MF3 - Ischemic Heart Disease

7/30/2019 MF3 - Ischemic Heart Disease

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ISCHEMIC HEART DISEASE

LORRAINE CAUSING


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Is a condition in which there is an inadequatesupply of blood and oxygen to a portion to the

myocardium

Most common cause: atherosclerosis


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epidemiology

In U.S : 13 million IHD

> 6 million angina pectoris

> 7 million - MI

In U.S and western Europe:

IHD is growing among low-income groups


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Risk factor:

obesity

insulin resistance

type 2 diabetes mellitus


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CORONARY ATHEROSCLEROSIS

Major sites :

epicardial coronary arteries

Major risk factors :

high plasma low-density lipoprotein (LDL)

low plasma high-density lipoprotein (HDL)

cigarette smoking

hypertension

diabetes mellitus


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Segmental narrowing of coronary arteries is

caused commonly by the formation of plaque


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Effects of ischemia

Transient LV failure

Mitral regurgitation occurs if papillary muscle

apparatus is involved

* When ischemia is transient, it is associated withangina pectoris

* When prolonged, it can lead to myocardial necrosis

and scarring with or without MI


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ASYMPTOMATIC VS. SYMPTOMATIC IHD

Asymptomatic phase

cardiomegaly

heart failure

* Ischemic cardiomyopathy

Symptomatic phase

chest discomfort


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STABLE ANGINA PECTORIS

Due to transient myocardial ischemia

Men : 50 yrs. and older

Women : 60 yrs. And older Chest discomfort

Last for 2-5 mins.

Radiate to either shoulder, arms, back,interscapular region,root of the neck, jaw,

teeth, and epigastrium


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Caused by :

exertion

emotion

* And are relieved by rest , but may also occur at

rest and while the patient is in recumbent


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Physical examination

Examination of fundi

- increased light reflex and arteriovenousnicking hypertension

Palpation- cardiac enlargement and abnormal

contraction

Auscultation- uncover arterial bruits, 3rd & 4th heart

sounds


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Laboratory examination

Urine examination Blood examination

Chest x-ray

Electrocardiogram

- used to measure the rate and

regularity of heartbeats, sizeand position of chambers and

presence of any damage


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Stress testing

Electrocardiographic

- test for both the diagnosis of IHD and

estimating the prognosis involves recording

the 12-lead ECG before, during and after

exercise, usually

on a treadmill


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Cardiac imaging

two-dimentional echocardiography

stress echocardiography

cardiac magnetic cardiography


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Prognosis

Principal prognostic indicators age

functional state of LV

location(s) and severity or coronary arterynarrowing

Severity or activity of myocardial ischemia

Patients with chest discomfort but normal LVfunction and normal coronary arteries haveexcellent prognosis


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Treatment

Nitrates

- vasodilator, thereby reducing myocardialwall tension and oxygen requirements

- dilates coronary vessels; increased bloodflow in collateral vessels

- exerts antithrombotic activity

- improves exercise tolerance- nitroglycerine : most commonly

administered sublingually


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Longacting nitrates

- not as effective as sublingual

nitroglycerine

isosorbate dinitrates or mononitrate

nitroglycerine ointment

sustained release transdermal patches


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Beta adrenergic blockers

- inhibits the heart rate, arterial pressure,

and myocardial contractility

- therapeutic aims: relief of angina and

ischemia

- contraindications: Asthma

chronic lung disease

AV conduction disturbances

severe bradycardia

Raynauds phenomenon

history of mental illness


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Calcium channel blockers

- coronary vasodilators

- reduce myocardial oxygen demands,contractility and arterial pressure

- indicated when beta blockers are

contraindicated, poorly tolerated, or

ineffective


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Antiplatelet drugs

aspirin

clopidogrel

Other therapies angiotensin-converting enzyme ( ACE ) inhibitors

nonsteroidal anti-inflammatory drugs ( NSAIDs)


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Coronary revascularization

Precutaneous Coronary Intervention

-involves balloon dilation usually

accompanied by coronary stenting

Coronary Artery Bypass Grafting

- anastomosis of one or both of the internal

mammary arteries or radial artery to the

coronary artery distal to the obstructive

lesion


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OT management

Energy conservation techniques

Stress management

Weight reduction Physical activities


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END

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MF3 - Ischemic Heart Disease