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ISCHEMIC HEART DISEASE
Coronary arteries Left coronary artery supplies:
Left ventricle Interventricular septum Part of right ventricle
Coronary arteries (cont’d) Right coronary artery supplies:
Right atrium Right ventricle Part of the left ventricle
Myocardial ischemia develops when there is an imbalance between supply of oxygen and the myocardial demand .
ETIOLOGY
Decreased coronary blood flow due to mechanical obstruction such as :
1. Atheroma .2. Spasm of coronary artery .3. Thrombosis .4. Embolus .5. Coronary arteritis ( SLE) .6. Congenital abnormalities of coronary artery .
Increased myocardial oxygen requirement
1. Increased cardiac out put : in thyrotoxicosis .2. Myocardial hypertrophy : from aortic stenosis or
hypertension .
Decreased flow of oxygenated blood to myocardium
1. Anemia .2. Hypotension .
ANGINA PECTORIS
DEFINITION
ANGINA PECTORIS :is a clinical syndrome characterized by paroxysmal chest pain due to transient myocardial ischemia.
It may be occur whenever there is imbalance between myocardial oxygen supply and demand .
The most common cause is atherosclerosis , aortic stenosis, and hypertrophic cardiomyopathy .
TYPES OF ANGINA
1. Stable angina .2. Unstable angina .
STABLE ANGINA
is the angina that occurs when coronary perfusion is impaired by fixed or stable atheroma of coronary arteries i-e patient has fixed capacity of exertion after that he starts feeling chest pain .
STABLE ANGINA
UNSTABLE ANGINA
is the angina that is characterized by rapidly worsening chest pain, pain on minimal exertion or pain at rest .
The lesion is usually a complex ulcerated or fissured atheroma with adherent platelet –rich thrombus and local coronary spasm .
Unstable angina = ulcerated atheroma +thrombus formation+ abrupt reduction of coronary blood flow caused by thrombus formation + angina at rest .
The obstruction is not complete .
UNSTABLE ANGINA
CLINICAL FEATURES
SYMPTOMS
1. CHEST PAIN .2. DYSPNEA . 3. ASSOCIATED SYMPTOMS .
TYPICAL ANGINA PAIN
SITE : pain may arise in one of the following sites :1. Middle or lower sternum .2. Left precordium .3. Epigastrium .4. Left shoulder or left upper arm .5. Lower jaw .6. Interscapular region .
TYPICAL ANGINA PAIN
CHARACTER
Patient feels tightness in the chest “like a band around the chest” .
He may also describe it as a sense of pressure, choking or heaviness in the chest.
The pain may be sharp and piercing .
AGGRAVATING
1. Physical exertion e.g. exercises, sexual activity .2. Heavy meal .3. Intense emotion e.g. stress, anger, fright or
frustration .4. Lying flat (decubatus angina) .5. Violet dreams (nocturnal angina) .
ASSOCIATED SYMPTOMS
Dizziness or fainting .Chocking sensation in throat .Polyuria after an attack .
SIGNS
Look anxious .Pale face .Dyspnea .Cold sweats .
INVESTIGATION
1. ECG .2. EXERCISE TOLERANCE TEST .3. ISOTOPE SCANNING .4. ECO 5. CORONARY ANGIOGRAPHY .
MANAGEMENT
GENERAL MEASURES :Do not moke .Aim at ideal body weight .Take regular exercise .Take sublingual nitrate .
TREATMENT
1. NITRATES .2. BETA BLOCKERS .3. CALCUIM AGONISTS .4. REVASCULARIZATION .
MYOCARDIAL INFARCTION
DEFINITION
Acute ischemic necrosis of an area of myocardium is known as myocardial infarction , OR myocardial necrosis occurring as a result of critical imbalance between coronary blood supply and myocardial demand is called myocardial infarction .
It has the the same symptoms and signs, etiology , as angina pectoris .
INVESTIGATION
The same as angina pluse :CARDIAC ENZYMES mainly troponin T .
Thank you .