Ischemic heart disease (IHD) caused by atherosclerosis of the epicardial vessels leading to coronary heart disease (CHD) is the main etiology of IHD. Leading cause of death Resulting from myocardial ischemia—an imbalance between the supply (perfusion) and demand of the heart for oxygenated blood. 90% of cases, the cause of myocardial ischemia is reduced blood flow due to obstructive atherosclerotic lesions in the coronary arteries. IHD is often termed coronary artery disease (CAD) or coronary heart disease. There is a long period (up to decades) of silent, slow progression of coronary lesions before symptoms appear. IHD are only the late manifestations of coronary atherosclerosis that may have started during childhood or adolescence

1. Dr. KANAD DEEPAK
Assisstant Professor
Dept. of Pharmacy Practice
ISF COLLEGE OF PHARMACY
Website: - www.isfcp.org
ISF College of Pharmacy, Moga
Ghal Kalan, GT Road, Moga- 142001,
Punjab, INDIA
(Internal Quality Assurance Cell -
(IQAC)

2. Ischemic heart disease (IHD) caused by
atherosclerosis of the epicardial vessels
leading to coronary heart disease (CHD)
is the main etiology of IHD.
Leading cause of death
Resulting from myocardial ischemia—an
imbalance between the supply (perfusion) and
demand of the heart for oxygenated blood.

3.  90% of cases, the cause of myocardial ischemia
is reduced blood flow due to obstructive
atherosclerotic lesions in the coronary arteries.
 IHD is often termed coronary artery disease
(CAD) or coronary heart disease.
 There is a long period (up to decades) of silent,
slow progression of coronary lesions before
symptoms appear.
 IHD are only the late manifestations of coronary
atherosclerosis that may have started during
childhood or adolescence

4.  Myocardial infarction, the most important
form of IHD, in which ischemia causes
the death of heart muscle.
 Angina pectoris, in which the ischemia is
of insufficient severity to cause infarction,
but may be a harbinger of MI.
 Chronic IHD with heart failure.
 Sudden cardiac death.

5. The dominant cause of the IHD syndromes
is insufficient coronary perfusion relative to
myocardial demand, due to
• Chronic, progressive atherosclerotic narrowing of
the epicardial coronary arteries, and
• Variable degrees of superimposed acute plaque
change, thrombosis, and vasospasm

6. Clinical manifestations of coronary
atherosclerosis are generally due to
• Progressive narrowing of the lumen leading to
stenosis (“fixed” obstructions) or
• Acute plaque disruption with thrombosis, both of
which compromise blood flow.

7. A fixed lesion obstructing 75% or greater
of the lumen is generally required to
cause symptomatic ischemia precipitated
by exercise (most often manifested as
chest pain, known as angina)
Obstruction of 90% of the lumen can lead
to inadequate coronary blood flow even
at rest.

8. Risk of an individual developing clinically
important IHD depends
• Number,
• Distribution
• Structure
• Degree of obstruction of atheromatous plaques

9. Angina pectoris is a clinical syndrome of chest
discomfort caused by reversible myocardial
ischemia that produces disturbances in
myocardial function without causing
myocardial necrosis.
Myocardial ischemia occurs secondary to
increased myocardial demand and/or decreased
myocardial oxygen supply.

10. Classification:
• Stable angina or typical angina
• Variant or Prinzmetal's angina
• Silent myocardial ischemia
• Unstable angina or crescendo angina

11.  Angina pectoris commonly is associated
with large single- to multivessel
atherosclerotic coronary artery disease,
coronary artery vasospasm, or both.
 Significant coronary artery disease is
generally defined as a 70% or greater
atherosclerotic reduction of intraluminal
area in one of the major epicardial
coronary vessels or a 50% reduction of the
left main coronary artery

12.  Dyslipidemia [elevated low density lipoprotein
(LDL) cholesterol or
 Reduced high density lipoprotein (HDL)
cholesterol]
 Family history of premature myocardial infarction
(MI) or sudden death
 Cigarette smoking
 Hypertension
 Diabetes mellitus
 Males >45 years of age, & females >55 years of
age
 Obesity

13. Sedentary lifestyle
Hypertriglyceridemia
Small LDL particles
Increased lipoprotein(a) conc
Increased serum homocysteine conc
Abnormalities in coagulation factors
Markers of chronic infection or
inflammation.

14. Caused by an imbalance between coronary
blood flow (supply) and the metabolic
needs of the myocardium (demand).
Myocardial ischemia occurs when
myocardial oxygen demand exceeds
myocardial oxygen supply