ISCHEMIC HEART DISEASE ppt.pptx

8/9/2019 ISCHEMIC HEART DISEASE ppt.pptx

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ISCHEMIC HEART DISEASE

Presenter: Dr. Mounika

Moderator: Dr. Jayapal Rao

MD,HOD,Dept o Pat!olo"y


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ISCHEMIC

HEART DISEASE


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P#A$ O% ST&D'

(. $eed or study

). Deinition

*. Risk a+tors

. Pat!o"enesis

-. Ee+ts o Is+!eia

/. An"ina

0. MI

1.In2esti"ations

3. Copli+ations

(4.DD

((.Mana"eent

(). Con+lusion

(*. Hooeopat!i+

approa+!(. 5i6lio"rap!y


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$eed or study

EPIDEMO#O7':

IHD +auses ore deat!s and disa6ility

and in+urs "reater e+onoi+ +osts t!an

any ot!er illness in t!e de2eloped 8orld.

IHD is t!e sin"le ost iportant +ause o

preature deat! in de2eloped 8orld. It is

serious, +!roni+, lie9t!reatenin" illness.


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it! ur6ani;ation in t!e de2elopin" 8orld,

t!e pre2alen+e o risk a+tors or IHD is

in+reasin" rapidly in t!ese re"ions su+!

t!at a a


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Spe+iality o +ardia+ us+le=

$o ati"ue=

$o tetanus=


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5lood supply

T!e t8o +oronary arteries, let and ri"!t,

arise ro t!e let and ri"!t sinus o

>alsal2a, respe+ti2ely. In (4? o

indi2iduals t!e +ir+ulation is +onsidered as

@let doinant@ as t!e +ir+ule artery

"i2es o t!e posterior des+endin" artery.

In 34?, t!e +ir+ulation is ri"!t doinant ast!e posterior inter2entri+ular artery is "i2en

o ro t!e ri"!t +oronary artery


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Supply to !eart o++urs durin"Systole or Diastole=


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%a+tors t!at aintain +ir+ulation

Pupin" a+tion o !eart

Elasti+ re+oil o t!e arteriesB

Pressure "radient Respiration

Mus+ular eer+ise

Ee+t o "ra2ity


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%a+tors re"ulatin" nutrition

a+tion o !eart

O) supply

5lood pressure Teperature

Inor"ani+ ions

$euro!arones


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%a+tors inluen+in" +oronary

+ir+ulation

Mean aorti+ pressure

Cardia+ output Meta6oli+ a+tors

O) supply


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Condu+tion ner2e supply

Autor!yt!i+

Sypat!eti+ parasypat!eti+


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DEFINITION OF IHD

T!e orld Healt! Or"anisation !as

deined is+!aei+ !eart disease IHD as

yo+ardial ipairent due to i6alan+e

6et8een +oronary 6lood lo8 andyo+ardial reFuireents.

T!e ost +oon +ause o IHD is

at!eros+leroti+ +oronary arterydiseaseGCAD


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Aetiolo"y

MAJOR RISK FACTORS

CO$STIT&TIO$A#

A"e

Se 7eneti+

%ailial

A+Fuired

Hyperlipidaeia

Hypertension DM

Sokin"


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PATHOPH'SIO#O7' O%

M'OCARDIA# ISCHAEMIA

Myo+ardial is+!aeia o++urs as a result o

i6alan+e 6et8een O) supply and

deand.


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Etiopat!o"enesis

(.Coronary at!eros+lerosis:

Distri6ution:G S>D, T>D

#o+ation.


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). Superadded +!an"es in +oronary

at!eros+lerosis:

A+ute +!an"es

+oronary artery t!ro6osis

platelet a""re"ation


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*.$on at!eros+leroti+ +auses:

>asospas,

Arteritis E6olis

Traua

Aneurys Copression.


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A$7I$A

It is deri2ed ro t!e "reek 8ord

STRANGULATION.

It is a syndroe SENSE OF BAND

AROUND CHEST. Patient presses !is

sternu 8it! +len+!ed ist to lo+ate t!e

pain.

Pro"ressi2e +onstri+tion o +oronaryarteries +ardia+ pain +alled an"ina.


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T!e types o an"ina in+lude

(. Sta6le an"ina, ). &nsta6le an"ina,

*. Prin;etals an"ina

. Post inar+tion an"ina


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Stable angina or effort angina

Also +alled He6erdeens an"ina, it o++urs

on kno8n p!ysi+al eort, and is relie2ed

8it! rest, standin" or su6lin"ualnitro"ly+erine.

Modalities Teperature,

Eotions,


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Diurnal E2en soeties sokin", seual a+t,

s!a2in", strainin" at stool


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Soe +ases pain is a6sent ,An"ina9eFui2alent syptos 6reat!lessness,

ati"ue, syptos o de+reased +ardia+

output.


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>ariants:

Start9up or alk9 t!rou"! an"ina,

$o+turnal an"ina, De+u6itius an"ina,

Post Prandal an"ina,

Aunition a+tories.

Class New York Heart Association Functional Canadian Cardiovascular Society


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New York Heart Association Functional

Classification

Canadian Cardiovascular Society

Functional ClassificationI

Patients have cardiac disease but without

the resulting limitationsof physical activity.

Ordinary physical activity does not causeundue fatigue, palpitation, dyspnea, or

anginal pain.

Ordinary physical activity, such

as walking and climbing stairs,

does not cause angina. Anginapresent with strenuous or rapid

or prolonged exertion at work or

recreation.

IIPatients have cardiac disease resulting in

slight limitationof physical activity. They are

comfortable at rest. Ordinary physical

activity results in fatigue, palpitation,

dyspnea, or anginal pain.

Slight limitationof ordinary

activity. Walking or climbing

stairs rapidly, walking uphill,

walking or stair climbing after

meals, in cold, or when under

emotional stress or only during

the few hours after awakening.

IIIPatients have cardiac disease resulting Marked limitation of


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Patients have cardiac disease resulting

in marked limitationof physical activity.

They are comfortable at rest. ess than

ordinary physical activity causes

fatigue, palpitation, dyspnea, or anginal

pain.

Marked limitationof

ordinary physical activity.

Walking one to two blocks

on the level and climbing

more than one flight of

stairs in normal

conditions.

IVPatients have cardiac disease resulting

in inabilityto carry on any physical

activity without discomfort. !ymptoms

of cardiac insufficiency or of the anginalsyndrome may be present even at rest.

"f any physical activity is undertaken,

discomfort is increased.

Inabilityto carry on any

physical activity without

discomfort#anginal

syndrome may be presentat rest.


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P!ysi+al eaination in patients 8it!

an"ina pe+toris is oten noral. Ho8e2er,

t!ere ay 6e indi+ation o +oronary risk

a+tors like ant!elasa or ant!oas.

Palpation ay re2eal t!i+kened arteries

and redu+ed or a6sent pulses as si"ns o"eneralised at!eros+lerosis. #>

enlar"eent, S* or S "allop.


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INVESTIGATIONS

(. K9ray +!est or +ardioe"aly or

pulonary +on"estion. ). #ipid proile *.

5lood su"ar, seru uri+ a+id and urine

eaination Electrocariogra! "In -4? o patients

8it! an"ina, t!e restin" EC7 is noral

6et8een an"inal episodes. Durin" anan"inal episode transient ST9T depression

ay 6e noted 8!i+! disappears 8it! rest

or 8it! su6lin"ual nitro"ly+erine


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Prinzmetal angina

Also +alled 2ariant an"ina, it 8as

des+ri6ed 6y Prin;etal in (3-3. T!e pain

usually o++urs at rest at ni"!t or in t!e

early ornin" !ours. It is asso+iated 8it!ST ele2ation on t!e EC7, responds to

su6lin"ual nitro"ly+erine, and is +aused 6y

spas o t!e +oronary artery.


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Eer+ise stress testin" ay ail to indu+e

is+!aei+ +!an"es. T!e spas +an 6e

indu+ed 6y sokin", !yper2entilation .

T!e +ause o spas ay 6e in+reasedalp!a9adrener"i+ a+ti2ity durin" t!e early

ornin" !ours or platelet a""re"ation.

Coronary an"io"rap!y ay re2eal noral+oronary arteries.


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Unstale angina

Also +alled interediate +oronary

syndroe and Preinar+tion an"ina, it is a

serious or o an"ina and needs spe+ial

attention sin+e )4? o t!ese patients arelikely to de2elop atal or nonatal

yo+ardial inar+tion 8it!in ont!s.

T!ere is a !i"!er in+iden+e o let ain+oronary artery disease in t!ese patients.


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&nsta6le an"ina in+ludes i an"ina o

re+ent onset less t!an /4 daysL ii sta6le

an"ina 8it! syptos ore se2ere in

intensity, reFuen+y or duration and oreeasily pro2okedL iii an"ina at restL i2

an"ina ollo8in" yo+ardial inar+tion

8it!in days or 8eeks.


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ST9T depression in t!e EC7 is +oon...

A6out )-? o t!ese patients !a2e

+oronary artery t!ro6osis. In t!e ot!ers,

spas plays an iportant role. Patients!a2e asso+iated se2ere +oronary artery

o6stru+ti2e disease.


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Mana"eent

T!ro6olyti+ a"ents

PTCA

CA57


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P!st in"ar#ti!n angina

Soe patients 8it! yo+ardial inar+tion

de2elop an"ina ) days to 1 8eeks

ollo8in" t!e a+ute inar+tion. Most

patients !a2e ulti2essel disease or

partially re+analised +oronary arteries 8it!

residual yo+ardial is+!aeia.


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M$OCARDIA% INFARCTION

T!e area o us+le t!at !as eit!er ;ero

lo8 or so little lo8 t!at it +annot sustain

+ardia+ us+le un+tion pro+ess +alled

Ina+rtion.


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Myo+ardial inar+tion is a serious

+opli+ation o at!eros+leroti+ +oronary

!eart disease. In ost patients 1493-? it

results ro t!ro6oti+ o++lusion o t!einar+t9related 2essel. Myo+ardial

is+!aeia and ne+rosis set in 8it!in a6out

)494 inutes


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T!is o++urs as a 8a2e9ront startin" ro

t!e su6endo+ardial re"ion and

pro"ressin" to t!e su6epi+ardial re"ion.

T!e entire pro+ess usually takes / !ours

to +oplete. T!ereore any inter2ention or

liitin" inar+t si;e s!ould 6e initiated int!is @tie 8indo8@ o / !ours.


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Eti!&at'!genesis(

Me+!anis o Myo+ardial is+!eia:

Diinis!ed +oronary 6lood lo8, In+reased

yo+ardial deand, Hypertrop!y o !eart

8it!out in+rease in +oronary 6lood lo8.


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In"ar#ts ma) e transm*ral +ers*s

s*en,!#ar,ial in"ar#ts: Transural

ost +oon type 3-?. Su6endo+ardial

inar+t "enesis is due to redu+ed +oronaryperusion 8it!out +riti+al stenosis


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Transmural

Full thickness

Superimposed thrombus in

atherosclerosis

Focal damage

Sub-endocardial

Inner 1/3 to half of ventricular

wall Decreased circulating blood

volume( shock, !potension,

"!sed thrombus#

$ircumferential


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Types o inar+ts:

(. A++ to anatoi+al re"ion o let2entri+le: Anterior, lateral, septal,

+ir+uerential or +o6inations.

). A++ to de"ree o t!i+kness : Transural,

Su6endo+ardial.

*. A++ to a"eold, ne8 G !ealed res!.


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#o+ation o inar+ts:

Inar+ts are ost reFuently lo+ated in let

2entri+le . Ri"!t 2entri+le is less

sus+epti6le to inar+tion due to its t!in 8all

less eta6oli+ reFuireent.


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* +oon re"ions o MI:

(. Stenosis o let anterior des+endin" +oronary

artery is ost +oonG4? to -4?

). Stenosis o ri"!t +oronary arteryG*4? to 4?

*. Stenosis o let +ir+ule +oronaryarteryG (-? to )4?


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M!r&'!l!g)- Pat'!l!gi#al #'anges.

li"!t i+ros+opy

%irst 49/!rs9 Stre+!in" o i6res.

/9()!rs ater MI Coa"ulati2e

ne+rosis neutrop!ils 6e"ins

&p to * days N Coa"ulati2e ne+rosis,

neutrop!ils

(9) 8eeks N 7ranulation tissue * 8eeks N ine s+ar

) ont!s N dense s+ar


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T!e dis+oort ay 6e elt as

+opression o +!est or a 6urnin"

sensation, asso+iated 8it! aniety and

eelin" o ipendin" deat!. Continuin"dis+oort is a sypto o on"oin"

is+!aeia and e2ol2in" inar+tion. As t!e

inar+tion is +opleted, t!e pain aysu6side +opletely..


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In (-9*4? o patients t!e inar+tion ay "o un

re+o"nised 6e+ause o a6sen+e o typi+alsyptos. A6out -? o su+! patients !a2e

silent inar+tion. T!is is +oon in dia6eti+s

and elderly patients. In ot!ers, 6reat!lessness

as in a+ute let 2entri+ular ailure, syn+ope,

"iddiness, ati"ue, a6doinal pain, nausea

and 2oitin" and uneplained !ypotension

ay 6e t!e presentin" aniestation


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C%

Pain

Indi"estion

Appre!ension

S!o+k

Oli"uria

#o8 "rade e2er A+ute pulonary oedea


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P!ysi+al eaination re2eals a pale

patient 8!o is s8eatin", restless, in a"ony

due to pain, and tossin" in t!e 6ed in an

attept to "et relie. T!e pulse ay 6erapid or slo8, and re"ular or irre"ular.

5rady+ardia ay 6e a proinent eature

in t!e early !ours espe+ially in t!ose 8it!inerior 8all inar+tion


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5lood pressure ay 6e noral, lo8 or !i"!.

Aus+ultation ay re2eal S* or S "allop.

Paradoi+al splittin" o t!e se+ond !eart sound

ay 6e ade out. Ri"!t 2entri+ular inar+tion

ay result in in+reased


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Cardia+ reser2e

Maiu aount o +ardia+ output t!at

+an in+rease a6o2e noral. It is 44?

6lood per in ore t!an 6ody reFuires.


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INVESTIGATIONS

#eu+o+ytosis 8it! polyorp!onu+lear

rea+tion and !i"! ESR due to tissue

ne+rosis are present durin" t!e irst 8eek.


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Electrocariogra#$ic c$ange% "T!e earliest+!an"es are ST ele2ation o++urrin" 8it! t!e

onset o +!est pain. Q 8a2es appear 8!en

transural inar+tion o++urs. ST se"ent

+!an"es start re2ersin" early 8it!in )

!ours or so and T 8a2es 6e"in to "et

in2erted..


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Anterior 8all inar+tionis dia"nosed 6y

+!an"es in leads >( to >, #ateral6y +!an"es in #(, a>#, >- and >/,

and

Inerior 8all inar+tion6y +!an"es in #), #*and a>%

Posterior 8all #> inar+tion is dia"nosed 6y

ST depression, upri"!t T 8a2e and tall R8a2e in >( and >).


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T!e initial EC7 +!an"es ay 6e present

in only a6out -490-? o patients. In

ot!ers, a typi+al !istory and serial seru

en;ye +!an"es pro2ide dia"nosti+ !elp.Serial EC7sipro2e t!e dia"nosti+ yield

to 1-?.


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Serum enzymes"$e+rosis o yo+ardial

+ells releases en;yes in t!e 6lood.

S7OT AST starts to rise 8it!in a e8

!ours, rea+!in" a peak at ) !ours andde+linin" o2er t!e net 190) !oursL it is

not spe+ii+ or +ardia+ us+le in


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Seru +reatinine p!osp!okinase CP risesiediately to /!rs L it alls to noral 2alues

8it!in 1 !ours. T!is en;ye is also not

spe+ii+ or +ardia+ +ells and is present inskeletal us+le and 6rain tissue. T!e CP

isoen;ye, CP9M5, is ore spe+ii+ or

+ardia+ tissueL its le2els !a2e 6een related to

t!e etent o yo+ardial inar+tion.


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Seru #DH le2els in+rease late ater

yo+ardial inar+tion. T!e in+rease starts

durin" t!e irst day, peak le2els area+!ie2ed durin" t!e *rd or t! day, and

t!ey ay reain !i"! or (9(- days. #DH

+ardia+ isoen;ye #DH( is orespe+ii+.

Troponin le2el is in+reased in AMI to

/!rs and is a ore sensiti2e indi+ator oyo+ardial neurosis !i"! or 0 to (4 days.


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MANAGEMENT

Alost *49*-? o patients 8it! AMI die

due to arr!yt!ias, #> ailure and

+ardio"eni+ s!o+k. Hal o t!ese deat!s

o++ur in t!e irst (9) !ours ater onset o

syptos and 04914? in t!e irst )

!ours. %urt!er, t!e Tie 8indo8 or

sal2a"in" t!e is+!aei+ yo+ardiu atrisk o ne+rosis is a6out / !ours


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Re&er"*si!n

An o++ludin" t!ro6us is responsi6le or

yo+ardial inar+tion in alost 1-? o

patients. It is kno8n t!at t!e inar+tion is

+opleted ater se2eral !ours. An attepts!ould t!ereore 6e ade to reo2e t!e

o6stru+tion and a+!ie2e reperusion to re9

esta6lis! 6lood lo8 to t!e


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Cell in


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%or approiately *4 inutesater t!e

onset o e2en t!e ost se2ere is+!eia,

yo+ardial in


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T$ro!bol&tic agent%'2i;. streptokinase,

urokinase, a+etylated streptokinase, and

tPA. It a+!ie2es re+analisation in a6out

-4? o patients, re+analisation rates arereportedly !i"!er 0-?. A a


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All t!ro6olyti+ a"ents s!ould 6e "i2en 8it!in

9/ !ours ater t!e onset o +!est pain. Soe

o t!e +opli+ations t!at +an o++ur in+lude

reperusion arr!yt!ias and 6leedin".

T!ro6olysis is "enerally a2oided in patientsollo8in" re+ent operations, t!ose 8it! re+ent

+ere6ro2as+ular a++idents, t!ose 8!o !a2e

6leedin" diat!esis or ollo8in"+ardiopulonary resus+itation.


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T!ro6olyti+ a"ents !elp in redu+in"

s!ort9ter ortality and ipro2in" #>

un+tion. %ollo8in" t!ro6olyti+ t!erapy,intra2enous Herapin is "i2en or t!e net

)91 !ours to pre2ent reo++lusion..


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(TCA!as 6een used as a et!od o

reperusion 8it! a su++ess rate o 349

3-?.. It is a pro+edure o iense 2aluein patients 8it! +ardio"eni+ s!o+k, se2ere

#> ailure and lar"e anterior yo+ardial

inar+tion.


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I$DICATIO$S O% PTCA:

Coronary arterio"rap!y is indi+ated in (

patients 8it! +!roni+ sta6le an"ina

pe+toris 8!o are se2erely syptoati+despite edi+al t!erapy and 8!o are

6ein" +onsidered or re2as+ulari;ation,

i.e., a per+utaneous +oronary inter2entionPCI or +oronary artery 6ypass "ratin"

CA57


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patients 8it! trou6lesoe syptos t!at

present dia"nosti+ dii+ultiesin 8!o

t!ere is a need to +onir or rule out t!edia"nosis o IHD.


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Anastoosis o one or 6ot! o t!e internalaary arteries or a radial artery to t!e

+oronary artery distal to t!e o6stru+ti2e

lesion is +arried out. %or additionalo6stru+tions t!at +annot 6e 6ypassed 6y

an artery, a se+tion o a 2ein usually t!e

sap!enous is used to or a +onne+tion6et8een t!e aorta and t!e +oronary artery

distal to t!e o6stru+ti2e lesion.


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O++lusion o *eno)%"rats is o6ser2ed in(4)4? o patients durin" t!e irst

postoperati2e year, in approiately )?

per year durin" -9 to 09year . #on"9terpaten+y rates are +onsidera6ly !i"!er or

internal aary and radial artery

iplantations t!an sap!enous 2ein "rats


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Rupture o 2entri+le into peri+ardial sa+ +ausin"

+ardia+ taponade

Deep 2ein t!ro6osis in le"s +ausin"

pulonary e6olis

Peri+arditisdurin" assi2e inar+tion

Aneurys o 2entri+le 8it! t!ro6osis and

t!ro6o9e6oli+ p!enoenon

Dresslers syndroepost yo+ardial inar+tionsyndroe


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Dre%%ler+% %&nro!eo++urs a e8 days to/ 8eeks ollo8in" yo+ardial inar+tion

and is +!ara+terised 6y e2er,

Pleuroperi+arditis,


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In addition, patients 8it! asyptoati+is+!eia ater suerin" a yo+ardial

inar+tion are at "reater risk or a se+ond

+oronary e2ent. T!e 8idespread use oeer+ise EC7 durin" routine eainations

!as also identiied soe o t!ese

!eretoore unre+o"ni;ed patients 8it!asyptoati+ CAD

CHRO$IC IHD


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CHRO$IC IHD

Is+!ei+ Cardioyopat!y or Diuse

i6rosis in t!e yo+ardiu

+!ara+tersti+ally ound in elderly a"e"roup.CH% is "radually de2eloped

de+opensation o2er a period o years

GC!roni+ anaeia

SUDDEN CARDIAC DEATH AND


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SUDDEN CARDIAC DEATH AND

CARDIAC ARREST

It is estiated t!at in )4? or ore o

patients 8it! +oronary artery disease, t!e

irst presentin" eature ay 6e sudden

+ardia+ deat!, deined as deat! 8it!in e8inutes to ) !ours ater onset o

syptos. T!e usual +ause is 2entri+ular

i6rillation or +ardia+ asystole ando++asionally ele+troe+!ani+al

disso+iation.

Dierential Dia"nosis


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Dierential Dia"nosis

(. Peri+arditisHours to daysL ay 6eepisodi+ S!arpRetrosternal or to8ard

+ardia+ apeL ay radiate to let s!oulder

May 6e relie2ed 6y sittin" up and leanin"or8ard +ou"!, s8allo8in", lyin" in

letsided supine.

Peri+ardial ri+tion ru6


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Aorti+ disse+tion :A6ruptonset o

unrelentin" pain Tearin" or rippin"

sensationL knielikeAnterior +!est, otenradiatin" to 6a+k, 6et8een s!oulder

6lades.


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Pulonary e6olis:A6rupt onsetL

se2eral inutes to a e8 !ours Pleuriti+

Oten lateral, on t!e side o t!e e6olisDyspnea, ta+!ypnea, ta+!y+ardia, and

!ypotension, !aeoptysis.


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Esop!a"eal relu 9(4/4 in, 5urnin"Su6sternal, epi"astri+, orsened 6y

postprandial re+u6en+y.

Relie2ed 6y anta+ids. Esop!a"eal spas9 )*4 in ,Pressure,

ti"!tness, 6urnin" retrosternal, Can

+losely ii+ an"ina,


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Pepti+ ul+er9 Prolon"ed 5urnin"

Epi"astri+, su6sternal relie2ed 8it! ood or

anta+ids. A+id pepti+ disease: Early rn"

G a+id se+retions are not neutralised 6y

ood.


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Mus+uloskeletal disease9 >aria6le,A+!in"

o2eent

May 6e reprodu+ed 6y lo+ali;ed pressureon eainationG +!ondrosternal,

+osto+!ondral .


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Eotional and psy+!iatri+ +onditions

ti"!tness a+!in"L ay 6e leetin"

>aria6leL ay 6e retrosternal, Situationala+tors ay pre+ipitate syptos

Aniety or depression oten dete+ta6le

8it! +areul !istory

Pro"nosis


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Pro"nosis

Depends on:

(.$u6er o diseased 2essels

). De"ree o #> dysun+tion

MA$A7EME$T GADAPTATIO$


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MA$A7EME$T GADAPTATIO$

Myo+ardial is+!eia is +aused 6y adis+repan+y 6et8een t!e deand o t!e

!eart us+le or oy"en and t!e a6ility o

t!e +oronary +ir+ulation to eet t!isdeand. Most patients +an 6e !elped to

understand t!is +on+ept and utili;e it in

t!e rational pro"rain" o a+ti2ity.


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Many tasks t!at ordinarily e2oke an"inaay 6e a++oplis!ed 8it!out syptos

siply 6y redu+in" t!e speed at 8!i+!

t!ey are perored. Patients ustappre+iate t!e diurnal 2ariation in t!eir

toleran+e o +ertain a+ti2ities and s!ould

redu+e t!eir ener"y reFuireents in t!eornin", iediately ater eals, and in

+old or in+leent 8eat!er.

On o++asion it ay 6e ne+essary to


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On o++asion, it ay 6e ne+essary to

re+oend a +!an"e in eployent or

residen+e to a2oid p!ysi+al stress.Ho8e2er, 8it! t!e e+eption o anual

la6orers, ost patients 8it! IHD +an

+ontinue to un+tion erely 6y allo8in"ore tie to +oplete ea+! task. In

soe patients, an"er and rustration ay

6e t!e ost iportant a+tors

pre+ipitatin" yo+ardial is+!eia. I

t!ese +annot 6e a2oided, trainin" in

stress ana"eent ay 6e useul.


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A treadill eer+ise test to deterine t!e

approiate !eart rate at 8!i+! is+!ei+

EC7 +!an"es or syptos de2elop ay6e !elpul in t!e de2elopent o a spe+ii+

eer+ise pro"ra.

EKERCISES


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A re"ular pro"ra o isotoni+ eer+ise

Gus+les +ontra+t t!ere is o2eentt!at is 8it!in t!e liits o ea+! patients

t!res!old or t!e de2elopent o an"ina

pe+toris and does not e+eed 14? o t!e!eart rate asso+iated 8it! is+!eia on

eer+ise testin" s!ould 6e stron"ly

en+oura"ed.

A2oid Isoetri+ eer+isesGus+le

+ontra+t in+rease in tension 6ut does not

o2e

CO$C#&SIO$


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CO$C#&SIO$

C!est dis+oort is one o t!e ost

+oon +!allen"es or +lini+ians in t!e

oi+e or eer"en+y departent. T!edierential dia"nosis in+ludes +onditions

ae+tin" or"ans t!rou"!out t!e t!ora and

a6doen, 8it! pro"nosti+ ipli+ations t!at2ary ro 6eni"n to lie9t!reatenin".

% il t i t ti ll i


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%ailure to re+o"ni;e potentially serious

+onditions su+! as a+ute is+!ei+ !eart

disease, aorti+ disse+tion, tension

pneuot!ora, or pulonary e6olis

+an lead to serious +opli+ations,

in+ludin" deat!. Con2ersely, o2erly+onser2ati2e ana"eent o lo89risk

patients leads to unne+essary !ospital

adissions, tests, pro+edures, andaniety.

Hooeopat!i+ approa+!


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Hooeopat!i+ approa+!

P!ysiolo"i+al a+tion 6asis said 6y Dr.Ri+!ard Hu"!es:

A+onite: In all diseases o !eart

+!ara+terised 6y in+reased a+tion 8!enletside is +!iely

in2ol2ed.UG P!ysiolo"i+ally +ardia+

depressentG %ear, aniety, ental

restlessness

Dr. Clark:Rapidity o a+tion relie2ed

soeties so painul distressin" spas


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Arseni+: %or in+iden+e o +ardia+ +a+!ey.

$i"!ts are trou6led 6y oppression and

an"uis!.Dr. Clark: Ars.Iod: A+t on !eart us+le

arrestin" de"eneration restorin" 2itality.

Dr. 5oeri+k9 Sae +!ara+ter o


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pain as in An"inaU Ca+tus: Pain as i +onstri+ted 6y Iron

6andUG It is a stiulant on "an"lioni+

+entres in t!e +ardia+ 8alls.

Haeotoylon: Sense o +onstri+tion is+!ara+teristi+. Sensation as i 6ar lay

a+ross +!estU

#a+trode+tus. Ma+tans: Pi+ture o An"ina,+onstri+tion o +!est us+les.


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Hydro+yani+ a+id: Spasodi+

+onstri+tion ti"!tness in +!est, torturin"pain in +!est.

Ana+ardiu: Also !as 6and like

sensation.


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7lonine: $itro"ly+erineG palliati2e non

!ooeopat!i+ Ay.$itrosu:%or palliation in Coronary

spas.


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Ta6a+u: Pro2e t!e ost !ooeopat!i+dru" or An"ina pe+toris, Constri+tion o

!eart.G $ausea, 2oitin" ,deat! like pallor

Cap!or: As a !eart stiulant oreer"en+y use is ost satisa+tory

reedy.G +ollapse

>eratru: 5est !eart stiulant.


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I6eris:Posess ei+a+y in +ardia+diseases.akes at ) a 8it! palpitation.

Op!idia G$a


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Type A Personality: A""ressi2eness,

Copetiti2e dri2e, A6itiousness, Sense

o ur"en+y G risk a+tors odalities.En2ironental inluen+es. Helpul in

sele+tion o reedy.

5I5#IO7RAPH'


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5I5#IO7RAPH'

Tet6ook o pat!olo"y 6y Dr. Hars!o!an

API tet6ook o edi+ine

Harrisons Internal edi+ine.

Tet6ook o edi+al p!ysiolo"y 6y 7uyton

THAN,-U


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THA$'&

ISCHEMIC HEART DISEASE ppt.pptx

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