Mohammad Muztaba Khan is an assistant professor in the Department of Pharmacology at Bhavdiya institute siwar Sohawal in Ayodhya. The document discusses ischemic heart disease (IHD), which occurs when there is an inadequate blood supply to the heart muscle caused by narrowed arteries. IHD includes conditions like angina and myocardial infarction. Angina is a type of chest pain or discomfort caused by reduced blood flow to the heart during physical activity or times of increased demand. There are different types of angina that vary based on triggers and symptoms. Diagnosis of IHD and angina involves tests like electrocardiograms, stress tests, and coronary angiography.

1. Mohammad Muztaba Khan
Assistant professor(Jr.)
Department of Pharmacology
Bhavdiya institute siwar Sohawal
Ayodhya
Ischemic heart disease
Angina & MI
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2. Ischemic heart disease
Also known as Coronary Artery Disease (CAD)
It's the term given to heart problems caused by narrowed heart
arteries. When arteries are narrowed, less blood and oxygen reaches
the heart muscle. This is also called coronary artery disease and
coronary heart disease. This can ultimately lead to heart attack.
• Ischemic heart disease (IHD) is a condition in which there is an
inadequate supply of blood and oxygen to a portion of the
myocardium
• Imbalance between myocardial oxygen supply
and demand.
• Caused mainly by Atherosclerosis of Coronary Artery
• It includes
– Angina: Stable & Unstable
– Myocardial infarction
– Heart failure & Arrhythmia
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3. • A type of chest pain
• Not a disease, its a symptom of an
underlying heart problem specially
IHD
• Ischemia often causes chest pain or
discomfort known as angina
pectoris.
Angina
Angina or ankhon = Pain/Stragling
Pectis = chest
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Knowing the types of angina and how they differ
is important.
 Stable Angina / Angina Pectoris.
 Unstable Angina.
 Variant (Prinzmetal) Angina.
 Refractory/Microvascular Angina.

5. Types of Angina contt………
 Stable Angina: occurs when increased physical activity (e.g.,
hurrying across a street or climbing a long stairs) which creates a
greater demand for oxygen-rich blood to reach heart tissue
• Pain is relieved by rest and medicine
 Unstable angina : Pain is not relieved by rest or medicine
•Arterial blockage by plaque and blood clots
•Pain occurs during rest or physical effort, and is unpredictable
• This type usually is caused by the formation of a blood clot at the
site of a ruptured plaque in a coronary artery.
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6. • Variant (Prinzmetal’s) angina: Prinzmetal’s angina almost
always occurs when a person is at rest, usually between
midnight and early morning. These attacks can be very
painful.
• Causes of Variant (Prinzmetal) Angina: The pain from
variant angina is caused by a spasm in the coronary arteries
(which supply blood to the heart muscle).
Types of Angina (cont.)
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7. • Refractory angina/microvascular : Spasms within the walls of
these very small arterial blood vessels causes reduced blood
flow to the heart muscle leading to a type of chest pain referred
to as microvascular angina.
• Pain is longer in duration and is not relieved by medicine or rest
Types of Angina (cont.)
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8.  Atherosclerosis
 Coronary artery spasm
 Use of cocaine
 Blockage of coronary artery by blood clot or compression
 Inflammation or infection of coronary artery
 Injury to coronary artery
 Poor functioning of tiny blood vessels
 Family history of premature coronary artery disease
 DM, systemic HTN.
 Cigarette smoking.
 Hypercholesterolemia.
 Others as obesity, increase levels of lipoprotein, fibrinogen,
Causes of angina
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9. Symptoms of angina
Gastrointestinal: heartburn, indigestion, or nausea
Respiratory: rapid breathing or shortness of breath
Chest pain or discomfort, possibly described as pressure,
squeezing, burning or fullness.
Pain in your arms, neck, jaw, shoulder or back accompanying chest pain.
Nausea.
Fatigue.
Shortness of breath.
Sweating.
Dizziness.
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10. Pathophysiology
• Myocardial ischemia develops when coronary blood flow becomes
inadequate to meet myocardial oxygen demand.
• This causes myocardial cells to switch from aerobic to anaerobic
metabolism, with a progressive impairment of metabolic,
mechanical, and electrical functions.
• Studies have shown that adenosine may be the main chemical
mediator of anginal pain. During ischemia, ATP is degraded to
adenosine, which, after diffusion to the extracellular space, causes
arteriolar dilation and anginal pain.
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11. Pathophysiology Cont……
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12. Diagnosis
 Electrocardiogram (ECG or EKG)
Stress test.
Echocardiogram.
Chest X-ray
Blood tests
Coronary angiography.
Cardiac computerized tomography (CT) scan.
Cardiac MRI.
coronary CT angiography,
Other treatment options may include medication, surgery, or angioplasty
and vascular stenting.
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