This comprehensive set of notes includes the aetiology, pathophysiology, clinical presentation, investigations, diagnosis and treatment of 20+ cardio conditions covered in medical school. The conditions are arranged in order of most common to least common. Information is compiled from BNF, and othe...
Ischemic Heart Disease
● Cardiac myocyte damage (and eventual death) due to insufficient oxygen-rich blood
● Can be due to increased myocardial workload + coronary artery occlusion OR due to
insufficient oxygen-rich blood supply
● (in ascending order of severity) stable angina < unstable angina < NSTEMI < STEMI
Risk Factors
● Age
● Family history
● DM
● Smoking
● obesity/lack of exercise
● Hyperlipidemia
● Outflow obstruction abnormalities (aortic stenosis/cardiomyopathy)
Symptoms of SA
● Chest pain precipitated by exertion/exposure to cold
● lasts 1-5min
● Relieved by rest/sublingual GTN spray
Symptoms for UA/NSTEMI/STEMI
● Chest pain: discomfort, heaviness, squeezing, burning
○ Prolonged, > 20 min at rest
, ○ Radiate to epigastrium, arms, shoulders, nec and jaw (mainly left arm and
neck)
● Sweating
● nausea/vomiting
● Dyspnoea
● Fatigue
Patients with DM/elderly patients may not present with chest pain!
Signs
● Vary greatly
● Low-grade fever
● Pale and cool
● Clammy skin
● hypertension/hypotension
Diagnosis
● Physical Examination
○ 3rd/4th Heart sound (caused by stiff, compliant ventricles)
○ Systolic murmur/pericardial rub (if mitral regurgitation/septal defect is primary
cause)
○ Pulmonary crackles (pulmonary oedema)
○ Elevated JVP
○ For stable angina, exclude symptoms of aortic stenosis: slow-rising carotid
pule, ejection murmur radiating to neck
● ECG
○ UA/NSTEMI
■ Could be normal or show symptoms
■ Transient T-wave inversions
■ ST-segment depression
○ STEMI
■ ST-segment elevation
■ Initially peaked T-waves, then T-wave inversion
● Cardiac Enzymes
○ SA, UA: little to no change in troponin
○ NSTEMI, STEMI: troponin, CK, myoglobin all rise and remain elevated
● FBC
○ Exclude anaemia
○ CRP: sign of inflammation
○ Hyperglycemia (reduces patient’s chance of surviving)
○ Monitor K+ levels (arrhythmias)
● CXR
○ Assess patient’s heart size, presence or absence of HF, pulmonary oedema
● Echo
○ Effect of ischemia on heart
● Coronary Angiography**
Treatment for SA
● Lifestyle: stop smoking, lose weight, control hypertension and DM
, ● Medical
○ (in the absence of contraindications) patients should receive statins (reduce
cholesterol) and aspirin (antiplatelets)
○ Nitrates: vasodilators that can abort attacks (sublingual GTN spray)
○ 1st Line: CCB/B-blockers
■ If CCB is used as first line, use rate-limiting (non-dihydropyridine) one
like verapamil
■ If CCB is used with B-blocker, use long-acting one like amlodipine
■ DO NOT combine a beta-blocker with a rate-limiting (non-
dihydropyridine) CCB as severe bradycardia and heart failure can
occur
● Surgery
○ Coronary artery bypass graft (CABG) - section of blood vessel is taken from
another part of the body and used to reroute blood flow past a blocked/narrow
section of artery
○ Percutaneous coronary intervention (PCI), AKA coronary angioplasty - where
a narrowed section of artery is widened using a tiny tube called a stent
○ CABG is usually the preferred surgical option for people who:
■ have diabetes, and/or
■ are over 65 years of age, and/or
■ have blockages in 3 or more blood vessels that supply the heart with
blood
**CCBs like verapamil should be avoided in patients with heart failure
, Treatment for STEMI: same as for UA/NSTEMI but without time to do angiography
Subsequent management for all patients
● Dual antiplatelet therapy (aspirin +2nd antiplatelet)
● ACE-inhibitor
● β-blocker: bisoprolol. If contraindicated, consider verapamil or diltiazem Statin: e.g.
simvastatin.
Heart Failure
● pathophysiologic state in which the heart fails to pump blood at a rate commensurate
with the requirements of the metabolizing tissues
● progressive ↓ in the heart’s ability to contract and relax
● Ejection fraction >40% is ejection fraction preserved HF (diastolic HF)
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