Ischemic heart Diseases ethiopathogenesis Treatment and prevention

1. INVESTIGATION & FINDINGS

2. Lipid profile
❖ Total cholesterol -Elevated(>200mg/dl)
❖ LDL-C: Elevated(>100mg/dl)
❖ HDL-Low levels(<40mg/dl)
❖ Triglycerides -Elevated (>150mg/dl).
Othe tests:- Thyroid function test
Liver function tests
Blood sugar levels

3. Cardiac markers
Onset Peak Duration
Myoglo
bin
1-4hr 6-7hr 24hrs
Troponi
n
3-12hr 18-24hr Upto 10
days
CK-MB 3-12hr 18-24hr 36-
48hrs

4. ECG changes
Evolution of STEMI

5. Anterior wall MI ECG changes
❖ ST segment
elevation seen in
anterior leads V3
and V4.
❖ Reciprocal ST
segment
depression in
the inferior leads
(II,III and aVF)

7. Echocardiography
● Assess Left ventricular function
Hypokinesis->decreased movement of LV wall
Akinesis->absence of movement
Dyskinesis->abnormal movements
● Wall motion abnormalities
● Mitral Valve abnormalities
● Others-Left atrial enlargement
Right ventricular dysfunction

8. Inferior wall stenosis LV dilatation in CAD

9. Large apical thrombus following
STEMIof anterior wall due to A.
descending artery occlusion
Large pseudo aneurysm
due to inferior wall rupture

10. In patients with IHD, the posterior leaflet motion in systole is restricted or tethered
secondary to the inadequate contraction of the posterolateral wall. The resulting
malcoaptation and malapposition is allied to a posteriorly directed mitral
regurgitation jet.

11. Stress test
● Treadmill test/cycling is done until the target heart rate is reached or patient becomes
symptomatic(like chest pain,light headedness, hypotension,marked dyspnea,
ventricular tachycardia)or development of ST- segment changes.
● Not done in patients with acute MI,unstable angina/severe aortic stenosis.
● If a person can't do exercise,test can be done by givi6IV dipyridamole/dobutamine
along with echocardiographic imaging.
Result:-Low risk test-> negative test result
Intermediate risk->equivocal/mild positive test result
High risk->positive test result

12. Positive findings
● ST-segment
depression≥1mm
● ST elevation ≥1mm in
leads without Q waves
● T wave inversion
● Arrythmias
● Hypotension-drop in
SBP≥10mmHg
Negative findings
● No ST changes
● No T wave changes
● No arrythmias
● Normal BP response
Equivocal
● ST depression<1mm
● T wave flattened

13. after 4-5 min
of exercise
● ST
depression
(+ve for
ishemia)
● Lead V4
(at rest)

14. Cardiac CT angiography
Comparison between CCTA and
invasive angiography. Image (A) shows
the stenosis of proximal segment of the
left anterior descendent coronary artery
(LAD), 99% of stenosis (black arrow).
The patient was sent to the
Interventional Cardiology Department
(see invasive angiography in image (B)),
the LAD lesion was confirmed (white
arrow), and a stent was implanted.

15. Coronary angiography

17. Findings
1. Stenosis-Narrowing of coronary artery due to
atherosclerosis.
2. Occlusion- complete blockage of coronary artery
3. Aneurysm -abnormal dilatation
4. Thrombus