IHD

3. INTRODUCTION
Ischemic heart disease also designated
as coronary artery disease refers to a
group of closely related syndromes
caused by an imbalance between
myocardial oxygen demand and blood
supply.

4. ETIOLOGY
The most common cause of imbalance
between need and supply of oxygen
is atherosclerotic narrowing of the
coronary arteries producing ischemia.

5. RISK FACTORS FOR
ATHEROSCLEROSIS
Fixed Risk Factors
Age
Male Sex
Family History

6. MODIFIABLE RISK FACTORS
STRONG ASSOCIATION
Hyperlipidemia
Hypertension
Cigarette Smoking
Diabetes Mellitus

7. OTHER ASSOCIATIONS
Obesity
Lack of exercise
Heavy alcoholism
Dietary factors
Oral contraceptives
Gout
High level of coagulation factor vii &
fibrinogen
Anxiety & depression

8. PATHOGENESIS
Defective Oxygen Delivery
Increased Oxygen Demand
IHD becomes symptomatic when there is 75% or
more reduction of the lumen of one or more
coronary arteries by atherosclerotic plaque.
Superimposed Lesions
 Acute changes in plaque morphology
 Local platelet aggregation
 Coronary artery spasm
 Coronary artery thrombosis

10. CLASSIFICATION OF IHD
Stable angina
Unstable angina
Myocardial infarction
Sudden cardiac death

12. WHAT IS ANGINA?
Angina is a clinical syndrome
characterized by intermittent chest
pain caused by reversible myocardial
ischemia.
The pain is usually substernal or
precordial radiating to the shoulder
and arm or to the jaw.
It lasts for several minutes.

13. TYPES OF ANGINA
STABLE ANGINA
VARIANT ANGINA
UNSTABLE ANGINA

14. STABLE ANGINA
It occurs due to increased myocardial
oxygen demand during exertion in a patient
of narrow coronary arteries.
VARIANT ANGINA
It occurs at rest and produced by the
reduction of the myocardial blood supply
due to coronary artery spasm.
UNSTABLE ANGINA
In this type of angina, frequency, severity
and duration of episodes are progressively
increased. It occurs at rest due to thrombus
formation and coronary artery spasm.

15. DIFFERENCE B/W STABLE &
UNSTABLE ANGINA
STABLE ANGINA UNSTABLE ANGINA
 Due to fixed stenosis  Due to dynamic
stenosis
 Demand-led ischemia  Supply-led ischemia
 Related to effort  Symptoms at rest
 Symptoms over long  Symptoms over short
term term

17. INVESTIGATIONS
ECG
ETT
Thallium scan
CT Angiography
Echocardiography
Coronary Angiography

18. ECG
During pain ECG shows
ST –segment depression with or without T
wave inversion that reverses after ischemia
disappears.
Elevation of ST segment in variant angina.
The resting ECG may be normal b/w
attacks however it may show old MI, heart
block or left ventricular hypertrophy.

19. ETT
When history is suggestive of angina
but ECG normal ETT is performed for
diagnosis.
Positive test is one in which ST
segment is depressed by 1 mm.

21. MYOCARDIAL
INFARCTION

22. INTRODUCTION
•MI is death or necrosis of myocardial
cells.
Myocardial infarction (MI or AMI for acute
myocardial infarction), commonly known as a
heart attack, occurs when the blood supply to
part of the heart is interrupted.

23. ETIOLOGY
Commonly caused due to occlusion of a coronary
artery following the rupture of a vulnerable
atherosclerotic plaque, in the wall of an artery. The
resulting ischaemia and hypoxia, if left untreated for
a sufficient period, can cause damage and or death
(infarction) of heart muscle tissue.

26. ETIOPATHOGENESIS
1. Mechanism of MI
i) Diminished coronary blood flow
ii) Increased myocardial demand
iii) Cardiac hypertrophy without se of
coronary blood flow
2. Role of Platelets
- rupture of atherosclerotic plaque exposes
subendothelial collagen to platelets
- aggregation, activation, release of platelets

27. 3. Complicated Plaques
i) Superimposed coronary thrombosis
ii) Intramural haemorrhage
4. Non-atherosclerotic causes
- coronary vasospasm
- arteritis
- embolism
- thrombotic diseases
- trauma

28. 5. Transmural versus subendocardial
infarcts
Transmural infarcts- involve full thickness of
ventricular wall subendocardial (laminar)
infarcts- affecting inner
subendocardial one-third to one-half.

30. Classical symptoms
of acute myocardial
infarction
 Sudden chest pain
 Shortness of breath
 Nausea
 Vomiting
 Palpitations
 Sweating
 Anxiety

31. Risk factors for
myocardial infarction
1. Older age
2. Sex (males)
3. Tobacco smoking
4. Hypercholesterolemia
5. Diabetes
6. Hypertension
7. Obesity
8. Stress

32. Pathological Changes
 Vary according to the age of the infarct
 Most infarcts occur singly (very less
multifocal), 4-10 cm size
 Most often in left ventricle
 Subendocardial infarcts produce less well-
defined infarcts gross changes than the
transmural infarcts.

33. CLINICAL DIAGNOSIS
Clinical diagnosis is based on
 Symptoms
ECG changes
Elevation of specific serum enzymes

34. SYMPTOMS
Onset is sudden with severe
constricting, crushing, burning
substernal or precordial pain that
radiates to the left shoulder and arm
or jaw.
Pain is accompanied by
sweating, nausea, vomiting or
dyspnea.
Cardiogenic shock.

35. ECG Changes
ST Segment elevation, follwed by
abnormal new Q waves and inverted
T wave.
Serum Enzymes
Creatinine phosphokinase
Lactic dehydrogenase
Cardiac troponin I & Troponin T.

37. CHRONIC ISCHEMIC
HEART DISEASE
Chronic IHD some times called
ischemic cardiomyopathy is used to
describe the development of
progressive CHF.
It is characterized by multifocal areas
of myocardial atrophy and fibrosis
secondary to slowly developing
coronary atherosclerosis leading to
dilatation of cardiac chambers.

38. CLINICAL FEATURES
Usually it remains asymptomatic and
progressively CHF develops.
Cardiac arrhythmias may occur when
scarring involves conduction system.
Angina, MI

39. TYPES OF HEART FAILURE
 ACUTE HEART FAILURE
 CHRONIC HEART FAILURE
 RIGHT AND LEFT HEART FAILURE
 CONGESTIVE HEART FAILURE
 FARWARD HEART FAILURE
 BACKWARD HEART FAILURE
 CARDIAC ARREST

40. ACUTE HEART FAILURE
Sudden onset of heart failure without
previous symptoms of ischemia or MI.
CHRONIC HEART FAILURE
Gradual onset of heart failure with
symptoms of ischemia or MI.
CONGESTIVE CARDIAC FAILURE
Bi ventricular heart failure.

41. CARDIAC ARREST
Complete cessation of heart function.
Conductive system of heart completely
block.