IHD also known as coronary artery diseases is a condition in which there is inadequate supply of blood and oxygen to a portion of myocardium. Imbalance between myocardial oxygen supply and demand causes Angina, MI, Hear failure, and Arrhythmia

1. ISCHEMIC HEART DISEASE.
IHD
MICHAEL KINO
MBBS, NEIGRIHMS

2. ISCHEMIC HEART DISEASE
• Definition:
• Ischemic heart disease (IHD) is a condition in which there is inadequate supply of
blood and oxygen to a portion of myocardium. It tipically occurs when there is an
imbalance between myocardial oxygen supply and demand.
• It’s the most common, serious, chronic, life-theatening disease in the developed
countries.
• The most common cause is atherosclerotic disease of an epicardial coronary artery.

3. PATHOPHYSIOLOGY OF MYOCARDIAL ISCHEMIA
• Myocardial oxygen supply is decreased
• Narrowed coronary arteries (sclerosis, thrombus, spasmus, coronary embolism,
vasculitis)
• Hypotension
• Severe anemia
• Methemoglobinemia, increased carboxyhemoglobin
• Myocardial oxygen demand is increased
• Left ventricle hypertrophy
• Fever
• Hyperthyroidism
• Tachycardia

4. CORONARY ARTERIES

5. BLOOD FLOW DURING SYSTOLE
AND DIASTOLE

8. ATHEROSCLEROSIS

12. IHD can cause:
- Angina .
- Myocardial infarction.
- Cardiac arrhythmia.
- Conduction defect.
- Heart failure.
- Sudden cardiac death.

13.  Assessment of coronary blood flow and myocardial perfusion:
• ECG(Electrocardiography) .
• Echocardiography.
• Stress testing .
• Cardiac catheterization .

14. RISK FACTORS
Uncontrollable
•Sex
•Hereditary
•Race
•Age
Controllable
•High blood pressure
•High blood cholesterol
•Smoking
•Physical activity
•Obesity
•Diabetes
•Stress and anger

15. CLINICAL PICTURE OF IHD IS DIVIDED IN TO
TWO GROUPS:
1. Chronic ischemic heart diseases:
A: Stable angina .
B: Silent myocardial ischemia .
C: Variant or vasospastic angina.
2. Acute coronary syndrome ( ACS ):
a) Unstable angina
b) NSTEMI.
c) STEMI .

16. 1. Chronic ischemic heart disease:
A: Stable angina:
• Symptoms:
- Chest pain(Location , radiation , severity & duration).
- Aggravating factors( Stress ,cold weather & physical activity).
- Relieving factors( Rest , sublingual nitroglycerine).

17.  Silent myocardial ischemia ( no chest pain):
• In elderly patient.
• In diabetic patient.
• In female.

18.  Variant or vasospastic angina:
• Vasospasm is present .
• Mostly at night .
• In the absent or present of stenosis.
• Clinical presentation:
- Chest pain .
• ECG:
- ST segment elevation or depression .

20. SUMMARY OF THE CHARACTERISTICS OF
ANGINA PECTORIS
• Typical angina pectoris:
• Retrosternal chest pain (discomfort)
• Complaints occur after exertion or emotional stress
• The pain is relieved by rest and nitroglycerin
• Atypical angina pectoris: only two from three characteristics (especially in
women and diabetics, angina may be atypical in location and not strictly
related to provocing factors)
• Pseudoangina: Only one or no one out of three characteristics.

21. CARDIAL AND EXTRACARDIAL CAUSES OF
CHEST DISCOMFORT
• CARDIOVASCULAR DISEASES
• Ischemic heart disease
• Pericarditis
• Aortic dissection
• Congestive heart failure
• Aortic stenosis and regurgitation
• Hypertrophic cardiomyopathy
• Pulmonary hypertension
• LUNG DISEASES
• Pulmonary embolism
• Pneumothorax
• Pleuro-pneumonia
• Pleuritis
• GASTROESOPHAGEAL DISEASES
• Gastroesophageal reflux
• Esophageal motility disorders
• Paptic ulcer
• Gallstones
• NEUROMUSCULOSKELETAL
DISEASES
• Fracture of sternum or rib
• Spondylarthrosis
• Periarthritis humeroscapularis
• Intercostal muscle cramp
• Tietze’ s syndrome
• MISCELLANEOUS
• Subphrenic abscess
• Herpes zoster
• Splenic infraction
• Psychiatric disease

22.  Diagnosis and treatment:
• Diagnosis:
- History ( Risk factors ) .
- Chest pain ( Rollout other chest pain ) .
- ECG .
- Echocardiography .
- Stress test .
- Angiography .

23. • Treatment:
- To reduce symptoms .
- To prevent myocardial infarction .
- Prevention from sudden death .
- Treat risk factors .

24.  Life style modification:
- Smoke cessation.
- Regular exercise .
- Weight reduction .
- Unsaturated fate .
- Prevent exposure to cold weather .

25.  Pharmacologic therapy :
- Antiplatelet(Aspirin & clopedogrile).
- Beta blockers( Metoprolole, Atenolol , Bisoprolol , Carvedilol ) .
- Calcium channel blocking agent(Verapamile , Deltiazem , Nefidipine ).
- Lipid lowering drugs ( Atrovastatin , Simvastatin , Rosuvastatin ).
- Nitroglycerine .

26. • Beta blocker :
- β₁ receptors( In the heart ).
- β₂ receptors (In bronchus and smooth muscles of vessels ).
- Beta blocker decreased sympathetic activity and reduced the oxygen
consumption of the heart.

27. • Calcium channel blocker (CCB) :
- It is used for variant angina or prenzmintal angina .
- Induce vasodilation in coronary and peripheral vessels .
• Nitroglycerine and nitrates( Isosorbide dinitrate and Isosorbide
mononitrate ):
- Dilate the vessels .
- Decreased preload and afterload .
- Antiplatelet effect .

28.  SURGICAL TREATMENT
1) Stenting
2) Angioplasty (balloon)
3) Bypass surgery
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