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SCHAEMIC HEART DISEASE (Coronary heart disease)

Posted by SAMUEL ISABIRYE on February 5, 2013 at 4:55 PM

A condition in which there is insufficient blood flow

through the coronary arteries of the heart thus

leading to ischaemia and/or infarction

 

Cause/risk factors

 

z

Deposition of fatty material (cholesterol plaques)

inside the coronary arteries

z

Enlarged heart following hypertension

z

Diabetes mellitus, obesity and hypertension

z

Smoking

z

Hyperlipidemia

z

Family history of heart disease

 

Clinical features

 

z

Chest pain which may be localised on the left or

central part of the chest ranging from mild to

severe deep pain

 

z

Tightness in the chest or a sense of oppression

worsening on exertion and relieved by rest and

lasting only a few minutes

 

UCG 2010

203

 

 

 

9. Cardiovascular diseases

z

There may be associated anxiety, vomiting and

sweating

 

z

Signs of sympathetic activation

eg. pallor and tachycardia

 

z

Low BP

 

z

shortness of breath

 

z

Arrythmias - may cause sudden death

 

Differential diagnosis

 

z

Indigestion

z

Peptic ulcers

z

Pleurisy

z

Pericarditis

z

Severe anaemia

z

Dissecting aneurysm

 

Management HC4

f

Give aspirin 150mg single dose (to be chewed)

f

glyceryl trinitrate 500 micrograms sublingually

 

Repeat after 5 min if no response

 

f

give propranolol 10-40mg daily for as long as is

required

 

- ensure close observation of the pulse rate and

circulatory status

´

avoid in patients with shock or hypotension

¾

Refer to higher level of care.

Prevention

 

z

Low-fat, low-cholesterol diet

 

z

Stop smoking

 

z

Effective control of hypertension and diabetes

mellitus

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