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    Ischaemic Heart Disease

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    KelvinTMaikana
    Ischemic heart disease is caused by an imbalance between the heart's oxygen supply and demand. It typically results from atherosclerosis which narrows the coronary arteries and reduces blood flow. Over time this can lead to angina, heart failure, myocardial infarction, or sudden cardiac death. The major clinical syndromes of ischemic heart disease depend on the severity and rate of reduced blood flow and include stable angina, unstable angina, heart attack, and sudden death often due to arrhythmias.

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    Ischaemic Heart Disease

    Uploaded by

    KelvinTMaikana
    34 views25 pages
    Ischemic heart disease is caused by an imbalance between the heart's oxygen supply and demand. It typically results from atherosclerosis which narrows the coronary arteries and reduces blood flow. Over time this can lead to angina, heart failure, myocardial infarction, or sudden cardiac death. The major clinical syndromes of ischemic heart disease depend on the severity and rate of reduced blood flow and include stable angina, unstable angina, heart attack, and sudden death often due to arrhythmias.

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    pathology

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    41. Ischaemic Heart Disease

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    Ischemic heart disease is caused by an imbalance between the heart's oxygen supply and demand. It typically results from atherosclerosis which narrows the coronary arteries and reduces blood flow. Over time this can lead to angina, heart failure, myocardial infarction, or sudden cardiac death. The major clinical syndromes of ischemic heart disease depend on the severity and rate of reduced blood flow and include stable angina, unstable angina, heart attack, and sudden death often due to arrhythmias.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    34 views25 pages

    Ischaemic Heart Disease

    Uploaded by

    KelvinTMaikana
    Ischemic heart disease is caused by an imbalance between the heart's oxygen supply and demand. It typically results from atherosclerosis which narrows the coronary arteries and reduces blood flow. Over time this can lead to angina, heart failure, myocardial infarction, or sudden cardiac death. The major clinical syndromes of ischemic heart disease depend on the severity and rate of reduced blood flow and include stable angina, unstable angina, heart attack, and sudden death often due to arrhythmias.

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    © All Rights Reserved
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    Download as pdf or txt
    of 25

    ISCHAEMIC HEART DISEASE

    Imbalance between supply & demand of


    myocardium for oxygenated blood.
    Results
    Hypoxia
    Inadequate supply of nutrients
    Inadequate removal of metabolites
    Causes
    Reduced coronary blood flow(90%)
    Increased myocardial demand: Tachycardia, hypertrophy
    Hypoxia
    Anaemia, advanced lung disease, cyanotic heart disease,
    carbon monoxide poisoning, cigarette smoking,
    Reduced coronary blood Flow
    Atherosclerosis(95%)
    Narrowed coronary ostia
    Atheroma of ascending aorta
    Syphilitic aortitis
    Dissecting aortic aneurysm

    Vasculitis of coronary arteries


    SLE, IE, PN, HIV, Takayasu, Kawasaki

    Thrombo-Embolism: IE, Mural thrombosis


    Atherosclerosis (Atheroma)

    Deposition of lipid in the intima eventually


    leading to elevated fibrofatty plaques
    Over 90% of coronary artery disease
    leading to IHD
    50% of all deaths in US attributable to
    atheroma
    The coronary artery shown here has narrowing of the lumen
    due to build up of atherosclerotic plaque. Severe narrowing
    can lead to angina, ischemia, and infarction.
    Atheroma:
    Sites
    Medium sized muscular arteries and large elastic
    arteries
    Abdominal aorta
    Coronary arteries
    Popliteal arteries
    Descending thoracic aorta
    Internal carotid arteries
    Circle of Willis

    Vessel lumen compromised


    Atheroma: Predisposing factors
    Increases with age
    Positive family history
    Hypercholestorolaemia
    low density lipoproteinaemia vs high density lp
    Hypertension
    Diabetes
    Cigarette smoking
    Atheroma:Pathogenesis
    Response to injury
    ? Chronic repeated endothelial injury

    Endothelial dysfunction
    ? Increased permeability to plasma lipids etc
    Atheroma:Morphology
    Fatty streaks
    Atheromatous plaque
    white yellow intimal lesions up to 1.5cm protruding
    into lumen

    Micro
    Fibrous cap
    Underlying necrotic core, smooth muscle cells, lipid
    material and inflammatory cells
    Periphery of proliferating small vessels
    Atheroma: complications
    Calcification
    Ulceration/fissures leading to thrombosis
    Haemorrhage into plaque
    Cholesterol microembolization
    Aneurysm formation
    CLINICOPATHOLOGICAL
    SYNDROMES of IHD
    Determined by rate and severity
    1. Angina pectoris
    2 Ischaemic cardiomyopathy
    3. Myocardial Infarction
    4. Sudden death
    ANGINA PECTORIS
    Transient ischemia not resulting in infarction
    Stable angina
    Triple vessel disease> 75% narrowing
    Severe paroxysmal pain on exertion
    Relieved by rest or medication
    No infarcts but severe coronary atheroma
    Unstable angina
    Thrombosis and occlusion -------- MI
    Prinzmetals angina
    Pain at rest
    Spasm of coronary arteries
    arrythmias
    ISCHEMIC
    CARDIOMYOPATHY
    Later decades of life
    Slow progressive reduction in Coronary
    blood flow (5 to 10 years)
    Diffuse fibrotic changes in myocardium
    Maybe episodic angina/ MI
    Usually silent and presents with failure
    Myocardial Infarction
    Death of myocardium due to reduced blood
    supply
    Anterior descending 40-50%
    Ant. Wall of left ventricle.
    Ant. 2/3 of interventricular. Septum
    Rt coronary art. 30-40%
    Post wall of left ventricle.
    Post 1/3 of interventricular. Septum
    Lt circumflex
    Lateral wall of left ventricle.
    TYPES OF INFARCTS
    Transmural
    -endocardium to pericardium

    Subendocardial
    -inner 1/3 of myocardium
    -multiple foci of necrosis
    MI: Sequence of events
    Up to 12hrs- biochemical changes only
    12hr- polymorphs infiltrate
    24hrs pale infarct
    2-4 days borders hyperemic/ infarct yellow
    4-10 days- infarct yellow necrotic
    10 days- progressive replacement by
    fibrous tissue
    3wks-3mths infarct converted to scar
    In this microscopic view of a recent myocardial infarction,
    there is extensive hemorrhage along with myocardial fiber
    necrosis with contraction bands and loss of nuclei.
    This myocardial infarction is about 3 to 4 days old. There is
    an extensive acute inflammatory cell infiltrate and the
    myocardial fibers are so necrotic that the outlines of them
    are only barely visible.
    Complications of Infarction
    Arrhythmias most frequent Cause of death
    Cardiac failure- extensive infarction of left vent.
    Mural thrombosis- release of tissue
    thromboplastin from damaged muscle
    Rupture of lt vent (myomalacia cordis)
    Cardiac tamponade
    Ventricular aneurysm
    Fibrosed weakened vent wall
    Recurrence of infarction
    SUDDEN DEATH:
    (sudden cardiac death)
    Death within 24hrs ( usually within 1 hr) after
    onset of symptoms in person previously well
    Pathogenesis
    Rhythm disturbance
    Severe sudden outflow obstruction
    Causes
    Coronary atheroma(commonest)
    Coronary malformation- anomalous origin etc
    Outflow obstruction
    Hypertrophic cardiomyopathy
    Aortic stenosis
    Pulmonary embolism
    Conduction system defects
    CONGENITAL
    Mitral Valve prolapse
    Myocarditis
    Aortic Valve Stenosis
    Hypertrophic Cardiomyopathy
    Conduction System abnormalities

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