Ischemic Heart Disease

Coronary Arteries

Atherosclerosis

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

Pathophysiology of myocardial ischemia Myocardial oxigen supply is decreased Narrowed coronary arteries (sclerosis, thrombus, spasms, coronary embolism, vasculitis) Hypotension Severe anemia Myocardial oxigen demand is increased Left ventricle hypertrophy Fever Hyperthyroidism Tachycardy

Coronary atherosclerosis Risk Factors: High LDL-cholesterol Low HDL-cholesterol Cigarette smoking Hypertension Diabetes

The clinical manifestations of ischemic heart disease without clinical symptoms, sudden death. Ischemic cardiomyopathy. Angina pectoris Acut coronary syndromes

Angina pectoris Angina pectoris means chest pain because of episodic myocardial ischemia Angina pectoris is the most common manifestation of the ischemic heart disease.

Approach to the patient with angina Hystory Location Radiation Quality Timing Factors that aggravate or relieve Associated symptoms

Approach to the patient with angina The context of the symptom development can give clues to diagnosis and management Stable exertional pectoris unstable angina acute coronary syndrome Prinzmetal’s variant angina

The typical clinical features of angina pectoris The typical location of pain is retrosternal. The pain can not be localized with one finger. Usually described as heaviness, pressure, squezzing. Usually associates with gradual intensification of symptoms over a period of minutes. It lasts typically 2-5 min. It can radiate to either shoulder and to both arms. It can also arise in or radiate to root of neck, jaw, teeth, and epigastrium. Exertional angina is typically relieved by rest and nitroglycerin. Associated symptoms Dyspnoe, Fatique, faintnessm Nausea, vomiting Sweating

Diagnostic tests in patients with chest discomfort ECG and X-ray are essential test for adults with chest discomfort life-threatening problems: Presence of electrocardigraphic changes consistent with ischemia or infarction: Troponin I or T PCI; percutaneous coronary intervention No evidence of life-threatening; stable angina exercise electrocradiography, stress echocardiography

ECG

ECG

ECG

ECG

Dental aspect If a patient with a history of angina experiences chest pain in the dental surgery, dental treatment must be stopped, the patient should be given GTN sublingually and oxygen, and be kept sitting upright. Vital signs should be monitored. The pain should be relieved in 2–3 min.

Dental aspect Pain that persists after three doses of nitroglycerin given every 5 min, that lasts more than 15–20 min, or that is associated with nausea, vomiting, syncope or hypertension is highly suggestive of MI(myocardial infarction). If pain persists, the patient should continue oxygen, and chew 300 mg of aspirin .

Dental aspect Any dental procedures should be deferred At least 3 months in patients with unstable angina. first 6 months after MI except Simple emergency dental treatment under LA but the opinion of a physician should be sought first. Older MI (more than12 months) patients can normally have elective dental care carried out safely. but it is wise to minimize pain and anxiety

Dental aspect Avoidance of NSAID Be aware about antiplatelet & anticoaglant Adrenaline containing LA should be avoided or minimized