Ischemic heart disease, clinical picture, treatment..

 Ischemic heart disease

Ischemic heart disease is a condition of recurring chest pain or discomfort that occurs when a part of the heart does not receive enough blood. This condition occurs most often during exertion or excitement, when the heart requires greater blood flow. Ischemic heart disease, also called coronary heart disease and is a leading cause of death worldwide.

Predisposing factors 

1. Smoking. 

2. Hypertension.

3. Hypercholesrolemia. 

4. Hyperlipidemia.

5. Nervous breakdown. 6. Obesity. 

7. Sedentary life style. 8. Age.

9. Positive family history.

10. Male gender 

Pathogenesis

1. Intimal tear.

2. Precipitation of platelets, fibrin and lipoprotein.

3. Narrowing of the coronary vessels.

4. Rupture of atherosclerotic plaque.

Clinical picture

1. Mild degree (angina pectoris)

- It is due to coronary atherosclerosis.

- Patient complains anginal pain( retrosternal referred to the left shoulder, arm and 

little finger and may be to the right arm, in rare cases to the back, side of the neck and 

lower jaw).

- Pain is burning, stapping or compression (squeezing).

- Pain relived by rest or coronary vasodilators.

2. Angina at rest

It is a more severe stage of coronary atherosclerosis where anginal pain occurs at rest.

3. Unstable angina

 It is a more severe stage of coronary atherosclerosis where anginal pain is 

prolonged, not relieved by rest or coronary vasodilators (considered as pre infarction 

syndrome) this case is accompanied with severe sweating and pallor. 

4. Acute myocardial infarction (acute M.I.)

- There is coronary occlusion by thrombus or rupture of atherosclerotic plaque.

- Anginal pain is severe accompanied with sweating and pallor.

- Anginal pain can not be relived by rest or coronary vasodilators.

- Patient is semi shocked (Hypotensive).

Treatment of acute M.I. and unstable angina:

a. Transfer patient to coronary care unit.

b. Oxygen inhalation.

c. Morfia injections.

Groups of drugs

-Group (1): Nitroglycerine.

-Group (2): Beta- blockers.

-Group (3): Calcium channel blocker.

Group (4): Anti-platelets.

Investigations

1. Resting E.C.G. (if normal do Exercise stress test).

2. Blood lipid profile.

3. Blood sugar analysis.

4. Echocardiography.

5. Catheterization.

Other treatment procedures

1. Balloon dilatation by coronary catheter.

2. Combination between balloon and stint.

3. Using laser technique.

Surgical treatment(CABG)

Take the graft from

1. Saphenous vein.

2. Internal mammary artery.

3. Superficial epigastric artery.

4. Radial artery.

5. Splenic artery.