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Ischemic heart diseases..

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Ischemic heart diseases...

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Ischemic heart diseases..

  1. 1. I schemic Heart Disease
  2. 2. <ul><li>Ischemia </li></ul>Demand Supply
  3. 3. <ul><li>Cause of Myocardial ischemia in </li></ul><ul><li>90% cases is </li></ul>Atherosclerosis in Coronaries
  4. 4. Clinical manifestations of IHD <ul><li>It’s a s p e c t r u m </li></ul><ul><li>MI : Most severe ischemia </li></ul><ul><li>Angina pectoris : Ischemia Less ischemia </li></ul><ul><li>Chronic IHD </li></ul><ul><li>Sudden cardiac death </li></ul>
  5. 5. Ischemic Heart Disease Atherosclerosis in Coronaries
  6. 6. <ul><li>Atherosclerosis </li></ul>
  7. 7. <ul><li> </li></ul><ul><li> </li></ul>
  8. 8. <ul><li>L ifestyle </li></ul>
  9. 13. Obstructive lesion of 75% or greater causes symptomatic ischemia induced by exercise 90% Obstruction can cause Symptoms at rest
  10. 14. Atherosclerosis Acute MI Sudden Cardiac Death Acute Plaque change
  11. 15. Acute Plaque changes <ul><li>Rupture </li></ul><ul><li>Erosion </li></ul><ul><li>Hemorrhage </li></ul>
  12. 16. <ul><li>Vulnerable Plaques </li></ul><ul><li>Plaques containing : </li></ul><ul><li>Large foam cells </li></ul><ul><li>High Lipid content </li></ul><ul><li>Thin Fibrous cap </li></ul><ul><li>Inflammatory cells </li></ul>
  13. 17. Angina pectoris <ul><li>A ttacks of substernal / precordial </li></ul><ul><li>chest discomfort causes by transient </li></ul><ul><li>myocardial ischemia that falls short </li></ul><ul><li>of infarction </li></ul>
  14. 18. Constricting Squeezing  Knifelike
  15. 19. Patterns of Angina pectoris <ul><li>Stable / Typical </li></ul><ul><li>Prinzmetal / Variant </li></ul><ul><li>Unstable / Crescendo </li></ul>
  16. 20. Myocardial Infarction <ul><li>Heart Attack </li></ul>
  17. 21. <ul><li>Myocardial infarction – Death of cardiac </li></ul><ul><li>muscles due to ischemia </li></ul><ul><li>Transmural Infarcts – Involving full thickness </li></ul><ul><li>Of ventricular wall </li></ul><ul><li>Subendocardial infarcs – Involving inner </li></ul><ul><li>1/3 area of ventricular wall. </li></ul>
  18. 22. <ul><li>Males > Females </li></ul><ul><li>(till menopause) </li></ul><ul><li>Risk factors : </li></ul>
  19. 23. Pathogenesis <ul><li>Sudden change in the Plaque </li></ul><ul><li>Adhesion of platelets to the exposed part </li></ul><ul><li>Platelets release : Thromboxane A2, </li></ul><ul><li>serotonin and Platelet factor 3 , 4 </li></ul><ul><li>Vasospasm </li></ul><ul><li>Stimulation of Coagulation pathway </li></ul><ul><li>Thrombus blocks the coronary artery </li></ul>90 %
  20. 24. In 10 % cases Vasospasm Emboli ?? Unexplained
  21. 25. Effects of MI on the Heart <ul><li>End of Aerobic glycolysis </li></ul><ul><li>Start of Anaerobic glycolysis </li></ul><ul><li>Lactic acid accumulation </li></ul><ul><li>Ischemia for 20 – 40 mins : </li></ul><ul><li>Irreversible damage to myocytes </li></ul>
  22. 26. <ul><li>Coagulation Necrosis is the Mechanism </li></ul><ul><li>of cell Death of Myocytes … </li></ul>

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