Ischemic heart disease, also known as coronary artery disease, is caused by an imbalance between the heart's demand for oxygenated blood and its supply. The left anterior descending artery supplies blood to the apex of the heart, the anterior wall of the left ventricle, and the anterior two-thirds of the ventricular septum. The right coronary artery supplies the posterior wall of the left ventricle, the right ventricle's free wall, and the posterior one-third of the ventricular septum. Angina pectoris and myocardial infarction are two effects of ischemic heart disease. Angina pectoris involves chest pain or discomfort caused by transient myocardial ischemia, while a myocardial infarction is ischemic necrosis of heart muscle due

1. Ischemic Heart disease
Pal Sagar
Bsc . Perfusion tech.

2. Ischemic Heart disease / coronary artery disease arise
from Imbalance between the myocardial supply and
demand for oxygenated blood.

3. LAD supplies :- 1. Apex
2. Anterior wall of left ventricle
3. Anterior ⅔ of ventricle septum
Note : M/c in atherosclerosis , MI

4. RCA supplies:- 1. Posterior wall of left ventricle.
2.Right ventricle free wall.
3. Posterior ⅓ of ventricle septum.
Note: Second commonly involved vesses in
atherosclerosis and MI.

5. Distribution:- LAD > RCA>LCX
● ⅓ of case have single vessel disease,... LAD.
● Another ⅓ have two vessel disease.
● Reminder has three major vessel disease..

6. Effects of IHD:

7. ANGINA PECTORIS
Is a symptom complex of IHD characterized by paroxysmal and recurrent attack
of substernal or precordial chest discomfort caused by transient myocardial
ischemic.

8. Classification:-
1. Stable or Classical angina : Reduction of coronary
Perfusion to a critical level due to coronary
atherosclerosis without plaque rupture. Levine’s
sign , 2 to 5 min ,radiate, cresendo-decresendo
2. Unstable or cresendo angina : Disruption of
atherosclerosis plaque with thrombosis. Last for
>10min
3. Prinzemental’ s varient angina:- Focal spasm in
right coronary artery.occur at rest

9. Myocardial infraction
Infraction (ischemic necrosis) of myocardium of heart due to decreased blood
supply
Etiopathogenesis:- ● Coronary atherosclerosis
● Superadded change in coronary atherosclerosis
● Non- atherosclerotic cause.
According to the degree of thickness of the ventricle wall involved
1. Full - thickness or transmural
2. Subendocardial

10. Morphology features
Gross :- myocardial infraction less than 12 hours
old are usually not apparent on gross examination.
But, necrotic area can be visualised after 2- 3 hours
by triphenyltetrazolium chloride (TTC)
Non infraction area - brick red
Infraction area unstained pale zone

11. Clinical features
1. Pain
2. Indigestion
3. Apprehension
4. Shock
5. Oliguria
6. Acute pulmonary edema

12. Diagnosis
● ECG - St elevation, T wave inversion, Deep Q
wave
● Serum enzyme determination (Cardiac marker)
Myoglobin
CPK- MB
Troponin (T&I)
AST / SGOT
LDH

13. Complications:
● Arrhythmias
● Heart failure
● Cardiogenic shock
● Cardiac aneurysm
● Pericarditis
● Dressler’s syndrome

14. Medicine
1. Oxygen therapy: 3ltr by nasal
2. Thrombolytic
3. Analgesic
4. Vasodilator
5. Ace inhibitors
6. Beta adrenergic blocker
7. Calcium channel blockers
8. Anticoagulant
9. Cholesterol lowering agent

15. Surgical management of MI
1. CABG
2. PTCA
3. Coronary stent
4. Atherectomy
5. Transmyocardial laser revasculazation

16. Thank You