ISCHEMIC HEART DISEASE

Coronary arteries Left coronary artery supplies:

Left ventricle Interventricular septum Part of right ventricle

Coronary arteries (cont’d) Right coronary artery supplies:

Right atrium Right ventricle Part of the left ventricle

Myocardial ischemia develops when there is an imbalance between supply of oxygen and the myocardial demand .

ETIOLOGY

Decreased coronary blood flow due to mechanical obstruction such as :

1. Atheroma .2. Spasm of coronary artery .3. Thrombosis .4. Embolus .5. Coronary arteritis ( SLE) .6. Congenital abnormalities of coronary artery .

Increased myocardial oxygen requirement

1. Increased cardiac out put : in thyrotoxicosis .2. Myocardial hypertrophy : from aortic stenosis or

hypertension .

Decreased flow of oxygenated blood to myocardium

1. Anemia .2. Hypotension .

ANGINA PECTORIS

DEFINITION

ANGINA PECTORIS :is a clinical syndrome characterized by paroxysmal chest pain due to transient myocardial ischemia.

It may be occur whenever there is imbalance between myocardial oxygen supply and demand .

The most common cause is atherosclerosis , aortic stenosis, and hypertrophic cardiomyopathy .

TYPES OF ANGINA

1. Stable angina .2. Unstable angina .

STABLE ANGINA

is the angina that occurs when coronary perfusion is impaired by fixed or stable atheroma of coronary arteries i-e patient has fixed capacity of exertion after that he starts feeling chest pain .

STABLE ANGINA

UNSTABLE ANGINA

is the angina that is characterized by rapidly worsening chest pain, pain on minimal exertion or pain at rest .

The lesion is usually a complex ulcerated or fissured atheroma with adherent platelet –rich thrombus and local coronary spasm .

Unstable angina = ulcerated atheroma +thrombus formation+ abrupt reduction of coronary blood flow caused by thrombus formation + angina at rest .

The obstruction is not complete .

UNSTABLE ANGINA

CLINICAL FEATURES

SYMPTOMS

1. CHEST PAIN .2. DYSPNEA . 3. ASSOCIATED SYMPTOMS .

TYPICAL ANGINA PAIN

SITE : pain may arise in one of the following sites :1. Middle or lower sternum .2. Left precordium .3. Epigastrium .4. Left shoulder or left upper arm .5. Lower jaw .6. Interscapular region .

TYPICAL ANGINA PAIN

CHARACTER

Patient feels tightness in the chest “like a band around the chest” .

He may also describe it as a sense of pressure, choking or heaviness in the chest.

The pain may be sharp and piercing .

AGGRAVATING

1. Physical exertion e.g. exercises, sexual activity .2. Heavy meal .3. Intense emotion e.g. stress, anger, fright or

frustration .4. Lying flat (decubatus angina) .5. Violet dreams (nocturnal angina) .

ASSOCIATED SYMPTOMS

Dizziness or fainting .Chocking sensation in throat .Polyuria after an attack .

SIGNS

Look anxious .Pale face .Dyspnea .Cold sweats .

INVESTIGATION

1. ECG .2. EXERCISE TOLERANCE TEST .3. ISOTOPE SCANNING .4. ECO 5. CORONARY ANGIOGRAPHY .

MANAGEMENT

GENERAL MEASURES :Do not moke .Aim at ideal body weight .Take regular exercise .Take sublingual nitrate .

TREATMENT

1. NITRATES .2. BETA BLOCKERS .3. CALCUIM AGONISTS .4. REVASCULARIZATION .

MYOCARDIAL INFARCTION

DEFINITION

Acute ischemic necrosis of an area of myocardium is known as myocardial infarction , OR myocardial necrosis occurring as a result of critical imbalance between coronary blood supply and myocardial demand is called myocardial infarction .

It has the the same symptoms and signs, etiology , as angina pectoris .

INVESTIGATION

The same as angina pluse :CARDIAC ENZYMES mainly troponin T .

Thank you .