Cardiologydr.mon5@hotmail.com 2. Ischaemic Heart Disease

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Ischaemic Heart Ischaemic Heart DiseaseDisease

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Etilogy- Most ischaemic heart disease is

caused by atherosclerosis of the coronary artereries.

- Initially there is sudden sever narrowing or closure of large coronary arteries and\ or narrowing of coronary artery end branches.

- Covering plaques.........

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Risk FactorsRisk Factors1- age.2- Gender.3- Serum cholesterol: VLDL....LDL...HDL.4- Hypertension; endothelial damage.5- Cigarate smoking; nicotine-----catecholamine-----

epinephrine-----endothelial damage----lipolysis.

6- Diabetes; disturbed lipid metabolism.

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Minor risk factors1- Hypothyrodism.2- obesity.3- Sedentary life.4-Intellectual professional.5- Contraceptive pills.

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Clinical ConsequencesClinical Consequences

A- Angina PectorisDef. Clinical syndrome characterized by

attack of pain due to ischaemia of the heart muscle, generally due to obstruction or spasm of coronary arteries.

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TypesTypes1- Stable: occurs under similar circumstances,

and with similar frequency over time.2- Un-stable:- Recent onset.- Increased severity and frequency .- Angina at rest or with minimal exertion.3- Variant:- At rest. - Spasm of coronary artery. -Not

precipitated by increase myocardial 02 demand

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Clinical PictureI.I. Pain:Pain:- Site- Radiation.- Character: burning..suffocation. stop all activities.- Precipitation:- Relief.- Duration.

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- Associated Symptoms: Dyspnea . Palpitation. Dizzness.

Fainting.Sweating.

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Clinical Picture:- Sings and symptoms: Pallor...tachycardia....hypertension.Investigation:- ECG: normal in 50%.- Stress ECG: Depression of st segment.

Ventricular Arrhythmias.- Cardiac Catheterization : arteriography.- Echocardiography: regional wall abnor. Ex

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TherapyTherapyAiming for :- Decrease myocardial oxygen demand.- Increase myocardial o2 supply.I. Medical Treatment:- Nitrates. Vosodilat.... Myo.02 sup- overload.... Myo o2 deman- Beta bolckers: - Calcium channel blockers- Antiplatelets: reduce incidence of MI

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II. Surgery:III. Preventive:1- Avoid precipitating factors.2- Control Risk factors.N.B . During Attack

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Myocardial InfarctionMyocardial InfarctionDef. Def. It is a medical condition that occurs

when the blood supply to the heart is interrupted , and the myocardium is deprived of its blood supply ‘” therefore oxygen “’ for a significant amount of time.

Pathogenesis:- Formation of occlusive thrombus at the

site of rupture or erosion of atherosclerotic plaques in coronary artery.

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Clinical Picture:Clinical Picture:A.A.Symptoms:Symptoms:- Prolonged cardiac pain:- Anxiety - Nausea . Vomiting- Breathlessness.- Syncope: Silent MI......elder....arrythmias

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II.SignsII.Signs::- Signs of sympathatic activities: pallor, sweating, tachycardia- Signs of vagal activation: vomiting...bradycardia.- Signs of impaired myocardial

function: hypotension.Narrow pulse pressure.- Signs of tissue damage. fever

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InvestigationInvestigation1) ECG:-- Early - Late: - Advanced : 2) Blood test:- Cardiac enzymes: Cardiospecific isoform of CK :CK- MB Troponin T and I

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- ESR:

3) Chest x ray: Pulmonary oedema. Cardiac enlargement

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TherapyA- Immediate Therapy: - High flow oxygen.- Aspirin 300 mg.- ECG monitoring.B) Acute perfusion therapy:1- Thrombolysis:Help restore coronary potency.Preserve ventricular function.Improve survival.Cardiology dr.mon5@hotmail.com 19

2) Primary percutaneous coronary intervension:

C) Adjunctive Therapy:- Beta blockers relief pain ------reduce

arrythmias.- Nitrates: Nitroglycerin:

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