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Ischemic Heart Disease. Dr. Fletcher. Week 3/ CVS module 9-11-2003. Ischemia heart disease. Restriction of blood supply, relative to demands of the heart. Ischein = to restrict. Recall: Heart has high : - Work load. - Metabolic Rate. - Aerobic metabolism.

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ischemic heart disease

Ischemic Heart Disease

Dr. Fletcher.

Week 3/ CVS module

9-11-2003

ischemia heart disease
Ischemia heart disease
  • Restriction of blood supply, relative to demands of the heart.
  • Ischein = to restrict.

Recall:

  • Heart has high : - Work load.

- Metabolic Rate.

- Aerobic metabolism.

- Oxygen demands.

features of ischemia heart disease
Features of Ischemia heart disease :
  • Coronary Obstruction.
  • Cardiac Pain.
  • Cardiac Ischemia lesions.
1 coronary obstruction
1) Coronary Obstruction:
  • Obstruction of coronary arteries  decrease blood to heart.
2 cardiac pain common characteristics
2) Cardiac Pain: Common Characteristics :
  • Sever pain  gripping, crushing, arresting.
  • Chest  “Retrosternal”, behind the sternum
  • Radiating to left arm, neck and jaw.
coronary obstruction cardiac pain cardiac ischemia lesion
Coronary obstruction/Cardiac pain/Cardiac Ischemia lesion

Obstruction:

Impediment.

Stenosis  Narrowing of blood vessle

Pain :

Angina Pectoris

Cardiac lesions Ischemia fibrosis.

Narrow lumen

I) Obstruction

II) Occlusion

Cardiac lesions Infarct (necrosis).

Pain : Infarct Pain

Occlusion:

Closed vessel

Closure of the lumen

i stenosis
I) Stenosis:
  • It is narrowing without complete closure  this is a gradual process.
  • As a result of slow gradual changes  it will give chance for adaptation by forming anastomosis ( other area feed the Ischemic area) Partial Ischemia.
  • Lesions: Occasional cell atrophy. It is not a vacuum, because fibrous tissue replace the space ( Fibrosis intravenous).
pain angina pectoris
Pain Angina Pectoris:
  • General chest pain.
  • Its specific characteristic are:

1) Induced by exertion.

2)Paroxysmal (~ 15 minutes) (to differentiate between it and other chest pain).

3) Relieved by rest.

4) Relieved by Nitroglycerin  vasodilatations.

ii occlusion
II) Occlusion:
  • Sudden onset ( due to thrombosis, plaque rupture)
  • Complete Ischemia to the area of heart.
  • Give area of infarction sizable.
pain of infarct type important for distinguishing
Pain of infarct type: (Important for distinguishing)

1) Very sever.

2) Prolonged pain - at least 30 min (not 15 min)

- often 1 hours.

- Some cases 6 hrs ( have to be controlled byopiates).

3) Not induced by exertion.

4) Not relieved by rest.

5) Not relieved by nitroglycerin.

3 cardiac lesions
3) Cardiac Lesions:
  • Ventricle lesions ( 97%).
  • Right ventricle lesion  extensions in the left or septal.
1 functional disruption of the heart
1. Functional disruption of the heart:

 Arrhythmia due to Ischemia ( local) of conducting system.

 it can be picked up by ECG

 & might end up with sudden death.

2 diffuse ischemic fibrosis
2. Diffuse ischemic fibrosis:
  • It is Patchy muscle fiber atrophy
  • There is a replacement fibrosis ( strengthens).
  • Post Mortem examination:

We see – Grayish-white sheen.

- ill defined  Vague

3 infarction due to occlusion
3. Infarction: due to Occlusion
  • Post mortem Features :
      • Inapparent until >18 hrs survival.
      • They become Apparent after 24 hrs.
  • Infarct site are Yellow due to Autolysis at 37C (viable muscle).
  • When tissue necrosis occur
    • The tissue release many substances such as LDH, CPK and Troponin
    • Induce inflammatory reaction  migration of neutrophils to the site of necrosis and Increase phagocytosis.
    • Electrolyte imbalance (increase Na and decrease K)
sudden death
Sudden Death:

Causes:

1) Arrhythmia  Ventricular fibrillation.

2) Ischemia : a) re-entrant circuit

b) damaged conducting system, coronary lesions (hard to find).

3) Massive Acute infarct: infarct is not visible but coronary thrombosis easily found.