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Chronic Ischemic Heart Disease

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Topic updated on 12/25/15 2:20pm

Introduction
  • Progressive development of heart failure as a consequence of many years of heart damage due to chronic ischemia
  • Pathophysiology
    • results from long standing coronary artery disease
    • contractile myocytes replaced with non-contractile fibrous tissue
  • Risk factors
    • diabetes mellitus (most important and considered a CAD equivalent)
    • smoking (#1 preventable factor)
    • HTN
    • cholesterol/lipid abnormalities
      • LDL > 160
      • HDL < 35
    • family history
    • age >45 (men), age >55 (women)
Presentation
  • Similar to congestive heart failure
  • Angina
    • patient may report history of angina due to reduced perfusion of myocardium
Evaluation
  • Chest radiograph
    • massive cardiomegaly, pulmonary vascular congestion, interstitial pulmonary edema.
  • Echocardiography
    • dilated cardiomyopathy and reduced ejection fraction.
Treatment
  • Coronary artery disease risk factor management
  • Control acute episodes of cardiac ischemia 
  • Heart failure treatment 
Complications
  • Angina
  • Heart failure
    • potential to progress to dilated cardiomyopathy   
    • and low output heart failure
  • Myocardial infarction
  • Sudden cardiac death


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