ischaemic heart diseases yola缺血性心脏病的折磨课件

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1、IschaemicheartdiseasesByDr.MohamedAbdAlmoneimAttiaIschemicheartdisease(IHD)includes:Anginapectoris:thereismyocardialischemiabutthemyocardiumisstillfreeandtheconditioniscorrectable.Myocardialinfarction(MI):suddenpersistentcessationofbloodflowtocertainareaofth

2、emyocardiumleadingtoirreversiblecoagulativenecrosis.Myocardialmetabolism:60%ofthemyocardialenergycomesfromaerobicoxidationoffattyacids(givesmoreenergybututilizesmoreO2).35%ofthemyocardialenergycomesfromaerobicoxidationofcarbohydrates(giveslessenergybututiliz

3、eslessO2).5%ofenergycomesfromoxidationofaminoacids,ketonebodies,etc.Definition:IschemicheartdiseaseisaconditioninwhichthereisimbalancebetweenO2supply(coronarybloodflow)andO2demand(heartwork).ANGINA:Itisaclinicalsyndromeduetotemporarymyocardialischemiaduetoim

4、balancebetweenmyocardialoxygensupplyandoxygenneeds,characterizedbyepisodesofchestpaintypicallyprecipitatedbyexertionandrelievedbyrest.PathophysiologyAnginaoccurswhenthemyocardialoxygendemandsexceedthesupply.Themyocardialmetabolismbecomesanaerobic.Thisleadsto

5、shiftinthemetabolismofthemyocardiumfromfattocarbohydratewithincreaseintherateofglycolysisandincreasedformationoflactateandpyruvate.InthesametimethereisaccumulationofsubstancePwhichisprobablyakininandwhichirritatesthesympatheticnerveendingsintheheartcausingca

6、rdiacpain.Etiology:1-Atherosclerosisofcoronaryarteryisthemostcommoncause.2-Thrombi,spasm,andcoronaryembolicauselimitationofcoronarybloodflow.3-HypertensionwherethemyocardialO2demandsisincreasedduetoventricularhypertrophy.4-ReductionintheO2carryingcapacityoft

7、hebloodasinsevereanemia.TypesofAngina:1-Stableangina:(Effort,typicalangina,classic):Thepainiscommonlyinducedbyexercise,emotionorheavymeals.Itisduetoatherosclerosis.Painisinducedbyeffortanddisappearswithrest.2-Variantangina:(Prinzmetal'sangina,-receptor–medi

8、atedvasoconst-riction):thecoronaryarteryundergoesseverespasmduetooveractivityofα1receptors.Mayormaynotbeassociatedwithatherosclerosis.PatientdevelopedpainevenatrestandexhibitelevationofSTsegment