1. Dr. Sohail Bashir Sulehria
Assistant Professor
(Medicine)
KEMU/ Mayo Hospital Lahore

2. Ischemic Heart Disease & its Management
4/26/20172/11/2009

3. The coronary arteries.

5. Ischemic Heart Disease
Ischemic Heart Disease 
ischemic heart disease (IHD): is a disease characterized by  reduction of blood supply of the heart muscle, usually due to coronary artery disease 
2-Myocardial infarction
STEMI
NSTEMI
1-Angina
Stable Angina
Unstable Angina
Variant Angina
decubitus angina
nocturnal angina

6. Epidemiology
• most common cause of cardiovascular morbidity and mortality
• atherosclerosis and thrombosis are the most important pathogenetic mechanisms.
• peak incidence of symptomatic IHD is age (men)
and (women)
M>F

7. Etiology
1- Decreased coronary blood flow due to mechanical obstruction such as:
Atheroma
Spasm of coronary artery
Thrombosis
Embolism
Coronary artreritis
2- Increased myocardial oxygen requirement :
Increased cardiac output :thyrotoxicosis
Myocardial hypertrophy: aortic stenosis , hypertension
3- Decreased flow of oxygenated blood :
anemia

8. Risk Factors Uncontrollable Controllable Sex Hereditary Race Age
High blood pressure
High blood cholesterol
Smoking
Physical activity
Obesity
Diabetes Mellitus
Stress and anger

9. Angina Pectoris
At least 70% occlusion of coronary artery resulting in pain. What kind of pain?
Chest pain
Radiating to:
Left shoulder
Jaw
Left or Right arm
Usually brought on by physical exertion as the heart is trying to pump blood to the muscles, it requires more blood that is not available due to the blockage of the coronary artery(ies)
Is self limiting usually stops when exertion is ceased

10. Angina Pectoris Continued
Angina Pectoris can be Stable or Unstable:
Stable:
The pain and pattern of events is unchanged over a period of time (months years)
Unstable:
The pain and pattern is changing, be it in duration, intensity or frequency
A Myocardial Infarction waiting to happen

11. Myocardial Infarction
Partial or total occlusion of one or more of the coronary arteries due to an atheroma, thrombus or emboli resulting in cell death (infarction) of the heart muscle
When an MI occurs, there is usually involvement of 3 or 4 occluded coronary vessels

12. Myocardial Infarctions: Statistics
250,000 deaths per year.
30% mortality within the first 2 hours
45 Minutes of Ischemia:
Cardiac muscle death occurs
How is the Diagnosis Made?
Electrocardiographic changes
ST elevation
Myocardial enzyme elevation
Creatine kinase
Troponin
C Reactive Protein
ECHO
ETT
ANGIOGRAPHY
THALIUM SCAN

13. Complications of M I
Infarction leading to inability of the heart to function properly leading to Heart Failure
Angina/Pain
Cardiogenic shock
Ventricular aneurysm and rupture
Embolism Formation
Arrhythmias  Myocardial Infarctions can lead to Ventricular Fibrillation (shockable!)

14. Sudden Death Sudden Death :
250,000 deaths in the US per year are caused by what is referred to as “sudden” cardiac death
Sudden Cardiac Death is also known as a “Massive Heart Attack” in which the heart converts from sinus rhythm to ventricular fibrillation
In V-Fib, the heart is unable to contract fully resulting in lack of blood being pumped to the vital organs
V-Fib requires shock from defibrillator “SHOCKABLE RHYTHM”

15. Treatment
Many people are able to manage coronary artery disease with lifestyle changes and medications.
Other people with severe coronary artery disease may need angioplasty or surgery.

16. Management of Ischemic Heart Disease:
Lifestyle:
Diet
Exercise Preventive treatment
Low fat, low cholesterol diet
Cessation of smoking
Red wine (in moderation)

17. Management of Ischemic Heart Disease:
Pharmacological Agents:
Beta Blockers
Act either selectively or non-selectively on Beta receptors:
Beta 1 cardiac muscle  increase rate and contraction
Beta 2 dilates bronchial smooth muscle
Ca++ Channel Blockers
Acts on vasculature blocking Ca++ and causing vasodilation
Nitrates
Vasculature vasodilation
Anti-Hypercholesterolemia
HMG CoA Reductase Inhibitors  reduction in “manmade” cholesterol thus helping to reduce atheroma formation
Antiplatelet Medication:
Clopidogrel (Plavix)
Aspirin

18. Surgical Treatment
Stenting
Angioplasty (balloon)
Bypass surgery

20. Thank You