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Ischemic Heart Diseases IHD. Ahmad Osailan. Introduction . What is IHD? Is a condition that affects the blood supply (coronary arteries of the heart) Another name for it : Coronary artery disease (CAD)

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introduction
Introduction
  • What is IHD?
  • Is a condition that affects the blood supply (coronary arteries of the heart)
  • Another name for it : Coronary artery disease (CAD)
  • Results when there is an imbalance between myocardial oxygen supply and demand due to partial blockage of the artery.
brief physiology of the heart
Brief Physiology of the heart
  • the layer that consist the Muscles of the Heart = Myocardium
  • What Helps the Blood to travel away from the Heart to organs?
brief physiology of the heart1
Brief Physiology of the heart
  • Now the heart in order to pump, Myocardium has to contract.
  • Myocardium requires action potential to contract and energy metabolism.
  • Action potential and energy metabolism require presence of O2 and nutrients within blood in coronary arteries.
  • If there is decrease in O2 and nutrients, does the heart will function normally?
causes and risk factors for ihd
Causes and risk factors for IHD
  • The most underlying causes are:
  • Atheroscelerosis:thickening and hardening of the artery wall.
  • Plaque: (the build-up of lipid/cholesterol) in the artery wall forms as a response toinjuryto the endothelium in the artery wall.
  • Therefore, causes the lumen of the artery to be narrow, which result in less oxygenated blood supply to the area after the narrowing
risk factors for ihd
Risk Factors for IHD
  • Age: (non-modifiable risk factor)
    • Male > 45 years
    • Female > 55 years or premature menopause without estrogen replacement therapy
  • Family History of premature disease(non- modifiable risk factor)
    • Male first-degree relative <55 years
    • Female first-degree relative < 65 years)
risk factors for ihd1
Risk Factors for IHD
  • Hypertension (Modifiable Risk factor(
    • Appears to weaken the artery wall at points of high pressure leading to injury and invasion of cholesterol.
  • Cigarette Smoking (modifiable Risk factor)
    • #1 cause of preventable death in US
    • 1 in 5 CHD deaths attributable to smoking
risk factors for ihd2
Risk Factors for IHD
  • Diabetes (modifiable risk factor)
    • 50% of deaths related to DM is due to CHD
  • Inactivity (modifiable Risk factor)
    • Sedentary person has 2x risk for developing CHD as a person who is active
risk factors for ihd3
Risk Factors for IHD
  • Abnormal Blood Lipids (modifiable Risk factor)
  • LDL Cholesterol (low density lipoprotein)
  • HDL Cholesterol (high density lipoprotein)
ldl low density lipoproteins
LDL (Low Density Lipoproteins)
  • Some LDL can be oxidized and takes up by endothelial cells and macrophages in the arterial wall, which leads to the first stages of atherosclerosis.
high density lipoproteins hdl
High Density Lipoproteins (HDL)
  • HDL-C is thought to be involved in the transport of excess cholesterol from membranes to the liver for removal from the body
problems resulting from hd
Problems resulting from HD
  • Most common problems:
  • Angina Pictoris (stable angina)
  • Unstable angina (Acute myocardial infarction)
  • Heart failure.
angina pictoris
Angina Pictoris
  • When part of the heart receive insufficient blood supply.
  • DEF: uncomfortable sensation in the chest or neighboring anatomic structures produced by myocardial ischemia during physical exertion or emotional stress. relieved by rest with in few minutes
  • Temporary depression of ST segment with no permanent myocardial damage
unstable angina acute mi
Unstable angina ( Acute MI)
  • Increased frequency and duration of Angina episodes, produced by less exertion or at rest = high frequency of myocardial infarction if not treated
myocardial infarction
Myocardial Infarction
  • Death of parts or area of myocardium.
  • Region of myocardial necrosis due to prolonged cessation of blood supply
  • Results from acute thrombus at side of coronary atherosclerotic stenosis
  • May be first clinical manifestation of ischemic heart disease or history of Angina Pectoris
common signs and symptoms of ihd
Common signs and symptoms of IHD
  • Pain or discomfort in the chest
  • Nausea
  • Dyspnea
  • Radiating pain to Left shoulder
electrocardiogram
Electrocardiogram
  • When ischemia results in transient horizontal or downsloping ST segments or T wave inversions which normalize after pain resolution
  • ST elevation suggest severe transmural ischemia or coronary artery spasm which is less often
pharmacologic therapy
Pharmacologic Therapy
  • Therapy is aimed in restoring balance between myocardial oxygen supply and demand
  • Useful Agents: nitrates, beta-blockers and calcium channel blockers
types of common cardiac revascularization surgeries
Types of common cardiac revascularization surgeries
  • Coronary artery bypass Grafting (CABG)
  • PercuatneousTransluminal coronary Angioplastgy (PTCA)
  • Valve replacement
management goals to reduce anginal symptoms
Management Goals to reduce Anginal Symptoms
  • Prevent complications – myocardial infarction, and to prolong life
  • No smoking, lower weight, control hypertension and diabetes
  • Patients with CAD – LDL cholesterol should achieve lower levels (<100)
  • Exercise and maintain active life style.