Ischemic Heart Diseases ppt

IHD also known as coronary artery diseases is a condition in which there is inadequate supply of blood and oxygen to a portion of myocardium. Imbalance between myocardial oxygen supply and demand causes Angina, MI, Hear failure, and Arrhythmia

1. Ischemic heart disease. IHD Michael Kino MBBS, NEIGRIHMS

2. I s chemic heart disease Definition: Ischemic heart disease (IHD) is a condition in which there is in adequate supply of blood and oxygen to a portion of myocardium. It tipically occurs when there is an imbalance between myocardial oxygen supply and demand. It’s the most common, serious, chronic, life-theatening disease in the developed countries. The most common cause is atherosclerotic disease of an epicardial coronary artery.

3. Pathophysiology of myocardial ischemia Myocardial ox y gen supply is decreased Narrowed coronary arteries (sclerosis, thrombus, spasmus, coronary embolism, vasculitis) Hypotension Severe anemia Methemoglobinemia, increased carboxyhemoglobin Myocardial ox y gen demand is increased Left ventricle hypertrophy Fever Hyperthyroidism Tachycard ia

4. Coronary arteries

5. Blood flow during systole and diastole

6. A therosclero sis

7. IHD can cause: Angina . Myocardial infarction. Cardiac arrhythmia. Conduction defect. Heart failure. Sudden cardiac death.

8. Assessment of coronary blood flow and myocardial perfusion: ECG(Electrocardiography) . Echocardiography. Stress testing . Cardiac catheterization .

9. Risk Factors Uncontrollable Sex Hereditary Race Age Controllable High blood pressure High blood cholesterol Smoking Physical activity Obesity Diabetes Stress and anger

10. Clinical picture of IHD is divided in to two groups: Chronic ischemic heart diseases: A: Stable angina . B: Silent myocardial ischemia . C: Variant or vasospastic angina. Acute coronary syndrome ( ACS ): Unstable angina NSTEMI. STEMI .

11. Chronic ischemic heart disease: A: Stable angina: Symptoms: Chest pain(Location , radiation , severity & duration). Aggravating factors( Stress ,cold weather & physical activity). Relieving factors( Rest , sublingual nitroglycerine).

12. Silent myocardial ischemia ( no chest pain): In elderly patient. In diabetic patient. In female.

13. Variant or vasospastic angina: Vasospasm is present . Mostly at night . In the absent or present of stenosis. Clinical presentation: Chest pain . ECG: - ST segment elevation or depression .

14. Summary of the characteristics of angina pectoris Typical angina pectoris : Retrosternal chest pain (discomfort) Complaints occur after exertion or emotional stress The pain is relieved by rest and nitroglycerin Atypical angina pectoris : only two from three characteristics (especially in women and diabetics, angina may be atypical in location and not strictly related to provocing factors) Pseudoangina : Only one or no one out of three characteristics.

15. Cardial and extracardial causes of chest discomfort CARDIOVASCULAR DISEASES Ischemic heart disease Pericarditis Aortic dissection Congestive heart failure Aortic stenosis and regurgitation Hypertrophic cardiomyopathy Pulmonary hypertension LUNG DISEASES Pulmonary embolism Pneumothorax Pleuro-pneumonia Pleuritis GASTROESOPHAGEAL DISEASES Gastroesophageal reflux Esophageal motility disorders Paptic ulcer Gallstones NEUROMUSCULOSKELETAL DISEASES Fracture of sternum or rib Spondylarthrosis Periarthritis humeroscapularis Intercostal muscle cramp Tietze’ s syndrome MISCELLANEOUS Subphrenic abscess Herpes zoster Splenic infraction Psychiatric disease

16. Diagnosis and treatment: Diagnosis: History ( Risk factors ) . Chest pain ( Rollout other chest pain ) . ECG . Echocardiography . Stress test . Angiography .

17. Treatment: To reduce symptoms . To prevent myocardial infarction . Prevention from sudden death . Treat risk factors .

18. Life style modification: Smoke cessation. Regular exercise . Weight reduction . Unsaturated fate . Prevent exposure to cold weather .

19. Pharmacologic therapy : Antiplatelet (Aspirin & clopedogrile ). Beta blockers ( Metoprolole , Atenolol , Bisoprolol , Carvedilol ) . Calcium channel blocking agent( Verapamile , Deltiazem , Nefidipine ). Lipid lowering drugs ( Atrovastatin , Simvastatin , Rosuvastatin ). Nitroglycerine .

20. Beta blocker : β ₁ receptors( In the heart ). β₂ receptors (In bronchus and smooth muscles of vessels ). Beta blocker decreased sympathetic activity and reduced the oxygen consumption of the heart.

21. Calcium channel blocker (CCB) : - It is used for variant angina or prenzmintal angina . - Induce vasodilation in coronary and peripheral vessels . Nitroglycerine and nitrates( Isosorbide dinitrate and Isosorbide mononitrate ): Dilate the vessels . Decreased preload and afterload . Antiplatelet effect .

22. Surgical Treatment Stenting Angioplasty (balloon) Bypass surgery 28

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