(控股)Ischemic Heart Disease-(精选·课件).pptVIP

Ischemic Heart Disease Ana H. Corona, FNP-Student University of Phoenix May 2002 Myocardial Ischemia Results when there is an imbalance between myocardial oxygen supply and demand Most occurs because of atherosclerotic plaque with in one or more coronary arteries Limits normal rise in coronary blood flow in response to increase in myocardial oxygen demand Oxygen Carrying Capacity The oxygen carrying capacity relates to the content of hemoglobin and systemic oxygenation When atherosclerotic disease is present, the artery lumen is narrowed and vasoconstriction is impaired Coronary blood flow cannot increase in the face of increased demands and ischemia may result Angina When ischemia results it is frequently accompanied by chest discomfort: Angina Pectoris In the majority of patients with angina, development of myocardial ischemia results from a combination of fixed and vasospastic stenosis Chronic Stable Angina May develop sudden increase in frequency and duration of ischemic episodes occurring at lower workloads than previously or even at rest Known as unstable angina: up to 70% patients sustain MI over the ensuing 3 months Angina: cont Patients with mild obstruction coronary lesions can also experience unstable angina 90% of Acute MI result from an acute thrombus obstructing a coronary artery with resultant prolonged ischemia and tissue necrosis Treatment of Angina Treatment of Chronic Angina is directed at minimizing myocardial oxygen demand and increasing coronary flow Where as in the acute syndromes of unstable angina or MI primary therapy is also directed against platelet aggregation and thrombosis Epidemiology Modifiable Factors: hyperlipidemia- ^ LDL (130 normal) or low HDL (60 normal), Hypertension, cigarette smoking and diabetes, obesity, BMI of 30 Non-Modifiable Factors: advanced age, male sex, family medical history: male 55 y/o, female 65 y/o Other: sedentary lifestyle and stressful emotional stress Homocysteine Concentration of amino acid homocystein