Ischemic heart disease lecture for BDS students

Lecture on ISCHEMIC HEART DISEASE for 3rd Year BDS students.
Very easy and interactive lecture
It includes common causes of chest pain
Risk factors for ischemic heart disease
Features of typical angina
Diagnosis of Angina and Myocardial infarction
Treatment of Angina and Myocardial Infarction
Complications of Myocardial Infarction

1. Lecture: Chest pain and Ischemic Heart Disease Dr. Muhammad Zaid Iqbal FCPS Medicine , CHPE Senior Registrar Medical Unit 4 Nishtar Hospital Multan

2. Learning Outcomes At the end of session students will be able to: Enlist causes/differentials of chest pain Describe ischemic heart disease Describe acute coronary syndrome Describe management of acute coronary syndrome

3. Causes of Chest pain Cardiac vs Non-Cardiac

4. ISCHEMIC HEART DISEASE Coronary artery disease (CAD)/Ischemic Heart Disease (IHD) is the most common cause of angina and acute coronary syndrome and the most common cause of death worldwide. The World Health Organisation (WHO) has estimated that 3.8 million men and 3.4 million women die from cardiovascular disease (CVD) each year, and since 1990, more people have died from CVD than any other cause.

5. PATHOGENESIS Atherosclerosis is a progressive inflammatory disorder of the arterial wall that is characterised by focal lipid-rich deposits of atheroma that remain clinically silent until they become large enough to impair tissue perfusion, or until ulceration and disruption of the lesion result in thrombotic occlusion or distal embolisation of the vessel.

6. Risk Factors for IHD

7. Risk Factors Age and sex Genetics Smoking Hypercholesterolemia Hypertension Diabetes Mellitus Physical activity Obesity Alcohol Diet

8. Case scenerio John, a 58-year-old man, has a history of hypertension and high cholesterol levels. He presents to his primary care physician with complaints of chest discomfort that occurs during physical activity. He describes the discomfort as a squeezing sensation in his chest that sometimes radiates to his left arm. The pain typically lasts for a few minutes and is relieved by rest. What is the most likely diagnosis?

9. Chronic Stable Angina Clinical Features Investigations Treatment

10. CLINICAL FEATURES OF TYPICAL ANGINA Constricting discomfort in the front of the chest, or in the neck, shoulders, jaws or arms Precipitated by physical exertion Relieved by rest or GTN within about 5 minutes

11. INVESTIGATIONS OF ANGINA ECG EXERCISE ECG MYOCARDIAL STESS IMAGING Myocardial perfusion scintigraphy Multi-gated acquisition scan (MUGA) Stress echocardiography 4. PET and SPECT CARDIAC CT SCAN AND MRI CORONARY ANGIOGRAPHY

12. TREATMENT OF ANGINA PHARMACOLOGICAL Nitrates Beta blockers Calcium channel blockers Potassium channel activators Ivabradine Ranolazine

13. INVASIVE PROCEDURES Percutaneous intervention (angiography + angioplasty) Coronary artery bypass grafting (CABG)

14. ACUTE CORONARY SYNDROME ST-ELEVATION MYOCARDIAL INFARCTION (STEMI) NON-ST ELEVATION MYOCARDIAL INFARCTION (NSTEMI) UNSTABLE ANGINA

15. Diagnosis Clinical presentation ECG Cardiac Biomarkers / enzymes

16. CARDIAC ENZYMES

17. Emergency Management Provide oxygen Attach cardiac monitor Administer I/V opioid analgesia Aspirin 300mg Clopidogrel 300mg / ticagrelor 180mg Metoprolol 5-15mg IV / 50-100 PO Nitrate infusion

18. MANAGEMENT

19. Management of Non-ST Elevation MI PCI with stenting (if therapy is Ineffective)

20. Management of ST-Elevation MI Anti-Platelet therapy Reperfusion therapy PCI with Stenting: door to balloon time 90min or less Fibrinolysis: Alteplase, Reteplase , Tenecteplase, Streptokinase Post Fibrinolysis Management: Heparin (LMWH, unfractioned Heparin)

21. LATE MANAGEMENT OF MI Lifestyle modification : Diet, Smoking cessation,regular exercise Secondary prevention Drug Therapy Aspirin Clopidogrel Nitrates Beta blockers ACE/ARBs Statin Additional therapy for control of Diabetes and Hypertension

22. Thank you