ISCHEMIC HEART DISEASE

:Chest X-ray-1
often normal
coronary artery calcification
pulmonary venous hypertension following acute infarction (40%)
LV aneurysm
:ECHO-2
region of dilatation with disturbance of wall movement
Akinesis = no wall motion (1)
Hypokinesis = reduced wall motion (2)
Dyskinesis = paradoxical systolic expansion (3)
Asynchrony = disturbed temporal sequence of contraction (4)
Ischaemic Heart Disease
.There are two clinical syndromes associated with ischaemic heart diseases=
When the ischaemia is transient and reversible, the term 'angina pectoris' is used. =
=When ischaemia is irreversible and leads to necrosis, then 'myocardial infarction'
develops, healing by scar formation if the patient survives
Angina Pectoris
:Pathology
Angina pectoris is a clinical syndrome of periodic chest pain, usually of a crushing =
nature, often associated with characteristic radiation, typically to the left arm or jaw.
=Its hallmark is its onset in relationship to exercise, and its relief by rest or nitrates.
=Many patients, however, have pains triggered off by cold or emotion, or even
.occurring spontaneously
:Radiology
:Plain film-1
Angina pectoris itself has no plain radiographic manifestations, though evidence of =
.coronary artery disease or previous myocardial infarction may be seen
Angina pectoris with apparently completely normal coronary arteries is known as =
''Syndrome X
:Nuclear-2

-1-
Thallium-201 scintigraphy, done first on exercise (or drug stimulation) and then at =
.rest, may be helpful
A myocardial perfusion deficit present on exercise, but filling in at rest, points to =
.reversible ischaemia
.Thallium scintigraphy has proven less specific than was at first hoped=
Sestamibi (99mTc methoxyisobutyl-isonitrile) may be used in the acute phase of =
myocardial infarction to reveal perfusion deficits within the myocardium and their
.evolution over time
Positron emission tomography: using fluorinated glucose products is the definitive-3
investigation of myocardial viability is
.Coronary arteriography: The definitive investigation for angina -4
MYOCARDIAL INFARCTION
Incidence: 1,500,000 per year in United States resulting in 500,000 deaths (50%
occur in asymptomatic individuals
:Presentation
Atrioventricular block (common with inferior wall infarction as AV nodal branch =
originates from RCA)
Complete heart block has worse prognosis because it indicates a large area of =
infarction
:Radiology
:Chest X-ray -1
normal-sized heart (84 - 95%) in acute phase if previously normal
cardiomegaly: high incidence of congestive heart failure in anterior wall
infarction, multiple myocardial infarctions, double- and triple-vessel CAD, LV
aneurysm
CECT -2
perfusion defect within 60 - 90 seconds after bolus injection
delayed enhancement of infarcted tissue peaking at 10 - 15 minutes (due to
accumulation of iodine in ischemic cells), size of enhanced area correlates well with
size of infarct
Coronary Arteriography-3

-2-