of IHD
Management of complication of IHD / co morbidities
Education of the patient ( eg: driving- DVLA guideline , sexual activity etc)

Download DOAMSmrcp Suggestion Part 1 – IHD

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