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Ischaemic Heart Disease

. Ischaemic Heart Disease. Etilogy. Most ischaemic heart disease is caused by atherosclerosis of the coronary artereries. Initially there is sudden sever narrowing or closure of large coronary arteries and or narrowing of coronary artery end branches. Covering plaques. Risk Factors. 1- age.

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Ischaemic Heart Disease

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  1. . Ischaemic Heart Disease dr.mon5@hotmail.com

  2. dr.mon5@hotmail.com

  3. Etilogy • Most ischaemic heart disease is caused by atherosclerosis of the coronary artereries. • Initially there is sudden sever narrowing or closure of large coronary arteries and\ or narrowing of coronary artery end branches. • Covering plaques......... dr.mon5@hotmail.com

  4. Risk Factors 1- age. 2- Gender. 3- Serum cholesterol: VLDL....LDL...HDL. 4- Hypertension; endothelial damage. 5- Cigarate smoking; nicotine-----catecholamine-----epinephrine-----endothelial damage----lipolysis. 6- Diabetes; disturbed lipid metabolism. dr.mon5@hotmail.com

  5. Minor risk factors 1- Hypothyrodism. 2- obesity. 3- Sedentary life. 4-Intellectual professional. 5- Contraceptive pills. dr.mon5@hotmail.com

  6. Clinical Consequences A- Angina Pectoris Def. Clinical syndrome characterized by attack of pain due to ischaemia of the heart muscle, generally due to obstruction or spasm of coronary arteries. dr.mon5@hotmail.com

  7. Types 1- Stable: occurs under similar circumstances, and with similar frequency over time. 2- Un-stable: • Recent onset. • Increased severity and frequency . • Angina at rest or with minimal exertion. 3- Variant: - At rest. - Spasm of coronary artery. -Not precipitated by increase myocardial 02 demand dr.mon5@hotmail.com

  8. Clinical Picture • Pain: • Site • Radiation. • Character: burning..suffocation. stop all activities. - Precipitation: • Relief. • Duration. dr.mon5@hotmail.com

  9. Associated Symptoms: Dyspnea . Palpitation. Dizzness. Fainting.Sweating. dr.mon5@hotmail.com

  10. Clinical Picture: • Sings and symptoms: Pallor...tachycardia....hypertension. Investigation: • ECG: normal in 50%. • Stress ECG: Depression of st segment. Ventricular Arrhythmias. - Cardiac Catheterization : arteriography. - Echocardiography: regional wall abnor. Ex and rest. dr.mon5@hotmail.com

  11. Therapy Aiming for : • Decrease myocardial oxygen demand. • Increase myocardial o2 supply. I. Medical Treatment: • Nitrates. Vosodilat.... Myo.02 sup • overload.... Myo o2 deman • Beta bolckers: • Calcium channel blockers • Antiplatelets: reduce incidence of MI dr.mon5@hotmail.com

  12. II. Surgery: III. Preventive: 1- Avoid precipitating factors. 2- Control Risk factors. N.B . During Attack dr.mon5@hotmail.com

  13. Myocardial Infarction Def. It is a medical condition that occurs when the blood supply to the heart is interrupted , and the myocardium is deprived of its blood supply ‘” therefore oxygen “’ for a significant amount of time. Pathogenesis: - Formation of occlusive thrombus at the site of rupture or erosion of atherosclerotic plaques in coronary artery. dr.mon5@hotmail.com

  14. Clinical Picture: • Symptoms: • Prolonged cardiac pain: • Anxiety • Nausea . Vomiting • Breathlessness. • Syncope: Silent MI......elder....arrythmias dr.mon5@hotmail.com

  15. II.Signs: • Signs of sympathatic activities: pallor, sweating, tachycardia • Signs of vagal activation: vomiting...bradycardia. • Signs of impaired myocardial function: hypotension. Narrow pulse pressure. - Signs of tissue damage. fever dr.mon5@hotmail.com

  16. Investigation • ECG:- • Early • Late: • Advanced : 2) Blood test: • Cardiac enzymes: Cardiospecific isoform of CK :CK- MB Troponin T and I dr.mon5@hotmail.com

  17. ESR: 3) Chest x ray: Pulmonary oedema. Cardiac enlargement dr.mon5@hotmail.com

  18. Therapy A- Immediate Therapy: - High flow oxygen. • Aspirin 300 mg. • ECG monitoring. B) Acute perfusion therapy: 1- Thrombolysis: Help restore coronary potency. Preserve ventricular function. Improve survival. dr.mon5@hotmail.com

  19. 2) Primary percutaneous coronary intervension: C) Adjunctive Therapy: • Beta blockers relief pain ------reduce arrythmias. - Nitrates: Nitroglycerin: dr.mon5@hotmail.com

  20. dr.mon5@hotmail.com

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