1. Ischemic Heart Disease

2. Coronary Arteries

3. Atherosclerosis

4. 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.

5. 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

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

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

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

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

10. 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

11. 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

12. 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

13. ECG

14. ECG

15. ECG

16. ECG

17. 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.

18. 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 .

19. 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

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