Ischemic heart disease

1. Ischemic heart disease (IHD)

2. Sign and
Symptoms
Introduction
Definition
Pathophysiology
Risk factors
Types of Ischemic heart disease
Content

3. Sign and
Symptoms
Causes
Clinical Manifestations
Complications
Dagonistic Studies
Emergency Management and Treatment
Content

4. Introduction

5. Introduction
The oxygenation of the heart
muscles occurs primarily
through the coronary
circulation, which consists of
arteries and veins that supply
blood to and from the heart
muscle itself. These coronary
arteries branch off the aorta
and provide oxygen-rich blood
to the heart muscle during
diastole (the resting phase of
the cardiac cycle).

6. Introduction
This oxygenated blood
nourishes the heart muscle
cells, allowing them to function
properly and sustain the heart's
pumping action. When
coronary blood flow is
compromised, such as in
ischemic heart disease, the
heart muscle may not receive
enough oxygen, leading to
chest pain (angina) or even a
heart attack.

7. Definition

8. Definition
Ischemic heart disease (IHD)
also known as coronary artery
disease (CAD), occurs when
there is a reduced blood flow to
the heart muscle due to
narrowed coronary arteries.
This narrowing is often caused
by the buildup of plaque
(atherosclerosis) in the arteries,
leading to reduced oxygen
supply to the heart.

9. Pathophysiology

10. The pathophysiology of ischemic
heart disease involves:
 Atherosclerosis:
The most common cause of
ischemic heart disease,
atherosclerosis involves the
formation of plaques within the
coronary arteries. These plaques
consist of cholesterol, fatty
deposits, calcium, and other
cellular debris. Over time, the
plaques can narrow the arteries,
reducing blood flow to the heart
muscle.
Pathophysiology

11.  Coronary Artery Spasm:
In some cases, the coronary
arteries can undergo spasms,
leading to a temporary reduction
in blood flow. This can occur in
individuals with or without
significant atherosclerosis.
Pathophysiology

12.  Thrombosis:
Atherosclerotic plaques can
rupture, leading to the formation
of blood clots (thrombi) at the site
of the plaque. These clots can
further narrow or completely
occlude the coronary artery,
leading to a sudden reduction or
cessation of blood flow to the
heart muscle.
Pathophysiology

13.  Impaired Oxygen Delivery:
Reduced blood flow to the heart
muscle results in decreased
oxygen delivery, leading to
myocardial ischemia. This can
manifest as angina (chest pain) or,
in more severe cases, as
myocardial infarction (heart
attack) if the blood flow is
severely compromised for an
extended period.
Pathophysiology

14.  Myocardial Infarction:
If a coronary artery becomes
completely blocked by a blood
clot, the portion of the heart
muscle supplied by that artery is
deprived of oxygen and nutrients,
leading to cell death. This results
in a myocardial infarction, causing
irreversible damage to the
affected area of the heart.
Pathophysiology

15. The pathophysiological
processes of ischemic heart
disease can lead to various
clinical manifestations, including
angina, acute coronary
syndromes, myocardial
infarction, and potentially heart
failure if the heart muscle is
damaged.
Pathophysiology

16. Risk factors

17. Non-modifiable Risk Factors:
 Age:
The risk of developing ischemic
heart disease increases with
age.
 Gender:
Men are generally at higher risk,
but after menopause, women's
risk approaches that of men.
Risk factors

18. Non-modifiable Risk Factors:
 Family history:
Having a close relative with a
history of heart disease
increases the risk.
Risk factors

19. Modifiable Risk Factors:
 High blood pressure
(hypertension):
Elevated blood pressure puts
extra strain on the heart and
blood vessels, increasing the
risk of heart disease.
Risk factors

20. Modifiable Risk Factors:
 High cholesterol levels:
Elevated levels of LDL
cholesterol (bad cholesterol)
and low levels of HDL
cholesterol (good cholesterol)
can contribute to the
development of atherosclerosis,
leading to ischemic heart
disease.
Risk factors

21. Modifiable Risk Factors:
 Smoking:
Tobacco smoke contains
chemicals that can damage blood
vessels and heart tissue,
increasing the risk of
atherosclerosis and blood clots.
Risk factors

22. Modifiable Risk Factors:
 Diabetes:
Uncontrolled diabetes can
contribute to the development
of cardiovascular disease.
Risk factors

23. Modifiable Risk Factors:
 Obesity and physical
inactivity:
Being overweight or obese, and
leading a sedentary lifestyle, can
contribute to the development of
various risk factors for heart
disease, including high blood
pressure, high cholesterol, and
diabetes.
Risk factors

24. Modifiable Risk Factors:
 Unhealthy diet:
Consuming a diet high in
saturated fats, trans fats, and
cholesterol can contribute to the
development of atherosclerosis
and heart disease.
Risk factors

25. Modifiable Risk Factors:
 Excessive alcohol
consumption:
Drinking too much alcohol can
raise blood pressure and increase
the levels of triglycerides in the
blood, both of which are risk
factors for heart disease.
Risk factors

26. Types of Ischemic Heart disease:

27. Sign and
Symptoms
Angina
Myocardial infarction
There are two main
types of Ischemic
heart disease:

28. Sign and
Symptoms
Angina
Angina:
is severe chest pain due to
ischemia ( a lack of blood and
oxygen supply) of the heart muscle
,due to obstruction of the coronary
arteries. The pain is often triggered
by physical activity or emotional
stress.

29. Sign and
Symptoms
Types of Angina
Stable Angina:
this refers to Angina related to
myocardial ischemia. Typical
presentation of stable angina are
that of chest discomfort and
develops when heart works harder
in case of exercise or climb stairs
with minimal symptoms at rest
.lasts short time perhaps five
minutes or less following cessation
of precipitating activities.

30. Sign and
Symptoms
Types of Angina
Unstable Angina "Angina Pectoris":
It develops due to the formation of
blood clots that can block or reduce
flow through a narrowed artery, and
decreasing blood flow to the heart
muscle.
Characteristics of unstable angina:
 Occurs even at rest.
 Is unexpected.
 It is usually more severe and lasts 30
minutes or longer.
 May not disappear with rest or use of
angina medication.
 Might signal a heart attack.

31. Sign and
Symptoms
Types of Angina
Variant Angina:
 It is occurring often at
night (unrelated to
activity).
 It is caused by coronary
artery spasm with or
without atherosclerotic
lesions.
 It may often sever and may
be relieved by angina
medication.

32. Sign and
Symptoms
Types of Angina
Silent Ischemia:
it may occur with either activity
or with mental stress.

33. Sign and
Symptoms
Myocardial infarction
Myocardial infarction
is a form of ACS. They occur when
your heart doesn’t get enough
blood supply. myocardial
infarction is also known as heart
attacks.

34. Sign and
Symptoms
Types of MI
Non-ST segment elevation
myocardial infarction (NSTEMI):
is myocardial necrosis
(evidenced by cardiac markers
in blood; troponin I or troponin
T and CK will be elevated)
without acute ST-segment
elevation. ECG changes such as
ST-segment depression, T-wave
inversion, or both may be
present.

35. Sign and
Symptoms
Types of MI
ST segment elevation
myocardial infarction (STEMI):
is myocardial necrosis with ECG
changes showing ST-segment
elevation that is not quickly
reversed by nitroglycerin or
showing new left bundle branch
block.

36. Sign and
Symptoms
Types of MI
ST segment elevation
myocardial infarction (STEMI):
 Troponin I or troponin T and
creatine kinase (CK) are
elevated.
 New left bundle branch block
(LBBB) represents large
anterior infarction, indication
for reperfusion therapy.

38. Causes

39. Atherosclerosis:
The narrowing of the arteries
due to the buildup of
cholesterol and other
substances, leading to
restricted blood flow to the
heart.
High blood pressure
(hypertension):
Elevated blood pressure can
damage the arteries and make
them more susceptible to
atherosclerosis.
Causes

40. High cholesterol:
Elevated levels of cholesterol
can promote the formation of
plaque in the arteries.
Smoking:
Tobacco smoke can damage the
lining of the arteries, making
them more prone to
atherosclerosis.
Causes

41. Diabetes:
Poorly controlled diabetes can
contribute to the development
of atherosclerosis and increase
the risk of heart disease.
Obesity:
Being overweight or obese can
lead to conditions such as
hypertension, high cholesterol,
and diabetes, which are all risk
factors for ischemic heart
disease.
Causes

42. Sedentary lifestyle:
Lack of physical activity can
contribute to obesity, high
blood pressure, and high
cholesterol, all of which are risk
factors for heart disease.
Causes

43. Clinical Manifestations

44. Chest pain or discomfort:
 lasting 20 min or longer.
 Pain can be described as:
pressure, tightness, heaviness, burning,
or a squeezing or crushing sensation,
located typically in the central chest or
epigastrium; it may radiate to the arms,
shoulders, neck, jaw, or back.
 Radiation of chest pain into the jaw
or teeth, shoulder, arm, and/or
back.
Clinical
Manifestations

45. Respiratory:
 Shortness of breath, dyspnea,
tachypnea, and crackles if MI
caused pulmonary congestion.
 Pulmonary edema may be
present.
Clinical
Manifestations

46. Gastrointestinal:
 Nausea and vomiting.
 Epigastric pain
Genitourinary:
 Decreased urinary output may
indicate cardiogenic shock.
Clinical
Manifestations

47. Skin:
 Cool, clammy, diaphoretic,
and pale skin due to
sympathetic stimulation
from
 loss of contractility.
Clinical
Manifestations

48. Neurological manifestation:
 Anxiety, restlessness, may
indicate increased
sympathetic stimulation or
decrease in contractility and
cerebral oxygenation.
 Headache, visual
disturbances, altered speech,
altered motor function.
Clinical
Manifestations

49. Dagonistic Studies

50. Medical History:
The healthcare provider will ask
about symptoms, risk factors,
and any family history of heart
disease. Symptoms such as
chest pain (angina), shortness
of breath, and fatigue are
important indicators.
Dagonistic Studies

51. Dagonistic Studies
Physical Examination:
This may include checking vital
signs, listening to the heart and
lungs, and looking for signs of
heart disease such as swelling in
the legs or abnormal heart
sounds.

52. Dagonistic Studies
Electrocardiogram (ECG):
This test records the electrical
activity of the heart and can
help identify abnormal rhythms,
areas of prior heart attack, and
signs of reduced blood flow to
the heart.

53. Dagonistic Studies
Stress Tests:
These tests are used to assess
how the heart responds to
exertion. They can be done
through an exercise stress test or
a pharmacological stress test (if
the patient is unable to exercise).
The aim is to detect any
abnormalities in the heart's blood
flow during physical activity.

54. Dagonistic Studies
Echocardiogram:
This test uses sound waves to
create a moving picture of the
heart. It can show areas of the
heart that aren't contracting
normally due to poor blood flow,
as well as evaluate the heart
valves and overall pump
function.

55. Dagonistic Studies
Coronary Angiography:
This invasive procedure involves
injecting a contrast dye into the
coronary arteries and taking X-
ray images to visualize any
blockages or narrowing in the
arteries.

56. Dagonistic Studies
Cardiac CT or MRI:
These imaging tests can provide
detailed pictures of the heart and
its blood vessels, helping to
identify areas of reduced blood
flow or damage to the heart
muscle

57. Dagonistic Studies
Blood Tests:
These may be done to check for
certain enzymes that are
released into the bloodstream
when the heart is damaged, such
as troponin or creatine kinase-
MB.

58. Emergency Management:

59. In initial stages, of
emergency
management:
1) Ensure patent airway & Place
patient in position of comfort.
2)MONA: morphine, O2, NTG,
and 162–325 mg non-enteric
coated aspirin.
 Administer IV morphine 4–8
mg initially and then 2-8 mg
every 5-15 min until
 Pain is controlled. (Monitor
for hypotension and
respiratory depression.)
 Administer supplemental O2
to maintain SpO2 >90%.

60. In initial stages, of
emergency
management:
3) Continuous ECG monitoring,
and prepare resuscitation
equipment.
4) Determine location of pain-
Assess severity using pain scale
(0-10).
5) Insert IV & urinary catheter.
6)Obtain cardiac enzyme levels.

61. In initial stages
of emergency
management:
7)Monitor vital signs , level of
consciousness, O2 saturation and
pain
8)Intubation if respiratory
distress is evident.

62. Treatment

63. Treatment
Treatment of ischemic heart
disease aims to relieve
symptoms, reduce the risk of
complications, and improve
overall heart health.
1) Lifestyle Modifications:
Healthy lifestyle habits, Regular
exercise, Smoking cessation, and
Stress management

64. Treatment
2) Medications:
 Antiplatelet Agents:
Drugs like aspirin or clopidogrel
are used to prevent blood clots
from forming in the coronary
arteries.

65. Treatment
2) Medications:
 Cholesterol-lowering
Medications:
Statins are commonly prescribed
to lower cholesterol levels and
reduce the risk of atherosclerosis
progression.

66. Treatment
2) Medications:
 Nitroglycerin:
Used to relieve chest pain
(angina) by dilating the coronary
arteries.
 Beta-blockers:
These medications can help
reduce the heart's workload and
decrease the risk of future heart
attacks.

67. Treatment
3) Revascularization Procedures:
 Angioplasty and Stenting:
This minimally invasive procedure
involves widening narrowed or
blocked coronary arteries using a
balloon-tipped catheter and
placing a stent to help keep the
artery open.

68. Treatment
3) Revascularization Procedures:
 Coronary Artery Bypass
Grafting (CABG):
In more severe cases, bypass
surgery may be recommended to
create new routes for blood flow
to the heart muscle, bypassing
blocked arteries.

69. Treatment
4) Cardiac Rehabilitation:
This structured program involves
exercise training, education on
heart-healthy living, and
counseling aimed at improving
overall cardiovascular health.

70. Treatment
5)Implantable Devices:
 Implantable Cardioverter
Defibrillator (ICD):
This device monitors heart
rhythm and can deliver a shock
to restore a normal rhythm if a
life-threatening arrhythmia
occurs.
 Pacemaker:
Used to control abnormal heart
rhythms by sending electrical
impulses to the heart to maintain
a suitable heart rate and rhythm.

71. Treatment 6) Continuous Medical
Monitoring

72. Complications

73. Complications
Myocardial infarction (heart
attack):
This occurs when a coronary
artery becomes completely
blocked, usually by a blood clot,
leading to permanent damage
to a portion of the heart muscle
due to lack of blood flow and
oxygen.

74. Complications
Heart failure:
Ischemic heart disease can lead
to weakened heart muscle
(cardiomyopathy) and impaired
cardiac function, resulting in
heart failure, a condition in
which the heart is unable to
pump blood effectively to meet
the body's needs.

75. Complications
Arrhythmias:
Ischemic heart disease can
disrupt the normal electrical
activity of the heart, leading to
abnormal heart rhythms
(arrhythmias) such as atrial
fibrillation, ventricular
tachycardia, and ventricular
fibrillation.

76. Complications
Sudden cardiac death:
Severe ischemic heart disease
can increase the risk of sudden
cardiac death, which occurs
when the heart suddenly stops
beating due to a life-threatening
arrhythmia or other cardiac
event.

77. Complications
Complications of medical
treatments:
Some treatments for ischemic
heart disease, such as coronary
artery bypass surgery or
percutaneous coronary
intervention (angioplasty and
stent placement), can carry risks
of complications such as
bleeding, infection, or blood
vessel damage.