Ischemic Heart Disease (IHD) | Schemes and Mind Maps Medicine

IschemicHeartDisease

Overview

Definition

Determinants

1772WilliamHeberden Uncomfortablechestwhilewalking AnginaPectoris

Ischemicheartdisease(IHD)

AnginaPectoris

StableAngina

VariantAngina

SilentIschemia

UnstableAngina

MyocardialInfarction

Conditioninwhichimbalancebetweenmyocardialoxygensupplyand

demandresultsinmyocardialhypoxiaandaccumulationofwaste

metabolites,mostoftencausedbyatheroscleroticdiseaseofthecoronary

arteries(oftentermedcoronaryarterydisease)

Uncomfortablesensationinthechestandneighboringanatomicstructures

producedbymyocardialischemia

Chronicpatternoftransientanginapectoris,precipitatedbyphysicalactivity

oremotionalupset,relievedbyrestwithinaewminutes

EpisodesoftenassociatedwithtemporarydepressionoftheSTsegment,

butpermanentmyocardialdamagedoesnotresult

Typicalanginaldiscomfort,usuallyatrest,whichdevelopsbecauseof

coronaryarteryspasmratherthananincreaseofmyocardialoxygendemand

EpisodesoftenassociatedwithtransientshiftsoftheSTsegment,usuallySTelevation

AlsotermedPrinzmetalangina/Vasospasticangina

Asymptomaticepisodesomyocardialischemia

Canbedetectedbyelectrocardiogramandotherlaboratorytechniques

Patternofincreasedrequencyanddurationofanginaepisodesproduced

bylessexertionoratrest

Highrequencyoprogressiontomyocardialinfarctionifuntreated

Regionofmyocardialnecrosisusuallycausedbyprolongedcessationof

bloodsupply

Mostoftenresultsromacutethrombusatsiteofcoronary

atheroscleroticstenosis

maybeafirstclinicalmaniestationofischemicheartdisease,

ortheremaybeahistoryofanginapectoris

OxygenSupply

OxygenDemand

O2content

Coronarybloodflow(tendtobedynamic)

Coronaryperfussionpressure

Coronaryvascularresistance

Ventricularwallstress Pxr/2h

Heartrate

Contractility(inotropicstate)

Determinant(relativelyconstant)

SystemicOxygenation

Coronaryperfussiontakesplaceduringdiastole

Aorticdiastolicpressure Conditionthatinterferes

Hypotension

Aorticregurgitation

Majordeterminantofcoronarybloodflow

Modulatedby

Externalcompression

Intrinsicfactorsaltercoronarytone Factorsthatparticipateinregulatingcoronaryvascularresistances

Accumulationoflocalmetabolites

Endotheliumderivedsubstances

Neuralinnervation

Duringhypoxemia Anaerobicmetabolismgenerated IncreasedADP Adenosine

DecreasedCaentryintocells

relaxation

vasodilatation

Increasedcoronarybloodflow

Prostacyclin

EDHF

Endothelin1(Vasoconstrictor)

Sympathetic

Parasympathetic

AlphaAdrenergic

Beta2Adrenergic

Stimulationleadstovasoconstriction

Stimulationleadstovasodilatation

Cathecolamine

VasoconstrictionviastimulationtoAlphaadrenergic

IncreasedHRandcontractilityviastimulationtoB2adrenergic increasedO2consumption

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Ischemic Heart Disease

Overview

Definition

Determinants

1772 William Heberden Uncomfortable chest while walking Angina Pectoris Ischemic heart disease (IHD) Angina Pectoris Stable Angina Variant Angina Silent Ischemia Unstable Angina Myocardial Infarction Condition in which imbalance between myocardial oxygen supply and demand results in myocardial hypoxia and accumulation of waste metabolites, most often caused by atherosclerotic disease of the coronary arteries (often termed coronary artery disease) Uncomfortable sensation in the chest and neighboring anatomic structures produced by myocardial ischemia Chronic pattern of transient angina pectoris, precipitated by physical activity or emotional upset, relieved by rest within a ew minutes Episodes often associated with temporary depression of the ST segment, but permanent myocardial damage does not result Typical anginal discomfort, usually at rest, which develops because of coronary artery spasm rather than an increase of myocardial oxygen demand Episodes often associated with transient shifts of the ST segment, usually ST elevation Also termed Prinzmetal angina / Vasospastic angina Asymptomatic episodes o myocardial ischemia Can be detected by electrocardiogram and other laboratory techniques Pattern of increased requency and duration of angina episodes produced by less exertion or at rest High requency o progression to myocardial infarction if untreated Region of myocardial necrosis usually caused by prolonged cessation of blood supply Most often results rom acute thrombus at site of coronary atherosclerotic stenosis may be a first clinical mani estation of ischemic heart disease, or there may be a history of angina pectoris Oxygen Supply Oxygen Demand O2 content Coronary blood flow (tend to be dynamic) Coronary perfussion pressure Coronary vascular resistance Ventricular wall stress P x r / 2h Heart rate Contractility (inotropic state) Determinant (relatively constant) Hb Systemic Oxygenation Coronary perfussion takes place during diastole Aortic diastolic pressure Condition that interferes Hypotension Aortic regurgitation Major determinant of coronary blood flow Modulated by External compression Intrinsic factors alter coronary tone Factors that participate in regulating coronary vascular resistances Accumulation of local metabolites Endothelium derived substances Neural innervation During hypoxemia Anaerobic metabolism generated Increased ADP Adenosine Decreased Ca entry into cells relaxation vasodilatation Increased coronary blood flow NO Prostacyclin EDHF Endothelin 1 (Vasoconstrictor) Sympathetic Parasympathetic Alpha Adrenergic Beta 2 Adrenergic Stimulation leads to vasoconstriction Stimulation leads to vasodilatation Cathecolamine Vasoconstriction via stimulation to Alpha adrenergic Increased HR and contractility via stimulation to B2 adrenergic increased O2 consumption

Ischemic Heart Disease (IHD), Schemes and Mind Maps of Medicine

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Download Ischemic Heart Disease (IHD) and more Schemes and Mind Maps Medicine in PDF only on Docsity!

Ischemic Heart Disease

Overview

Definition

Determinants