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Ischemic Heart Disease

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Page 1: Ischemic heart diseases

Ischemic Heart Disease

Page 2: Ischemic heart diseases

Ischemia

DemandSupply

Page 3: Ischemic heart diseases

Cause of Myocardial ischemia in

90% cases is

Atherosclerosis in

Coronaries

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Clinical manifestations of IHD

It’s a spectrum

MI : Most severe ischemia

Angina pectoris : Ischemia Less ischemia

Chronic IHD

Sudden cardiac death

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Ischemic Heart

Disease

Atherosclerosis in Coronaries

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Atherosclerosis

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Lifestyle

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Obstructive lesion of 75% or greater causes symptomatic ischemia induced by exercise90% Obstruction can cause Symptoms at rest

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Atherosclerosis

Acute MI

Sudden Cardiac Death

Acute Plaque change

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Acute Plaque changes

Rupture

Erosion

Hemorrhage

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Vulnerable Plaques

Plaques containing :

Large foam cells

High Lipid content

Thin Fibrous cap

Inflammatory cells

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Angina pectoris

Attacks of substernal / precordial

chest discomfort causes by transient

myocardial ischemia that falls short

of infarction

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Constricting

Squeezing

Knifelike

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Patterns of Angina pectoris

1. Stable / Typical

2. Prinzmetal / Variant

3. Unstable / Crescendo

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Myocardial Infarction

Heart Attack

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Myocardial infarction – Death of cardiac

muscles due to ischemia

Transmural Infarcts – Involving full thickness

Of ventricular wall

Subendocardial infarcs – Involving inner

1/3 area of ventricular wall.

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Males > Females

(till menopause)

Risk factors :

Page 23: Ischemic heart diseases

Pathogenesis

Sudden change in the Plaque

Adhesion of platelets to the exposed part

Platelets release : Thromboxane A2,

serotonin and Platelet factor 3 , 4

Vasospasm

Stimulation of Coagulation pathway

Thrombus blocks the coronary artery

90%

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In 10% cases

Vasospasm

Emboli

?? Unexplained

Page 25: Ischemic heart diseases

Effects of MI on the Heart

End of Aerobic glycolysis

Start of Anaerobic glycolysis

Lactic acid accumulation

Ischemia for 20 – 40 mins :

Irreversible damage to myocytes

Page 26: Ischemic heart diseases

Coagulation Necrosis is the Mechanism

of cell Death of Myocytes …

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