Ischemic Coronary heart Disease

• IHD is a group of path physiological syndrome resulting from myocardial ischemia--- an imbalance between supply and demand of the heart for oxygenated blood.

• So there is insufficiency of oxygen as well as reduce availability of nutrients and removal of metabolites.

• In IHD or CAD the insufficient coronary perfusion is due chronic progressive ethrosclerotic narrowing of epcardial coronary arteries, and acute plaque changes,thrombosis and vasospasm

Ischaemic heart disease may present with any of the following problems:

Angina pectoris: is episodic pain or discomfort in substrenal area of the chest precipitated by exertion, in cold weather or emotional situations and relieve by rest.

Sign of myocardial ischemia caused

• Atherosclerosis 90%• Vasospasm of coronary artery 5%• Small blood vessel diseases of myocardium(DM).• Aortic vavular disease.Clinical forms of Angina.o Stable angina: precipitated by exercise last

30sec -30mino Unstable or crescendo Angina: also called

preinfarction . It is characterized by frequent boots of chest pain at rest or wd minimal exertion.

o is due to disrupted plaque with or without platelet non occlusive thrombi.

Prinzmetal ‘s Angina:also known as variant angina or angina inversa, occur in rest and related to spasm of coronary arteries.

• Have intermittent coronary spasm at rest.• Vasoconstr due to platelet thrombaxane A2 or

decrease endothlin.• ECG show S-T segment elevation during stress.• It respond well to vasodilator ,nitroglycerin &

calcium channel blockers.

Pathological finding in myocardium caused by angina

• Stable & Prinzmetal’s angina do not cause any significant myocardium cell necrosis.

• Unstable angina may associated with focal myocyte necrosis that repaired by foci of fibrosis

• R/: Revascularization procedure:One method of treating patients with severe angina due to diffuse coronary disease is transmyocardial laser revascularization (TMR).

coronary blockage denoted by red arrow) can be treated by percutaneous interventions or bypass surgery, there are an increasing number of patients with diffuse coronary artery disease (fig. on right) that are not candidates for such interventions.  

Heart failure (HF) is a condition in which a problem with the structure or function of the heart impairs its ability to supply sufficient blood flow to meet the body's needs

• Myocardial infarction (MI) commonly known as a heart attack, is the interruption of blood supply to part of the heart, causing some heart cells to die. This is most commonly due to occlusion (blockage) of a coronary artery following the rupture of a vulnerable atherosclerotic plaque.

• Sudden death. due to vent fibrillation