IHD/CAD

1. Background/Cultural Points:

   Ischemic Heart Disease and Coronary Artery Disease is increasingly common in Cambodia due to: uncontrolled hypertension, rheumatic heart disease or other valvular disease, genetic predisposition, and increasing obesity secondary to a more Western diet. Patients in Cambodia often misunderstand MI & CAD as an acute problem rather than a progressive problem and often present for the first time when symptomatic.

2. Diagnosis & Lab:

   1. Ischemia diagnosed by: ST segment depression more than 1 mm from J point, T-wave inversion, ST segment elevation, dysrythmia.
   2. Clinical manifestations include: angina, dyspnea, epigastric pain, and arrhythmias
   3. Consider: H/H, Glucose, U/A, Creatinine, Na/K, CXR, EKG, Echocardiogram (Calmette), TSH (only if suspected/hi-risk)

3. Management/Education/Treatment:

   1. Review with patient: 1) IHD/CAD is a chronic condition; 2) consistent life-long treatment significantly reduces risk of worsening disease ; 3) good management requires the patient’s willingness to adjust his/her lifestyle and use medication as prescribed.
   2. Lifestyle Points:
      1. Reduce cholesterol/saturate fat intake. Avoid too much fried meats and breads. Increase soluble fiber (mangos, morning glory)
      2. Change from white-rice-only diet to minimum 20% brown rice
      3. Weight loss if obese; Exercise if sedentary
      4. Smoking cessation, abstinence or moderation of alcohol use
   3. Medications (consider, if no contraindications, and based on comorbidities):
      1. Antiplatelet: Aspirin (ASA) 81mg QD if benefit > risk. Warn regarding stomach irritation – consider GI protection prophylaxis or at follow-up. Clopidogrel may be available if ASA contraindicated.
      2. Beta blocker: Atenolol/Metoprolol
      3. Plaque stability/cholesterol: Simvastatin
      4. Anti-anginals: Isosorbide mononitrate po
      5. ACEI: Lisinopril/Enalapril
   4. Referral:
      1. Jeremiah’s Hope or Visiting Cardiology Team List for CAD (stent, etc)

4. Follow-Up:

   1. Initial follow-up at 1 month, then q3-6 mos, then annually
   2. Monitor labs appropriately, based on medication chosen (EKG, Cr/K, LFTs q3-12 mos).
   3. Monitor for metabolic syndrome, HTN