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.

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