Key points in Ischemic heart disease

Key points in Ischemic heart disease

Most common risk factor for ischemic heart disease is Hypertension.
The worst risk factor is DM.
Consider Positive Family history of  CAD if it was under 55 in man under 65 in women.

Non-ischemic chest pain

  • Tenderness
  • Positional
  • Pleuritic chest pain, pain increase with breathing

Ischemic chest pain

  • STEMI
    • Give Aspirin then perform PCI within 90 min if it is available or Thrombolytics
    • PCI lower mortality more
    • Do not transfer to PCI available hospital do Thrombolytics
    • Thrombolytics should be used within 12 hours after the onset of the pain, followed by heparin
  • Unstable angina
    • No ST-segment elevation
    • No elevation of cardiac enzymes after 4-12 hours
  • NSTEMI
    • No ST-segment elevation
    • Elevated cardiac enzyme ++ Troponin, and CK-MB

Medication that lower mortality in ischemic heart disease

  • Asprin for All as an initial step, or clopidogrel if he can’t tolerate aspirin
  • Metoprolol or Atenolol
  • ACE when EF < 40%
  • Give Statin for any patient with LDL > 100.

Medication that will not lower mortality but it is helpful

  • Morphine
  • Oxygen
  • Nitroglycerin
  • Calcium channel blocker used it in
    • Cocaine-induced chest pain
    • Prinzmetal angina
    • Server Asthma can’t tolerate metoprolol

 

Most comment side effect of statins is not myositis, it increases liver enzymes LST, so you have to monitor liver enzyme level.

Statin with fibric acid derivatives increases the risk of myositis.

Statin lower mortality in ACS, while ACE inhibitor lower the mortality after ST-elevation MI

Aspirin is the most important initial step in any patent with a suspected coronary event.
Start with aspirin, clopidogrel, heparin, and tenecteplase.

Adding Prasugrel as a second antiplatelet drug with aspirin is has great benefits after coronary reperfusion, however, it increases the risk of bleeding

Accelerated idioventricular rhythm is the most common arrhythmias after cardiac reperfusion

CABG in Three vessels or Two vessels and Diabetics

Propranolol decrease the risk of atrial fibrillation after CABG

New left bundle branch block is equal to ST-segment elevation, This is a Thrombolytic indication

Acute Coronary Syndrom ACS, Or Non-ST-Elevation MI
ACS is History and EKG
EKG could be ST-depression or Normal is still ACS

 

PCI or Fibrinolytic

PCI has a better outcome, Do PCI if you can do it in less than 120 min

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