Ischaemic/Coronary Heart Disease

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Ischaemic/Coronary Heart Disease (IHD)

Most common heart disease – most important cause of premature death in western world. Occurs when oxygen demand of the heart muscle exceeds supply (supply is usually impeded by atheroma, thrombosis or spasm).

Risk factors
Age, male and family history.
Modifiable risk factors – smoking, hypertension, dyslipidaemia, diabetes mellitus, inactive lifestyle/fitness, obesity, dietary deficits

Clinical manifestations:
• Stable angina - ischaemia is due to an atheromatous stenosis of coronary artery(s)
• Unstable angina – ischaemia is due to dynamic obstruction of coronary artery from rupture of atheromatous plaque
• myocardial infarction – acute occlusion from plaque rupture and thrombosis  necrosis
• heart failure – dysfunction of heart due to the infarction or ischaemia
• arrhythmia – conduction disorder from the infarction or ischaemia

Public and personal heath issue.

Public health strategies:
• modification of risk factors
• stop smoking, regular exercise, weight reduction, diet

Personal/targeted strategies:
• targeting of high risk individuals
• more aggressive management of risk factors (eg hypertension, diabetes, obesity, dyslipidaemia).

Implications for Podiatric Management:
• impaired ability to self care of feet  need to make use of family/care givers
• presence of peripheral vascular disease  symptoms and potential for reduced wound healing
• oedema  hosiery and footwear advice
• potential for acute event when in clinic
• reinforce public health message
• increased risk for foot pathology from advice to increase exercise  advice re selection of footwear, prevention of foot problems, etc

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