Bems Kiran presentation1
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Ischemic heart disease, also known as coronary artery disease, refers to a group of syndromes caused by an imbalance between myocardial oxygen supply and demand. The most common cause is atherosclerotic narrowing of the coronary arteries. Risk factors include age, male sex, hypertension, hyperlipidemia, diabetes, and smoking. Angina occurs when ischemia is reversible, while a myocardial infarction involves cell death due to prolonged ischemia. Diagnosis involves symptoms, electrocardiogram changes, and elevated cardiac enzymes. Chronic ischemic heart disease can lead to heart failure over time due to multifocal scarring.
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Bems Kiran presentation1
- 3. INTRODUCTION Ischemic heart disease also designated as coronary artery disease refers to a group of closely related syndromes caused by an imbalance between myocardial oxygen demand and blood supply.
- 4. ETIOLOGY The most common cause of imbalance between need and supply of oxygen is atherosclerotic narrowing of the coronary arteries producing ischemia.
- 5. RISK FACTORS FOR ATHEROSCLEROSIS Fixed Risk Factors Age Male Sex Family History
- 6. MODIFIABLE RISK FACTORS STRONG ASSOCIATION Hyperlipidemia Hypertension Cigarette Smoking Diabetes Mellitus
- 7. OTHER ASSOCIATIONS Obesity Lack of exercise Heavy alcoholism Dietary factors Oral contraceptives Gout High level of coagulation factor vii & fibrinogen Anxiety & depression
- 8. PATHOGENESIS Defective Oxygen Delivery Increased Oxygen Demand IHD becomes symptomatic when there is 75% or more reduction of the lumen of one or more coronary arteries by atherosclerotic plaque. Superimposed Lesions Acute changes in plaque morphology Local platelet aggregation Coronary artery spasm Coronary artery thrombosis
- 10. CLASSIFICATION OF IHD Stable angina Unstable angina Myocardial infarction Sudden cardiac death
- 12. WHAT IS ANGINA? Angina is a clinical syndrome characterized by intermittent chest pain caused by reversible myocardial ischemia. The pain is usually substernal or precordial radiating to the shoulder and arm or to the jaw. It lasts for several minutes.
- 13. TYPES OF ANGINA STABLE ANGINA VARIANT ANGINA UNSTABLE ANGINA
- 14. STABLE ANGINA It occurs due to increased myocardial oxygen demand during exertion in a patient of narrow coronary arteries. VARIANT ANGINA It occurs at rest and produced by the reduction of the myocardial blood supply due to coronary artery spasm. UNSTABLE ANGINA In this type of angina, frequency, severity and duration of episodes are progressively increased. It occurs at rest due to thrombus formation and coronary artery spasm.
- 15. DIFFERENCE B/W STABLE & UNSTABLE ANGINA STABLE ANGINA UNSTABLE ANGINA Due to fixed stenosis Due to dynamic stenosis Demand-led ischemia Supply-led ischemia Related to effort Symptoms at rest Symptoms over long Symptoms over short term term
- 18. ECG During pain ECG shows ST –segment depression with or without T wave inversion that reverses after ischemia disappears. Elevation of ST segment in variant angina. The resting ECG may be normal b/w attacks however it may show old MI, heart block or left ventricular hypertrophy.
- 19. ETT When history is suggestive of angina but ECG normal ETT is performed for diagnosis. Positive test is one in which ST segment is depressed by 1 mm.
- 22. INTRODUCTION •MI is death or necrosis of myocardial cells. Myocardial infarction (MI or AMI for acute myocardial infarction), commonly known as a heart attack, occurs when the blood supply to part of the heart is interrupted.
- 23. ETIOLOGY Commonly caused due to occlusion of a coronary artery following the rupture of a vulnerable atherosclerotic plaque, in the wall of an artery. The resulting ischaemia and hypoxia, if left untreated for a sufficient period, can cause damage and or death (infarction) of heart muscle tissue.
- 26. ETIOPATHOGENESIS 1. Mechanism of MI i) Diminished coronary blood flow ii) Increased myocardial demand iii) Cardiac hypertrophy without se of coronary blood flow 2. Role of Platelets - rupture of atherosclerotic plaque exposes subendothelial collagen to platelets - aggregation, activation, release of platelets
- 27. 3. Complicated Plaques i) Superimposed coronary thrombosis ii) Intramural haemorrhage 4. Non-atherosclerotic causes - coronary vasospasm - arteritis - embolism - thrombotic diseases - trauma
- 28. 5. Transmural versus subendocardial infarcts Transmural infarcts- involve full thickness of ventricular wall subendocardial (laminar) infarcts- affecting inner subendocardial one-third to one-half.
- 30. Classical symptoms of acute myocardial infarction Sudden chest pain Shortness of breath Nausea Vomiting Palpitations Sweating Anxiety
- 31. Risk factors for myocardial infarction 1. Older age 2. Sex (males) 3. Tobacco smoking 4. Hypercholesterolemia 5. Diabetes 6. Hypertension 7. Obesity 8. Stress
- 32. Pathological Changes Vary according to the age of the infarct Most infarcts occur singly (very less multifocal), 4-10 cm size Most often in left ventricle Subendocardial infarcts produce less well- defined infarcts gross changes than the transmural infarcts.
- 33. CLINICAL DIAGNOSIS Clinical diagnosis is based on Symptoms ECG changes Elevation of specific serum enzymes
- 34. SYMPTOMS Onset is sudden with severe constricting, crushing, burning substernal or precordial pain that radiates to the left shoulder and arm or jaw. Pain is accompanied by sweating, nausea, vomiting or dyspnea. Cardiogenic shock.
- 35. ECG Changes ST Segment elevation, follwed by abnormal new Q waves and inverted T wave. Serum Enzymes Creatinine phosphokinase Lactic dehydrogenase Cardiac troponin I & Troponin T.
- 37. CHRONIC ISCHEMIC HEART DISEASE Chronic IHD some times called ischemic cardiomyopathy is used to describe the development of progressive CHF. It is characterized by multifocal areas of myocardial atrophy and fibrosis secondary to slowly developing coronary atherosclerosis leading to dilatation of cardiac chambers.
- 38. CLINICAL FEATURES Usually it remains asymptomatic and progressively CHF develops. Cardiac arrhythmias may occur when scarring involves conduction system. Angina, MI
- 39. TYPES OF HEART FAILURE ACUTE HEART FAILURE CHRONIC HEART FAILURE RIGHT AND LEFT HEART FAILURE CONGESTIVE HEART FAILURE FARWARD HEART FAILURE BACKWARD HEART FAILURE CARDIAC ARREST
- 40. ACUTE HEART FAILURE Sudden onset of heart failure without previous symptoms of ischemia or MI. CHRONIC HEART FAILURE Gradual onset of heart failure with symptoms of ischemia or MI. CONGESTIVE CARDIAC FAILURE Bi ventricular heart failure.
- 41. CARDIAC ARREST Complete cessation of heart function. Conductive system of heart completely block.