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Ischemic Heart
Disease

Zoya Liaquat
Risk factors for coronary
artery disease
 Risk Factors for Coronary artery
disease
Non-modifiable Modifiable
 Age  Cigarette smoking
 Family history  Diabetes mellitus
 Sex  Hyperlipidemia
 Hypertension
Pathogenesis of coronary
artery disease
 Development of atherosclerosis
Smoking

Blood Brain attack

pressure
A Thrombosis Heart attack
t
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Atherosclerosis
• The key processes in atherosclerosis are
– intimal thickening
– lipid accumulation

• These processes will produced the atheromatous plaque

Atheroma in coronary artery
Atheromatous plaque/ Atheroma

Fatty streak

Atheroma
Pathogenesis of myocardial
ischemia
 Presentation of coronary heart
disease

Asymptomatic Chronic stable Acute coronary Heart failure

angina syndrome (ACS) Death

Unstable angina
Non ST elevation MI
ST elevation MI

(
M
 ANGINA
Canadian Cardiovascular Society (CCS)

Functional Class Symptoms

I Normal ordinary activity
Angina with strenuous exercise

II Slight limitation of ordinary activity

III Marked limitation of ordinary activity

IV Inability to perform any activity without

symptom. May be present at rest
Types of angina

Angina

Stable angina Prinzmetal variant Unstable angina

angina
Stable angina
• Also called exertional angina

• The lumen of coronary artery is narrowed and hard; thus,

dilation in response to increased demand is impossible
Stable angina
• Initiated by known amount of activity
• Same activity tends to produce same symptoms
• Produced by
– physical activity
– emotional excitement
– cause of increased cardiac workload
• Relieved by rest, Nitrate
Printzmetal angina
• Also called variant angina, Prinzmetal’s variant angina
• An uncommon pattern of episodic angina that occurs at
rest
• Due to coronary artery spasm.
Printzmetal angina
• Occurs without a precipitating event, usually at the same
time of day
• Often awakens patient from sleep
• Unpredictable, occurs most often at rest
Acute coronary syndrome

Acute
Coronary
Syndrome

Non-ST
Acute
Unstable Elevation
Myocardial
angina Myocardial
infarct
Infarct
PLAQUE RUPTURE
ATHEROMATOUS PLAQUE PLAQUE RUPTURE
End of Phase II