IHD - Symptoms/Investigations/Complications/Prognosis
Symptoms of IHD:
Angina
Radiating pain
Nausea
Breathlessness
Weakness
Feeling faint
Signs of IHD:
Diskinetic cardiac apex (no apex beat)
Mitral regurgitation
Pulmonary Oedema
Cardiac enlargement
Arterial bruits
3rd and or 4th heart sounds – sometimes only if examined during an anginal attack due to transient left ventricular failure.
Apical systolic murmur (papillary muscle death)
There may be evidence of other atherosclerotic disease at other sights i.e.
o Abdominal aortic aneurism
o Carotid bruit
o Diminished peripheral pulses
o Increased light reflexes because of hypertension
o Anemia
o Thyroid disease
If the chest wall is tender or if pain can be reproduced by chest palpation then it is unlikely to be
Investigations
Cardiac Markers
Troponin and CK/CKMB are the cardiac markers that are currently investigated.
CK is released as in skeletal muscle breakdown (trauma, prolonged exercise, hypothermia) but CKMB is specific to cardiac muscle.
CK-CKMB ratio is usually less than 5% anything higher = bad
Troponin is great but it stays elevated (as one can see from the beautiful graph) for many days after an event making it less useful for repeat infarctions or after any cardiac surgery. Also it peaks after 12 to 24 hours so it can show the size of the infarct but not immediately. Last interesting thing is that Troponin levels are thought to rise before injury actually occurs thus it can be used for early detection.
Complications of MI
Heart failure
Myocardial rupture and aneurismal dilation – Rupture of the free wall of the ventricle is normally early and fatal. A sub acute rupture may allow for pericardiocentesis followed by the surgical repair of the rupture. Aneurysmal dilation of the infracted myocardium is a late complication that may require surgical repair.
Ventricular septal Defect VSD – Mortality is very high with a 12-month inoperative mortality of 92%.
Mitral Regurgitation
Cardiac Arrhythmias - including ventricular tachycardia, atrial fibrillation and bradyarrhythmias
Conduction Disturbances – Are very common following an MI. Heart Block can last for only a few minutes, but frequently continues for several days. Permanent pacing may need to be considered if heart block persists for over two weeks.
Prognosis of IHD:
Principal prognostic indicators:
o Age
o Functional state of the left ventricle
o Locations and severity of arterial narrowing
o And activity and severity of myocardial infarction
o Blood pressure
o Diabetes
o ST segment deviation
Using these factors, 90-day mortality ranged from as low as 0.4% in patients with no risk factors to 21.1% for those with more than 4 risk factors.
Angina
Radiating pain
Nausea
Breathlessness
Weakness
Feeling faint
Signs of IHD:
Diskinetic cardiac apex (no apex beat)
Mitral regurgitation
Pulmonary Oedema
Cardiac enlargement
Arterial bruits
3rd and or 4th heart sounds – sometimes only if examined during an anginal attack due to transient left ventricular failure.
Apical systolic murmur (papillary muscle death)
There may be evidence of other atherosclerotic disease at other sights i.e.
o Abdominal aortic aneurism
o Carotid bruit
o Diminished peripheral pulses
o Increased light reflexes because of hypertension
o Anemia
o Thyroid disease
If the chest wall is tender or if pain can be reproduced by chest palpation then it is unlikely to be
Investigations
Cardiac Markers
Troponin and CK/CKMB are the cardiac markers that are currently investigated.
CK is released as in skeletal muscle breakdown (trauma, prolonged exercise, hypothermia) but CKMB is specific to cardiac muscle.
CK-CKMB ratio is usually less than 5% anything higher = bad
Troponin is great but it stays elevated (as one can see from the beautiful graph) for many days after an event making it less useful for repeat infarctions or after any cardiac surgery. Also it peaks after 12 to 24 hours so it can show the size of the infarct but not immediately. Last interesting thing is that Troponin levels are thought to rise before injury actually occurs thus it can be used for early detection.
Complications of MI
Heart failure
Myocardial rupture and aneurismal dilation – Rupture of the free wall of the ventricle is normally early and fatal. A sub acute rupture may allow for pericardiocentesis followed by the surgical repair of the rupture. Aneurysmal dilation of the infracted myocardium is a late complication that may require surgical repair.
Ventricular septal Defect VSD – Mortality is very high with a 12-month inoperative mortality of 92%.
Mitral Regurgitation
Cardiac Arrhythmias - including ventricular tachycardia, atrial fibrillation and bradyarrhythmias
Conduction Disturbances – Are very common following an MI. Heart Block can last for only a few minutes, but frequently continues for several days. Permanent pacing may need to be considered if heart block persists for over two weeks.
Prognosis of IHD:
Principal prognostic indicators:
o Age
o Functional state of the left ventricle
o Locations and severity of arterial narrowing
o And activity and severity of myocardial infarction
o Blood pressure
o Diabetes
o ST segment deviation
Using these factors, 90-day mortality ranged from as low as 0.4% in patients with no risk factors to 21.1% for those with more than 4 risk factors.
posted by third year at
10:31 AM
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