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ISCHAEMIC HEART DISEASE Pathophysiology And Stable Angina Pectoris

ISCHAEMIC HEART DISEASE Pathophysiology And Stable Angina Pectoris. JD Marx Department of Cardiology University of the Free State. Definition. The blood supply to the myocardium is insufficient to comply fully with physiological needs of the heart muscle. Pathophysiology.

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ISCHAEMIC HEART DISEASE Pathophysiology And Stable Angina Pectoris

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  1. ISCHAEMIC HEART DISEASEPathophysiologyAnd Stable Angina Pectoris JD Marx Department of Cardiology University of the Free State

  2. Definition The blood supply to the myocardium is insufficient to comply fully with physiological needs of the heart muscle.

  3. Pathophysiology • Blood supply - epicardial vessels with perforating branches • Blood flow from epicardium to endocardium

  4. Pathophysiology • Control of blood flow • Perfusion in diastoly • Oxygen extraction maximal O2 supply can only be increased by increasing bloodflow • Humeral factors important - ADENOSIN

  5. Pathophysiology • Factors influencing myocardial oxygen supply and demand Oxygen demand Oxygen supply Coronary bloodflow Duration of diastoly Coronary perfusion pressure Coronary vasomotor tone Oxygenation Haemoglobin Oxygen saturation • Heart rate • Blood pressure • Myocardial contractility

  6. Auto-regulation Metabolic control Extravascular compressive forces Vascular resistance Diastolic phase Humoral factors Heart Rate Contractility Neural control Coronary blood flow Systolic wall tension O2-Carrying Capacity SUPPLY DEMAND

  7. Pathogenesis Causes of vessel obstruction • Fixed lesions • Atherosclerosis • Arteritis • Embolization • Dynamic narrowings • Spasm

  8. Pathogenesis Atherosclerosisis by far the most common cause of obstruction in patients with IHD

  9. Pathogenesis Birth of Plaque

  10. Pathogenesis Plaque progression

  11. Pathogenesis Plaque rupture

  12. Pathogenesis • Risk factors for Atherosclerosis Fixed factors Modifiable factors Smoking Hypertension Hypercholesterolemia Diabetes Mellitus Obesity Inactivity Stress • Family history • Gender - male • Age

  13. Clinical Presentation • of patients with Ischaemic Heart Disease • Stable angina pectoris • Acute Coronary Syndromes • Unstable Angina Pectoris • Non ST-segment elevation myocardial infarction • ST-segment elevation myocardial infarction • Arrhythmias • Sudden death • IschaemicCardiomyopathy with LV failure

  14. Symptomatic Presentation • of patients with Ischaemic Heart Disease The patients most often present with chest pain which should clinically evaluated!

  15. Symptomatic Presentation • Chest Pain ANGINA PECTORIS Typical chest pain caused by ischaemic myocardium

  16. Symptomatic Presentation • Chest Pain Clinically patients with angina pectoris present with: • Stable Angina Pectoris • Acute Coronary Syndromes

  17. Symptomatic Presentation • Chest Pain Chest pain resulting from a specific other disease process • Pericarditis • Pleuritis • Radicular or neural pain • Musculoskeletal pain • Gastroinstestinal pain • Other

  18. Symptomatic Presentation • Chest Pain Atypical chest pain • The chest pain is not typical of any clinical disease entity • Several special tests necessary to evaluate

  19. Angina Pectoris STABLE ANGINA PECTORIS • Diagnosis: • Clinical diagnosis: emphasis on history • Angina with stable pain pattern • Confirmed by: • Resting ECG • Stress ECG • Isotope perfusion study • Coronary angiography

  20. Angina Pectoris Exercise Stress Test

  21. Angina Pectoris Isotope Stress Test Exercise Rest

  22. Angina Pectoris Angiogram LCA RCA

  23. Angina Pectoris TREATMENT Conservative treatment: • General treatment • Aspirin • Anti-anginal medication • Nitrates • β-blockers • Calcium antagonists • Disease Modifying Therapy • Statins • ACE Inhibitors Interventional treatment: • Coronary angioplasty ( PTCA ) • Coronary Artery Bypass Graft Surgery ( CABG )

  24. Thank you

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