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ISCHEMIC HEART DISEASE EXAM STUDY SET
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ISCHEMIC HEART DISEASE EXAMSTUDY SET
Ischemic Heart Disease - Definition & Major Cause
DEFINITION: Generic designation for a group of pathophysiologically related
syndromes resulting from myocardial ischemia due to an imbalance between the
supply (perfusion) and the demand of the heart for oxygenated blood.
MAJOR CAUSE (>90%): Reduced blood flow due to obstructive
atherosclerotic lesions in the coronary arteries (so IHD is often termed Coronary
Artery Disease, CAD)
Clinical Manifestations of IHD
Myocardial Infarction
Angina Pectoris
Chronic IHD with Heart Failure
Sudden Cardiac Death
IHD Causes
Reduced Coronary Flow (Major)
Increased myocardial demand (2° to hypertrophy)
Reduced availability of O₂ in the blood
Epidemiology of IHD
Leading cause of death in US
Decline in # of cases due to: lifestyle modification, elimination of risk factors,
early diagnosis, advanced therapies
Pathogenesis
Reduced coronary perfusion relative to myocardial demand
What leads to reduced Coronary Artery perfusion?
1. Acute Plaque Change
2. Inflammation
, 3. Thrombosis
4. Vasoconstriction
Acute Plaque Change
1. Rupture/fissuring, exposing the highly thrombogenic plaque constituents
2. Erosion/ulceration exposing the thrombogenic subendothelial basement
membrane to blood
3. Hemorrhage into the atheroma, expanding its volume
Inflammation
Very important in pathogenesis of atherosclerosis.
REMINDER: High sensitivity CRP predicts the risk of CAD
Thrombosis
1. Thrombosis in a partially occluded artery can lead to complete occlusion
2. Mural thrombi can also embolize
Vasoconstriction - Causes & Effect
CAUSES:
-Circulating adrenergic agonists
-Locally released platelet contents
-Impaired secretion of endothelial cell relaxing factors
EFFECT: Potential plaque disruption
Stable Angina, Unstable Angina, Transmural MI, Subendocardial MI, Sudden
Death - Stenoses, Plaque Disruption, Thrombus
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