ischemic heart Disease And_Myocardial infarction.pptx

Topic for BAMS

1. i s chemic heart Disease And Myocardial infarction Submitted by- chhaya waskale

2. Ischemic heart disease Introduction Etiopathogenesis Risk factors Effectects of myocardial ischemia

3. Introduction- IHD also known as coronary heart disease, coronary artery disease IHD is defined as acute or chronic for cardiac disability arising from imbalance between myocardial supply and demand for oxygenated blood Since narrowing or obstruction Of coronary artery system is the most common cause of myocardial anoxia

4. Etiopathogenesis - It is convenient to consider the etiology of IHD under there broad headings: Coronary atherosclerosis Superadded changes in coronary atherosclerosis; and Non – atherosclerotic causes

5. Coronary atherosclerosis - Coronary atherosclerosis resulting in fixed obstruction is the major cause of IHD in more than 90% cases Distribution – highest incidence in the anterior descending branch of left coronary artery, followed in descending frequency by the right coronary artery and still less in circumflex branch of left coronary > 75% occlusion causes symptomatic ischemia included by exercise Location – area of severe involvement is 3-4 cms from coronary ostia, most often at/ near the bifurcation Slowly developing atheromas over long periods Lead yo collateral circulation

6. Super added changes in coronary atherosclerosis - Acute coronary syndrome are precipitated by changes superimposed on pre- existing fixed coronary atheroma Haemorrage : causes volume expansion Fissuring,ulceration- exposure of highly thrombogenic subendothelial tissues of blood Local platelets aggregation plug – which release thrombaxaneA2 ( vasospasmic mediator) responsible for coronary vasospasm Thrombosis, emboli,microinfacts

7. Non-atherosclerotic causes - Vasospasm – despite no significant atherosclerotic coronary narrowing may cause angina / M.I Circulating adrenergic agonist’ s Local released content of platelets Decrease secretion of relaxing factors Stenosis of coronary ostia – from syphilitic aortitis Arteritis – polyarteritis nodosa, tuberculosis and other bacterial infection Thrombotic disease- sickle cell anaemia ,polycythaemia vera, : hypercoagulability of blood – coronary occlusion Trauma

8. Risk factors- High blood pressure Smoking Obesity High blood cholesterol Lack of exercise Diabetes

9. Effects of myocardial ischemia - CORONAR ARTERY Disease Asymptomatic state Angina pectoris Acute myocardial infarction Chronic ischemic heart disease Sudden cardiac death

10. MYOCARDIAL INFACTION - Introduction Types of infarcts Epidemiology Etiology Etiopathogenesis Diagnosis Complications

11. INTRODUCTION- MI is defined as a diseased condition which is caused by reduced blood flow in coronary artery due to atherosclerosis and occlusion of an artery by an embolus or thrombus MI or heart attack is the irreversible damage of myocardial tissue caused by prolonged ischemia and hypoxia

12. Types of infarcts- According to anatomic region of left ventricle involved- Anterior Posterior Lateral Septal Circumferential Combinations-anterolateral,posterolateral,anteroseptal

13. According to degree of thickness of ventricular wall involved- Transmural ( full thickness) Laminar ( Subendocardial) According to age of infarcts- Newly formed ( acute,recent,fresh) Advanced infarcts ( old,healed, organised)

14. EPIDEMIOLOGY- In industrial countries MI accounts of 10-25% of all death’s Incidence is higher in elderly people about, 5% occurs at people under the age 40 Male have higher risk Women during reproductive period have low risk Over last 30 years, the rate of disease increase from 2-3 rural population and 4-12% in urban population

15. ETIOLOGY- Tobacco,smoking Hypertension Drug abuse Obesity Stress

16. Gender Diabetes Hyperlipoproteinaemia Family history of ischemic heart disease

17. ETIOPATHOGENESIS- The etiologic role of severe coronary atherosclerosis ( more than 75% compromise of lumen) of one or more of the three major coronary arterial trunks in the pathogenesis of about 90% cases of acute MI is well documented by autopsy studies as well as by coronary angiographic studies. A few notable features in etiology and pathogenesis of acute MI are considered below: Mechanism of myocardial ischemia Role of platelets Acute plaque rupture Non- atherosclerotic cause Transmural versus subendocardial infarcts Complications Arrhythmias congestive heart failure Cardiogenic shock Mural thrombosis and thromboembolism

18. DIAGNOSIS- Clinical features- Pain – usually sudden,severe,crushing,and prolonged,substerna in location, often radiating to one or both the arm’s,neck,and back Indigestion Apprehension- the patient is often terrified,restless and apprehensive , due to great fear of death Shock Low grade fever ( accomplished by leucocytosis and elevated ESR

19. Serum cardiac markers-: Creatinine phosphokinase( ck) – ck has three forms : CK-MM - derived from skeletal muscle CK-BB - derived from brain and lungs CK-MB - mainly from cardiac muscles and insignificant amount from extra cardiac tissue Lactic dehydrogenase Cardiac specific troponins ECG changes -: ST segment elevation T wave inversion Appearance of wide deep Q waves