2. 2 Ischemic heart disease by Islam Osman
Ischemic Heart Disease (IHD)
schemic heart disease (IHD) is called the black plague of the recent centuries; it's
ranked as the leading cause of death in developed countries. The worst thing
about IHD is the explosive increase of it's incidence and prevalence nowadays, also
it affects younger age and kills adults at the peak of their reproductive years.
The term ischemic heart disease refers to inadequate perfusion of the myocardium
(ischein in Greek language means restrict).
Patho-Physiology:
dramatic sequence of events occur
1-obstruction of the lumen of the coronaries.
2-interfere with coronary blood flow.
3-deprivation of blood supply to myocardium
there are many causes that may obstruct the coronaries, but the main cause is
atherosclerosis of the coronaries or hardening of the coronaries which is
characterized by formation of the atheromatus patches that leads to ischemia or
thrombosis over it leading to infarction. Other rare causes may obstruct the
coronaries including Embolism of the coronaries, Periarteritis nodosa and
Dissecting aneurysm.
Risk Factors :
as other non-communicable diseases , IHD has no specific etiology but there are
number of underlying factors or risk factors that may precipitate or predispose to
it's development, these risk factors can be classified into two large groups ;
I
3. 3 Ischemic heart disease by Islam Osman
Un-modifiable risk factors
1-Age: the risk increase with age increase (marked after the age of 40 years and
lowest below the age of 30 years)
2-Sex: before menopause males/females ratio = 5:1 & after menopause males
/females = 1:1
3-Family history of IHD: the risk markedly increase if both parents are diseased.
4-Genetic
Modifiable risk factors
1-Hypertension
2-Smoking
3-Dyslipidemia: i.e. hypercholesterolemia and hypertriglyceridemia, in other words
high serum LDL and low serum HDL.
4-Diet: high intake of saturated fats, calories and salts
5-Diabetes Mellitus (D.M)
6-Obesity
SQUARE OF DANDER OF HYPRERTENSION ,DM,OBESITY ,HYPERCHOLESTEROLEMIA.
7-Emotional stress & mental over activity: in personality type A i.e. hard working,
ambitious and competitive.
8-Contraceptives.
Diagnosis of IHD:
(A) Clinical Manifestations:
1-Asymptomatic if the obstruction is slight.
2-Angina Pectoris , increased obstruction leads to hypoxia of the cardiac
muscles leads to severe chest pain , this pain has the following characters
site behind the upper two thirds of the sternum (retrosternal)
radiation to the left upper arm ,left shoulder and neck including the jaw (difficulty
in speech)
nature compressing pain , never stitching
Provocated by exercise , emotions , cold , hypoglycemia
duration minutes (about 15) never seconds or hours
Relief by rest ,nitroglycerine.
3-Acute myocardial infarction (AMI):
4. 4 Ischemic heart disease by Islam Osman
complete obstruction of the involved vessel(s) leads to necrosis of a part of the
cardiac muscle , It may be fatal .
(B) Investigation ECG
During angina attack After AMI
depression of the S-T segment T
Treatment:
effective treatment should be accompanied by change in the lifestyle of the patient
such as quit smoking ,eat healthy food , exercise regularly , reduce stress and lose
excess weight.
Drugs various drugs may be used in treatment of IHD including
Cholesterol modifying medications which decrease the amount of cholesterol in
the blood , especially low density lipoprotein (LDL)
Aspirin reduce the tendency of the blood to clot
Beta blockers slow the heart rate and decrease blood pressure , so they decrease
the heart demand for oxygen
Nitroglycerin in the form of tablets , sprays and patches can control the chest pain
Angiotensin converting enzyme inhibitors (ACEI) and Angitensin II receptors
blockers (ARBs)
Elevation of S-T segment , inversion
of T wave and deep wide Q wave
.
ggg
5. 5 Ischemic heart disease by Islam Osman
Calcuim channel blockers (CCB)
Sometimes we use number of procedures to restore and improve the normal
coronary blood flow , the main tow procedures are:
-Angioplasty and stent placement (precutanous coronary revascularization)
-Coronary artery bypass surgery.
Prevention of IHD:
mainly by management of the modifiable risk factors e.g
-Diet control adequate fats ,calories ,slats..
-Avoid smoking
-Regular exercise
-Medical supervision of D.M , obesity , contraceptive pills ..
6. 6 Ischemic heart disease by Islam Osman
References:
-Richard Mitchell , Nelson Fausto , Abul K Abbas, Vinay Kumar . Robbins Basic
Pathology 7th
edition.
- Swinkels DW, Demacker PN, Hendricks JC, van 't Laar A. Low density lipoprotein
subfractions and relationship to other risk factors for coronary artery disease in
healthy individuals. Arteriosclerosis 1989; 9(5): 604-13. (Abstract)
-Brendan Phibbs , The Human Heart: Basic Guide to Heart Disease 2007
-John R. Hampton, The ECG MADE EASY .sixth edition.
