2. Cardiologydr.mon5@hotmail.com 2. Ischaemic Heart Disease

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4. Etilogy - Most ischaemic heart disease is caused by atherosclerosis of the coronary artereries. - Initially there is sudden sever narrowing or closure of large coronary arteries and\ or narrowing of coronary artery end branches. - Covering plaques......... Cardiologydr.mon5@hotmail.com 4

5. Risk Factors 1- age. 2- Gender. 3- Serum cholesterol: VLDL....LDL...HDL. 4- Hypertension; endothelial damage. 5- Cigarate smoking; nicotine-----catecholamine-----epinephrine- ----endothelial damage----lipolysis. 6- Diabetes; disturbed lipid metabolism. Cardiologydr.mon5@hotmail.com 5

6. Minor risk factors 1- Hypothyrodism. 2- obesity. 3- Sedentary life. 4-Intellectual professional. 5- Contraceptive pills. Cardiologydr.mon5@hotmail.com 6

7. Clinical Consequences A- Angina Pectoris Def. Clinical syndrome characterized by attack of pain due to ischaemia of the heart muscle, generally due to obstruction or spasm of coronary arteries. Cardiologydr.mon5@hotmail.com 7

8. Types 1- Stable: occurs under similar circumstances, and with similar frequency over time. 2- Un-stable: - Recent onset. - Increased severity and frequency. - Angina at rest or with minimal exertion. 3- Variant: - At rest. - Spasm of coronary artery. -Not precipitated by increase myocardial 02 demand Cardiologydr.mon5@hotmail.com 8

9. Clinical Picture I. Pain: - Site - Radiation. - Character: burning..suffocation. stop all activities. - Precipitation: - Relief. - Duration. Cardiologydr.mon5@hotmail.com 9

10. - Associated Symptoms: Dyspnea. Palpitation. Dizzness. Fainting.Sweating. Cardiologydr.mon5@hotmail.com 10

11. Clinical Picture: - Sings and symptoms: Pallor...tachycardia....hypertension. Investigation: - ECG: normal in 50%. - Stress ECG: Depression of st segment. Ventricular Arrhythmias. - Cardiac Catheterization : arteriography. - Echocardiography: regional wall abnor. Ex and rest. Cardiologydr.mon5@hotmail.com 11

12. Therapy Aiming for : - Decrease myocardial oxygen demand. - Increase myocardial o2 supply. I. Medical Treatment: - Nitrates. Vosodilat.... Myo.02 sup - overload.... Myo o2 deman - Beta bolckers: - Calcium channel blockers - Antiplatelets: reduce incidence of MI Cardiologydr.mon5@hotmail.com 12

13. II. Surgery: III. Preventive: 1- Avoid precipitating factors. 2- Control Risk factors. N.B. During Attack Cardiologydr.mon5@hotmail.com 13

14. Myocardial Infarction Def. Def. It is a medical condition that occurs when the blood supply to the heart is interrupted, and the myocardium is deprived of its blood supply ‘” therefore oxygen “’ for a significant amount of time. Pathogenesis: - Formation of occlusive thrombus at the site of rupture or erosion of atherosclerotic plaques in coronary artery. Cardiologydr.mon5@hotmail.com 14

15. Clinical Picture: A. Symptoms: - Prolonged cardiac pain: - Anxiety - Nausea. Vomiting - Breathlessness. - Syncope: Silent MI......elder....arrythmias Cardiologydr.mon5@hotmail.com 15

16. II.Signs : - Signs of sympathatic activities: pallor, sweating, tachycardia - Signs of vagal activation: vomiting...bradycardia. - Signs of impaired myocardial function: hypotension. Narrow pulse pressure. - Signs of tissue damage. fever Cardiologydr.mon5@hotmail.com 16

17. Investigation 1) ECG:- - Early - Late: - Advanced : 2) Blood test: - Cardiac enzymes: Cardiospecific isoform of CK :CK- MB Troponin T and I Cardiologydr.mon5@hotmail.com 17

18. - ESR: 3) Chest x ray: Pulmonary oedema. Cardiac enlargement Cardiologydr.mon5@hotmail.com 18

19. Therapy A- Immediate Therapy: - High flow oxygen. - Aspirin 300 mg. - ECG monitoring. B) Acute perfusion therapy: 1- Thrombolysis: Help restore coronary potency. Preserve ventricular function. Improve survival. Cardiologydr.mon5@hotmail.com 19

20. 2) Primary percutaneous coronary intervension: C) Adjunctive Therapy: - Beta blockers relief pain ------reduce arrythmias. - Nitrates: Nitroglycerin: Cardiologydr.mon5@hotmail.com 20

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