treatment methods of ischemic heart disease

1. Jeevan kishore
Group – 16
4th year 2nd semester
Tbilisi statemedical university
ISCHEMIC HEART DISEASE
TREATMENT…

2. WHAT IS ISCHEMIC HEART DISEASE???
reduced blood
supply to heart…
by blockage in
the coronary
arteries or
narrowing…

3. CLASSIFICATION…
Sudden cardiac death…
Acute coronary syndrome…
- Myocardial infarction and unstable
angina pectoris
Stable angina pectoris…

4. Why treatment???
TREATMENT ???

5. Because it is a disease… and according
to our profession, we must treat
disease…
It is a life threatening problem which
can kill a person if left untreated and
so we must treat …

6. METHODS OF TREATMENT…
PHARMACOLOGICAL THERAPY
SURGICAL METHODS
NON INVASIVE METHODS

7. PHARMACOLOGICAL
THERAPY…
Therapy is aimed in restoring balance between
myocardial oxygen supply and demand…
Useful agents:
Nitrates…
beta-blockers …
calcium channel blockers…

8. NITRATES
Dilates arteries to the heart and increases blood flow to
the heart…
Dilates veins throughout the body to hold more blood,
thus reducing amount of blood going back to heart and
reducing heart workload…
Helps to relieve angina when used before doing some
stressful activities that can cause angina…
If usual dose of nitroglycerin doesn’t show relieve for
angina, that means that it is becoming more worse… call
a doctor immediately…
Isosorbidemononitrate,dinitrate,nitroglycerine

9. SIDE EFFECTS…
CALL EMERGENCY SERVICES RIGHT AWAY
IF YOU HAVE:
Trouble breathing.
Swelling of your face, lips, Tongue
or throat.
Hives.
Blurred vision.
Severe headache that does not go
away.
Skin rash.
COMMON SIDE EFFECTS OF
THIS MEDICINE INCLUDE:
Dizziness or light
headedness.
Headache.
Flushing, or feeling
warm, in the face
and neck.
Nausea.
Isosorbidemononitrate,dinitrate,nitroglycerine

10. BETA-BLOCKERS
Reduce workload of heart by slowing the
heart rate…
Help lower the blood pressure which helps to
lower the risk of heart disease, heart attack
and stroke…
Useful for patients with heart attack to avoid
future attacks…
Metoprolol,carvediol,labetalol,atenolol,nebivolol

11. CONTRAINDICATIONS…
Symptomatic CHF…
History of bronchospasm…
Bradycardia or AV block…
Peripheral vascular disease with s/s of
claudication…
Metoprolol,carvediol,labetalol,atenolol,nebivolol

12. SIDE EFFECTS…
CALL EMERGENCY
SERVICES RIGHT
AWAY IF YOU HAVE:
Trouble
breathing.
Swelling of your
face,
lips, tongue, or
throat.
Fainting or
severe dizziness.
CALL YOUR
DOCTOR RIGHT
AWAY IF YOU
HAVE:
Hives.
A very slow heart rate
(less than 50 beats per
minute).
Swelling in your legs or
feet.
Shortness of breath.
Cold hands and feet.
COMMON SIDE
EFFECTS OF THIS
MEDICINE INCLUDE:
Dizziness
Feeling tired.
Trouble
sleeping.
Metoprolol,carvediol,labetalol,atenolol,nebivolol

13. CALCIUM CHANNEL BLOCKERS…
Increases blood flow to the heart by dilating
coronary arteries…
Prevent spasm of the coronary arteries…
Lower blood pressure and heart’s workload, so that
heart muscle functions with less oxygen and blood
flow…
Controls irregular heart rhythms…
Amlodipine,diltiazem,nicardipine,nifidipine,
verapamil

14. SIDE EFFECTS
CALL EMERGENCY SERVICES
RIGHT AWAY IF YOU HAVE:
Trouble breathing.
Swelling of your face,
lips, tongue, or throat.
Hives
COMMON SIDE EFFECTS OF THIS
MEDICINE INCLUDE:
Slow heart rate.
Swelling in the lower legs
or ankles.
Constipation or diarrhoea.
Dizziness or light headedness.
Flushing or feeling warm.
Amlodipine,diltiazem,nicardipine,nifidipine,
verapamil

15. COMBINATION DRUGS…
Nitrate and beta blocker
Nitrate and verapamil or cardizem for similar reasons
Long acting dihydropyridine calcium channel blocker
and beta blocker
A dihydropyridine and nitrate is often not tolerated
without concomitant beta blockade because of marked
vasodilatation with resultant head ache and increased
heart rate

16. SURGICAL METHODS…
Angioplasty
Atherectomy
Coronary artery bypass
grafting

18. ATHERECTOMY…
It is alternative to angioplasty.
It results in cutting of plagues from the vessels.
There are 4 types of atherectomy devices :

20. CARDIAC REHABILITATION
prescribed after angina or angioplasty or cabg or
heart attack…
rehabilitation when recommended with surgery
and medicinal treatment helps in recovery faster…
it has 2 types of programme :
Exercise training
Educational and counselling training

21. NON-INVASIVE TREATMENT
• ENHANCED EXTERNAL COUNTER PULASTION IS THE
NON-INVASIVE TREATMENT OF ISCHEMIA.

22. The 3 pneumatic cuffs are wrapped around patient legs and
connected to telemetry monitors.
Telemetry monitors the heart rate and rhythm.
Cuffs are wrapped on the calves, lower thighs and upper thighs
or buttocks.
Cuffs are timed to inflate and deflate based on patient ECG.
Inflation is at the beginning of diastole.
Deflation is at the beginning of systole.
1st calves are inflated then lower thighs and then upper thighs
at about 200mmHg.
This decreases afterload and increases the preload of heart.

23. Indications…
Angina patients who are not relieved
by medicine
Patients who don’t want to
have bypass surgery
Patients who are contraindicated for
bypass or angioplasty due to kidney
failure, liver failure,
severe COPD cases, diffuse diabetes
disease, very old age, patients
of syndrome X, ischaemic and dilated
cardiomyopathy
Contraindications…
Severe aortic
regurgitation or aortic
stenosis
Deep vein thrombosis
Pregnancy
Very high blood
pressure
Severe peripheral
vascular disease
Possibility of stroke