Topical issues of diagnosis and treatment of IHD in out-patients

Август 5, 2022

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Topical issues of diagnosis and treatment of IHD in out-patients

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2. International classification of Ischaemic heart disease (ESC-2013) Sudden coronary death Angina pectoris Acute myocardial infarction Painless
4. Ischaemic heart disease . Anterior Heart Arteries The coronary arteries supply blood to the heart muscle.
5. Ischaemic heart disease . Posterior Heart Arteries The coronary arteries supply blood to the heart muscle.
6. Ischaemic heart disease Ischaemic heart disease (Coronary heart disease) – is the most common form of
7. RISK FACTORS Nonmodifable: -Age (> 45 ); -Male gender; -Family history (genetic predisposition); -Aethnic origin Modifable
10. Ischaemic heart disease ANGINA PECTORIS-DEFINITION Angina pectoris is the symptom complex caused by transient myocardial ischaemia
12. ETIOLOGY There are causes of angina. 1. Coronary (heart) artery atherosclerosis. Coronary spasm is also called
13. Coronary (heart) artery atherosclerosis
14. OTHER REASONS OF ANGINA AND ISCHAEMIA OF MYOCARDIUM Noncoronarogenic diseases: arterial hypertension, aortic stenosis, hypertrophic cardiomyopathy,
15. Ischaemic cascade 1-The discrepancy between the demand and the delivery of oxygen 2 - Myocardial ischemia
16. Identifying ischaemic cardiac chest pain Ischaemic cardiac chest pain: Location - central, diffuse Radiation -Jaw/neck/shoulder/ arm/back
17. SIGNS AND SYMPTOMS An uncomfortable pressure, fullness, squeezing or pain in the center of your chest
20. Stable Angina Stable angina is a repeating pattern of chest pain which has not changed in
23. Prinzmetal's Angina Prinzmetal’s or spontaneous or angiospastic angina is caused by a vasospasm, a spasm that
24. Microvascular Angina or Stable Angina Pectoris on angiographycally intact vessels or Coronary Syndrome X Microvascular angina,
25. Coronary Syndrome X Characterized by 3 specific typical signs as : Classic anginal chest pain ST
41. Pharmacological management
51. Скачать презентацию

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International classification of Ischaemic heart disease (ESC-2013)
Sudden coronary death
Angina pectoris
Acute

myocardial infarction
Painless myocardial ischaemia
Heart failure
Disturbences of rhythm and conductivity

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Ischaemic heart disease . Anterior Heart Arteries
The coronary arteries supply blood to

the heart muscle. The right coronary artery supplies both the left and the right heart; the left coronary artery supplies the left heart.

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Ischaemic heart disease . Posterior Heart Arteries
The coronary arteries supply blood to

the heart muscle. The right coronary artery supplies both the left and the right heart; the left coronary artery supplies the left heart.

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Ischaemic heart disease
Ischaemic heart disease (Coronary heart disease) – is the

most common form of heart disease and the single most important cause of premature death in Europe, Russia, North and South America, Australia and New Zealand. By 2020 it is estimated that it will be the major cause of death in all regions of the world.
Ischaemic heart disease (IHD) – heart disease due to imbalance between myocardial oxygen supply and demand, which assotiated with atherosclerosis of coronary arteries in 95-96% cases.

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RISK FACTORS
Nonmodifable: -Age (> 45 ); -Male gender; -Family history (genetic

predisposition); -Aethnic origin

Modifable : -Dyslipidaemia; -Arterial hypertension; -Smoking; -Diabetes mellitus; -Obesity; -Fatty food diet; -Physical inactivity; -Stress; -Hypoestrogenemia in female

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Ischaemic heart disease
ANGINA PECTORIS-DEFINITION
Angina pectoris is the symptom complex caused

by transient myocardial ischaemia and may occur whenever there is an imbalance between myocardial oxygen supply and demand.
Angina pectoris is the medical term used to describe chest pains caused by poor blood flow to certain areas of heart muscle. Often, the name is shortened to angina. Having angina means patient has an increased risk of having a heart attack (myocardial infarction). Angina can be a useful warning sign if it makes you seek timely medical help and avoid a heart attack. Prolonged or unchecked angina can lead to a heart attack or increase risk of having a heart rhythm abnormality. That could lead to sudden death. Time is very important in regard to angina. The more time patient heart is deprived of adequate blood flow, and thus oxygen, the more heart muscle is at risk of heart attack or heart rhythm abnormalities.

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ETIOLOGY There are causes of angina. 1. Coronary (heart) artery

atherosclerosis. Coronary spasm is also called variant angina Prinzmetal angina. Variant angina typically occurs when you are at rest. But in as many as 96% of cases, at least 1 blood vessel of heart has severe coronary blockage. Critical blockage of a coronary artery from atherosclerotic plaque build up. When cholesterol or blood fats are too high, or patient has other risk factors, a fatlike material called atherosclerotic plaque builds up in blood vessels. Eventually the plaque will block blood flow through the vessel. 2. Exercise and emotional stress cause angina. Decreased oxygen content in the air patient breathe (flying or being at high altitude) may trigger angina. Low blood flow to the heart, which occurs when you are in deep sleep, also can bring on angina. People commonly arrive at the Emergency Department in the early morning complaining of chest pain that awakened them from sleep, or the pain started after "just going to the bathroom." 3. Microvascular dysfunction. 4 .The discrepancy between the demand and supply of myocardial oxygen

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Coronary (heart) artery atherosclerosis

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OTHER REASONS OF ANGINA AND ISCHAEMIA OF MYOCARDIUM
Noncoronarogenic diseases:
arterial hypertension,

aortic stenosis,
hypertrophic cardiomyopathy,
dilated cardiomyopathy,
paroxysmal tachyarrhythmias,
anaemia,
hypoxemia,
thyreothoxicosis.

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Ischaemic cascade
1-The discrepancy between the demand and the delivery of

oxygen 2 - Myocardial ischemia 3 - Reduced pH and the yield of K of cardiomyocytes 4 - Increased intracellular Ca 5 - Regional LV contractility violation 6 - Signs of global systolic and diastolic dysfunction 7 - The appearance of ST segment change 8 - Development of pain attack

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Identifying ischaemic cardiac chest pain
Ischaemic cardiac chest pain:
Location - central, diffuse
Radiation

-Jaw/neck/shoulder/ arm/back
Character -tight, burning ,squeezing, choking
Duration – less than 15 min (3-5 min)
Precipitation -by exertion and/or emotion
Relieving factors - rest, quick response to nitrates
Associated features- Breathlessness

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SIGNS AND SYMPTOMS
An uncomfortable pressure, fullness, squeezing or pain in

the center of your chest
Pain spreading to shoulders, neck, or arms and lasting more than a few minutes.The pain may be mild to intense.
It may feel like pressure, tightness, burning, or a heavy weight.
It may be located in the chest, upper abdomen, back, neck, jaw, or inside arms or shoulders.
Chest discomfort with light headedness
Anxiety, nervousness or fainting, sweating, nausea, or shortness of breath
Increased or irregular heart rate
Paleness
Cold sweaty skin
Feeling of impending doom

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Stable Angina
Stable angina is a repeating pattern of chest

pain which has not changed in character, frequency, intensity or duration for several weeks. The level of activity or stress that provokes angina is predictable and the pattern changes slowly. Stable angina is the most common form and it appears gradually. These patients have an increased risk of a heart attack, but an episode of stable angina does not indicate that a heart attack is about to happen. A crucial component of the management of the pain associated with angina pectoris is Identifying sources of stress and creating effective methods to minimize stress.

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Prinzmetal's Angina
Prinzmetal’s or spontaneous or angiospastic angina is caused by

a vasospasm, a spasm that narrows the coronary artery and lessens the blood flow to the heart. Prinzmetal's Angina usually occurs in arteries already narrowed by atherolsclerosis, in fact most people with it have severe coronary atherosclerosis in at least one major vessel. The spasm usually occurs very close to the blockage. Unlike stable and unstable angina, Prinzmetal's Angina usually occurs when a person is at rest or sleep (often at night) and not after physical exertion or emotional stress. It is associated with acute myocardial infarction, severe cardiac arrhythmias including ventricular tachycardia and fibrillation, and sudden cardiac death.

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Microvascular Angina or Stable Angina Pectoris on angiographycally intact vessels

or Coronary Syndrome X

Microvascular angina, or Syndrome X, occurs when the patient experiences chest pain but has no apparent coronary artery blockage. This condition results from poor functioning of the tiny blood vessels that nourish the heart, arms and legs. Microvascular angina can occur during exercise or at rest. Reduced vasodilator capacity of the coronary microvessels is thought to be a cause of angina during exercise, but the mechanism of angina at rest is not known. Coronary microvascular spasm and resultant myocardial ischemia may be the cause of chest pain in a subgroup of patients with microvascular angina

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