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Home > 11 The Heart > ISCHEMIC HEART DISEASE

ISCHEMIC HEART DISEASE (IHD)

IHD is a generic designation for a group of related syndromes resulting from myocardial ischemia supply (perfusion) and myocardial oxygen demand. Although ischemia can result from increased demand (e.g., increased hea hypertension), or diminished oxygen-carrying capacity (e.g., anemia, carbon monoxide poisoning), in the vast majority of case due to a reduction in coronary blood flow caused by obstructive atherosclerotic disease (Chapter 10 called coronary artery disease (CAD). Despite dramatic improvement over the past 3 to 4 decades, IHD in its various forms sti represents the leading cause of death in the United States and other industrialized nations.

The clinical manifestations of IHD are a direct consequence of insufficient blood supply to the heart. There are four basic clinic syndromes of IHD:

Angina pectoris (literally chest pain), wherein the ischemia causes pain but is insufficient to lead to death of myocardium will discuss, angina may be stable (occurring reliably after certain levels of exertion), may be due to vessel spasm angina or Prinzmetal angina), or may be unstable (occurring with progressively less exertion or even at rest). infarction (MI), wherein the severity or duration of ischemia is enough to cause cardiac muscle death progressive cardiac decompensation (heart failure) following MI.Sudden cardiac death (SCD), following myocardial ischemia. As discussed later, there are other causes of SCD as well.

These syndromes are all relatively late manifestations of coronary atherosclerosis that begins early in life but manifests only a vascular occlusions reach a critical stage. The term acute coronary syndrome is applied to three catastrophic manifestations o unstable angina, acute MI, and SCD. Epidemiology

Nearly 500,000 Americans die of IHD annually; nevertheless, this represents a spectacular improvement over previous eras. A peaking in 1963, the overall death rate from IHD has fallen in the United States by approximately 50%. The decline can be attr largely to the recognition of cardiac risk factors (that is, risk factors leading to atherosclerotic disease; such as stopping smoking, treating hypertension and diabetes, and lowering cholesterol. To a lesser extent, advances are also contributory; these include coronary angiography, aspirin prophylaxis, newer medications like statins, bett arrhythmia control, coronary care units, angioplasty and endovascular stents, thrombolysis for MI, and coronary artery bypass Nevertheless, continuing this progress in the 21st century will be particularly challenging in view of the predicted increased lon "baby boomers." Pathogenesis In most cases IHD occurs because of inadequate coronary perfusion relative to myocardial demand. This may result from a combination of pre-existing ("fixed") atherosclerotic occlusion of coronary arteries and new superimposed thrombosis and/or vasospasm (Fig. 11-7).

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