1. Ischemic Heart Diseases IHD
Ahmad Osailan

2. Introduction What is IHD?
Is a condition that affects the blood supply (coronary arteries of the heart)
Another name for it : Coronary artery disease (CAD)
Results when there is an imbalance between myocardial oxygen supply and demand due to partial blockage of the artery.

3. Brief Physiology of the heart
the layer that consist the Muscles of the Heart = Myocardium
What Helps the Blood to travel away from the Heart to organs?

4. Brief Physiology of the heart
Now the heart in order to pump, Myocardium has to contract.
Myocardium requires action potential to contract and energy metabolism.
Action potential and energy metabolism require presence of O2 and nutrients within blood in coronary arteries.
If there is decrease in O2 and nutrients, does the heart will function normally?

5. Normal coronary artery

6. Causes and risk factors for IHD
The most underlying causes are:
Atheroscelerosis: thickening and hardening of the artery wall.
Plaque: (the build-up of lipid/cholesterol) in the artery wall forms as a response to injury to the endothelium in the artery wall.
Therefore, causes the lumen of the artery to be narrow, which result in less oxygenated blood supply to the area after the narrowing

7. So, any narrowing or obstruction of the coronary arteries lead to Ischemic heart disease

9. Risk Factors for IHD Age: (non-modifiable risk factor)
Male > 45 years
Female > 55 years or premature menopause without estrogen replacement therapy
Family History of premature disease (non- modifiable risk factor)
Male first-degree relative <55 years
Female first-degree relative < 65 years)

10. Risk Factors for IHD Hypertension (Modifiable Risk factor(
Appears to weaken the artery wall at points of high pressure leading to injury and invasion of cholesterol.
Cigarette Smoking (modifiable Risk factor)
#1 cause of preventable death in US
1 in 5 CHD deaths attributable to smoking

11. Diabetes (modifiable risk factor) Inactivity (modifiable Risk factor)
Risk Factors for IHD
Diabetes (modifiable risk factor)
50% of deaths related to DM is due to CHD
Inactivity (modifiable Risk factor)
Sedentary person has 2x risk for developing CHD as a person who is active

12. Risk Factors for IHD Abnormal Blood Lipids (modifiable Risk factor)
LDL Cholesterol (low density lipoprotein)
HDL Cholesterol (high density lipoprotein)

13. LDL (Low Density Lipoproteins)
Some LDL can be oxidized and takes up by endothelial cells and macrophages in the arterial wall, which leads to the first stages of atherosclerosis.

14. High Density Lipoproteins (HDL)
HDL-C is thought to be involved in the transport of excess cholesterol from membranes to the liver for removal from the body

15. Problems resulting from HD
Most common problems:
Angina Pictoris (stable angina)
Unstable angina (Acute myocardial infarction)
Heart failure.

16. Angina Pictoris
When part of the heart receive insufficient blood supply.
DEF: uncomfortable sensation in the chest or neighboring anatomic structures produced by myocardial ischemia during physical exertion or emotional stress. relieved by rest with in few minutes
Temporary depression of ST segment with no permanent myocardial damage

18. Unstable angina ( Acute MI)
Increased frequency and duration of Angina episodes, produced by less exertion or at rest = high frequency of myocardial infarction if not treated

19. Myocardial Infarction
Death of parts or area of myocardium.
Region of myocardial necrosis due to prolonged cessation of blood supply
Results from acute thrombus at side of coronary atherosclerotic stenosis
May be first clinical manifestation of ischemic heart disease or history of Angina Pectoris

20. Common signs and symptoms of IHD
Pain or discomfort in the chest
Nausea
Dyspnea
Radiating pain to Left shoulder

21. Electrocardiogram
When ischemia results in transient horizontal or downsloping ST segments or T wave inversions which normalize after pain resolution
ST elevation suggest severe transmural ischemia or coronary artery spasm which is less often

22. treatment

23. Pharmacologic Therapy
Therapy is aimed in restoring balance between myocardial oxygen supply and demand
Useful Agents: nitrates, beta-blockers and calcium channel blockers

24. Types of common cardiac revascularization surgeries
Coronary artery bypass Grafting (CABG)
Percuatneous Transluminal coronary Angioplastgy (PTCA)
Valve replacement

25. PTCA

26. CABG

27. Management Goals to reduce Anginal Symptoms
Prevent complications – myocardial infarction, and to prolong life
No smoking, lower weight, control hypertension and diabetes
Patients with CAD – LDL cholesterol should achieve lower levels (<100)
Exercise and maintain active life style.