Ischaemic Heart Disease

Clinical Presentation and Differential Diagnosis

-Coronary Artery Disease (CAD)à Manifests as chronic stable angina, acute coronary syndrome (which includes unstable angina, ST elevation MI, and non-ST elevation MI), unrecognized MI or sudden cardiac death.

CAD- explained in Patho



1. Chronic Stable Angina (most likely) - when cardiac metabolic demand exceeds supply.
- usually present with chest pain, described as heavy, tight or gripping.
- pain is central/ retrosternal and may raditate to the jaw or left arm.
- other associated symptomsà sweating, breathlessness and fear.
- can be precipitated by exertion, emotional excitement, mental stress or exposure to cold.
-Symptoms resolve when precipitating events has ceased; resting

2. Acute Coronary Syndromes- when fibrous cap of a coronary artery plaque ruptured/ eroded.
- sudden onset of chest pain, also at rest or deterioration of a pre-existing angina unrelated to any precipitating event.
-ST elevation MI (STEMI)-severe chest pain lasting more than 20 minutes- not alleviated by rest nor sublingual GTN.-Pain often radiates to left arm, neck or jaw.
-Associated symptoms- dyspnoea, diaphoresis, nausea or vomiting and palpitations. -Autonomic symptoms- pale and clammy, with marked sweating.-Atypical presentation in particularly in elderly or diabetic – dyspnoea, fatigue, presyncope or syncope.”

Symptoms Explanations

Dyspnoea- Its COMPLICATED. Impairment of Left ventricular function due to ischaemia leads to an acute rise in left ventricular end-diastolic pressure raised pulmonary venous, interstitial fluid leakage and thus reduced lung compliance. A symptom of anxiety? In ichaemic condition, metabolites are released, stimulating cardiac sympathetic nerves (explains sweating, clamminess and palpitations)

Chest pain- Ischaemia causes visceral pain which stimulates the pain fibres and sympathetic sensory nerves which run closely to cervical and thoracic spinal nerves. Referred pain to chest, neck and arm area.


Provisional Diagnosis
-Ichaemic Heart Disease – Chronic Stable Angina

Differential Diagnosis
Aortic Dissection
Pulmonary Embolism
Acute Coronary Syndrome – Unstable Angina?
Ashma
Congestive Heart Failure.
Cheers,
Alvin