Ischaemic heart diseases Yola缺血性心脏病的折磨ppt课件.pptx

Ischaemic heart diseases;Ischemic heart disease (IHD) includes: ? Angina pectoris: there is myocardial ischemia but the myocardium is still free and the condition is correctable. Myocardial infarction (MI): sudden persistent cessation of blood flow to certain area of the myocardium leading to irreversible coagulative necrosis. ;Myocardial metabolism: 60% of the myocardial energy comes from aerobic oxidation of fatty acids (gives more energy but utilizes more O2). 35% of the myocardial energy comes from aerobic oxidation of carbohydrates (gives less energy but utilizes less O2). 5% of energy comes from oxidation of amino acids, ketone bodies, etc. ;Definition : Ischemic heart disease is a condition in which there is imbalance between O2 supply (coronary blood flow) and O2 demand (heart work). ANGINA: It is a clinical syndrome due to temporary myocardial ischemia due to imbalance between myocardial oxygen supply and oxygen needs, characterized by episodes of chest pain typically precipitated by exertion and relieved by rest. ;Pathophysiology Angina occurs when the myocardial oxygen demands exceed the supply. The myocardial metabolism becomes anaerobic. This leads to shift in the metabolism of the myocardium from fat to carbohydrate with increase in the rate of glycolysis and increased formation of lactate and pyruvate. In the same time there is accumulation of substance P which is probably a kinin and which irritates the sympathetic nerve endings in the heart causing cardiac pain. ;Etiology : ? 1-Atherosclerosis of coronary artery is the most common cause. 2-Thrombi, spasm, and coronary emboli cause limitation of coronary blood flow. 3-Hypertension where the myocardial O2 demands is increased due to ventricular hypertrophy. 4-Reduction in the O2 carrying capacity of the blood as in severe anemia. ;Types of Angina: ? 1-Stable angina: (Effort, typical angina, classic): The pain is commonly induced by exercise, emotion or heavy meals. It is due to atherosclerosis.