Internal Diseases · MU Plovdiv

21. Ischaemic Heart Disease.

Inside: 18 sections · 9 labelled pictures · 2 tables · 30 flashcards · 6 min

Topic 35 of 74 in the MU Plovdiv syllabus for Internal Diseases (Dental Medicine, Year 3). The free AceMed note covers it in 13 sections, about 610 words (6 min of reading), with 30 flashcards.

In this note

  1. Ischemic Heart Disease – Stable and Unstable Angina
  2. Definition
  3. Classification
  4. Etiology / Predisposition Factors
  5. Pathogenesis
  6. Symptoms
  7. Unstable Angina
  8. Physical Examination
  9. Laboratory Tests
  10. Instrumental Tests
  11. Ischemic Heart Disease – Myocardial Infarction
  12. Etiology & Pathogenesis
  13. Complications

Definition

  • Decreased blood flow to the heart muscle due to buildup of plaque in coronary arteries.

Classification

  • Stable angina
  • Unstable angina

Etiology / Predisposition Factors

  • Hypertension
  • Smoking
  • Diabetes
  • Obesity
  • Poor diet
  • High blood cholesterol
  • Lack of exercise
  • Depression, stress
  • Family history
  • Excessive alcohol consumption

Pathogenesis

  • Narrowing/obstruction of coronary artery lumen:
  • Atherosclerosis (main cause)
  • Thrombosis/embolism (rare)
  • Coronary artery spasm
  • Inflammation
  • Increased O2 demand:
  • Hypertrophy of myocardium
  • Tachycardia or tachyarrhythmia
  • Decreased cardiac output:
  • Aortic valve disease (aortic stenosis, regurgitation)

Symptoms

Stable Angina (Classic Angina)

  • Definition: Chest pain/discomfort that occurs during activity or emotional stress, most commonly due to coronary atherosclerosis.
  • Pathophysiology:
  • 70% coronary artery stenosis (narrowing).
  • At rest → blood flow is enough → no symptoms.
  • During exertion → increased O2 demand → inadequate blood supply → chest pain.
  • Symptoms
  • Pain, tightness, or discomfort in chest.
  • Often retrosternal, can radiate to:
  • Precordial area
  • Epigastrium
  • Back
  • Shoulder
  • Arm (especially last 2 fingers of left arm)
  • Jaw
  • Duration: ~20 minutes, subsides with rest.
  • Provoking factors:
  • Physical exercise
  • Emotional stress
  • Hypertension
  • Tachycardia or extreme bradycardia
  • Hypoglycemia
  • Cold weather (causes ↑ myocardial O2 demand)

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