Pharmacological management ischamic heart disease

1Primary prevention of ischaemic heart disease
2Pharmacological treatment ischaemic heart disease
3Principles of management of acute coronary syndrome
4risk factors for atherosclerosis to prevent coronary syndrome which causes ischaemic heart disease
5What are the risk factors of ischaemic heart disease

Pharmacological treatment:

1.Statin therapy: Can safely reduce incidence of major coronary events and stroke. Mainly use statin are Atorvastatin, Fluvastatin, Lovastatin, Rosuvastatin, Pitavastatin, Pravastatin.[ Side-effect of statin drug use severe muscle pain, feeling headache, dizziness, decrease blood platelet count.]

2)ACE inhibitors: Reduces the risk of death, myocardial infarction and stroke in patients with atherosclerotic vascular disease.[side-effect of ACE inhibitors: Dry cough, Angioedema, First dose hypotension, Hyperkalaemia, Acute kidney injury, Teratogenicity.]

3)Aspirin: Is effective in reducing morbidity and mortality (non- fatal myocardial infarction, stroke and cardiovascular death).
4) Treatment of hypertension: Blood pressure should be treated to a target of 130/80 mm Hg

Primary prevention of ischaemic heart disease:

1.Stopping smoking.
2.Take regular exercise (minimum of 20 minutes, three times a week)
3.Maintenance of ideal body weight (BMI < 25).
5.Eating a mixed diet rich in fresh fruit and vegetables.
6.Reduction of saturated fat in diet (< 10%).

What are the risk factors of ischaemic heart disease?

A) Irreversible / non-modifiable:
3)Family history of HTN, DM, ID, hypercholesterolaemia.
4)Type-1 personality
B) Reversible / modifiable:
2)Diabetes mellitus.
5)Physical inactivity.
7)Dietary habit (deficient fresh food, vegetables & polyunsaturated fatty acids)

One of the main reason of ischemic heart disease is coronary syndrome. Lets explain this topic:

Acute coronary syndrome (ACS):

Acute coronary syndrome is a term that encompasses both unstable angina and myocardial infarction(MI).
Unstable angina is characterized by new-onset or rapidly worsening angina (crescendo angina), angina on minimal exertion or angina at rest in the absence of myocardial injury.
Myocardial infarction (MI) is distinguished from unstable angina by the occurrence of myocardial necrosis and is diagnosed when myocardial injury occurs in the presence of clinical evidence of acute myocardial ischaemia.

Principles of management of acute coronary syndrome:
1.Bed rest.
2.Oxygen inhalation if needed.
3.Loading dose of antiplatelets e.g. Tab. Aspirin (300 mg) & Tab, Clopidogrel (300 mg). Then maintenance dose.
4.Loading and maintenance dose of Statin.
5.Sublingual nitroglycerine – Spray or tablet.
6.To relieve pain – Either morphine or pethidine.
7.If ST elevation MI with no contraindication – Thrombolytics e.g. Inj. Streptokinase, Tenecteplase, Alteplase etc.
8.If non-ST elevation MI or unstable angina – Low molecular weight heparin.
9.Coronary angiogram and PCI.
10.Treatment of risk factors.
11.Treatment of complication, if any.

2.Cardiac markers -Troponin-I, CK-MB.
4.Blood sugar, HbA1c.
5.Serum creatinine.
6.Lipid profile.
7.CBC with ESR.

Coronary syndrome is main occur due to atherosclerosis. So we must learn risk factors for atherosclerosis to prevent coronary syndrome which causes ischaemic heart disease :

1.Age is the most powerful independent risk factor for atherosclerosis.
2.Pre-menopausal women have much lower rates of disease than age & risk-matched males
3.The gender difference disappears after the menopause.
4.Family history / Genetics:
5.Atherosclerotic vascular disease often runs in families
9.Diabetes mellitus.
10.Haemostatic factors:
11.Platelet activation.
12.High levels of fibrinogen.
13.Anti-phospholipid antibodies are associated with recurrent arterial thomboses.
14.Physical inactivity.
18.Diets deficient in fresh fruit, vegetables and polyunsaturated fatty acids.
19.Low levels of vitamin C, vitamin E and other antioxidants.
20.Personality: Certain personality traits are associated with an increased risk of coronary disease.
21.Social deprivation.


50 years old obese patient admitted to hospital with sudden severe central chest pain radiating to left arm for four hours. BP 80/60 mmHg.
A)What is your clinical diagnosis?
Clinical diagnosis: Acute coronary syndrome (ACS) with cardiogenic shock.

B)How will you investigate the patient?

-Troponin-1 enzyme.
-Rendom Blood Suger Test.
-Serum creatinine.
-Serum electrolytes.
-Lipid profile.
-Complete blood count with ESR.

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