2 Introduction What is IHD? Is a condition that affects the blood supply (coronary arteries of the heart)Another name for it : Coronary artery disease (CAD)Results when there is an imbalance between myocardial oxygen supply and demand due to partial blockage of the artery.
3 Brief Physiology of the heart the layer that consist the Muscles of the Heart = MyocardiumWhat Helps the Blood to travel away from the Heart to organs?
4 Brief Physiology of the heart Now the heart in order to pump, Myocardium has to contract.Myocardium requires action potential to contract and energy metabolism.Action potential and energy metabolism require presence of O2 and nutrients within blood in coronary arteries.If there is decrease in O2 and nutrients, does the heart will function normally?
6 Causes and risk factors for IHD The most underlying causes are:Atheroscelerosis: thickening and hardening of the artery wall.Plaque: (the build-up of lipid/cholesterol) in the artery wall forms as a response to injury to the endothelium in the artery wall.Therefore, causes the lumen of the artery to be narrow, which result in less oxygenated blood supply to the area after the narrowing
7 So, any narrowing or obstruction of the coronary arteries lead to Ischemic heart disease
9 Risk Factors for IHD Age: (non-modifiable risk factor) Male > 45 yearsFemale > 55 years or premature menopause without estrogen replacement therapyFamily History of premature disease (non- modifiable risk factor)Male first-degree relative <55 yearsFemale first-degree relative < 65 years)
10 Risk Factors for IHD Hypertension (Modifiable Risk factor( Appears to weaken the artery wall at points of high pressure leading to injury and invasion of cholesterol.Cigarette Smoking (modifiable Risk factor)#1 cause of preventable death in US1 in 5 CHD deaths attributable to smoking
11 Diabetes (modifiable risk factor) Inactivity (modifiable Risk factor) Risk Factors for IHDDiabetes (modifiable risk factor)50% of deaths related to DM is due to CHDInactivity (modifiable Risk factor)Sedentary person has 2x risk for developing CHD as a person who is active
12 Risk Factors for IHD Abnormal Blood Lipids (modifiable Risk factor) LDL Cholesterol (low density lipoprotein)HDL Cholesterol (high density lipoprotein)
13 LDL (Low Density Lipoproteins) Some LDL can be oxidized and takes up by endothelial cells and macrophages in the arterial wall, which leads to the first stages of atherosclerosis.
14 High Density Lipoproteins (HDL) HDL-C is thought to be involved in the transport of excess cholesterol from membranes to the liver for removal from the body
15 Problems resulting from HD Most common problems:Angina Pictoris (stable angina)Unstable angina (Acute myocardial infarction)Heart failure.
16 Angina PictorisWhen part of the heart receive insufficient blood supply.DEF: uncomfortable sensation in the chest or neighboring anatomic structures produced by myocardial ischemia during physical exertion or emotional stress. relieved by rest with in few minutesTemporary depression of ST segment with no permanent myocardial damage
18 Unstable angina ( Acute MI) Increased frequency and duration of Angina episodes, produced by less exertion or at rest = high frequency of myocardial infarction if not treated
19 Myocardial Infarction Death of parts or area of myocardium.Region of myocardial necrosis due to prolonged cessation of blood supplyResults from acute thrombus at side of coronary atherosclerotic stenosisMay be first clinical manifestation of ischemic heart disease or history of Angina Pectoris
20 Common signs and symptoms of IHD Pain or discomfort in the chestNauseaDyspneaRadiating pain to Left shoulder
21 ElectrocardiogramWhen ischemia results in transient horizontal or downsloping ST segments or T wave inversions which normalize after pain resolutionST elevation suggest severe transmural ischemia or coronary artery spasm which is less often
27 Management Goals to reduce Anginal Symptoms Prevent complications – myocardial infarction, and to prolong lifeNo smoking, lower weight, control hypertension and diabetesPatients with CAD – LDL cholesterol should achieve lower levels (<100)Exercise and maintain active life style.