Pathology - Ischemic Heart Disease
Pathophysiology This disease is characterized by ischemia, or a decreased blood supply, which is typically brought on by coronary artery atherosclerosis. Growing older, smoking, having high blood pressure, diabetes, and having high cholesterol are risk factors. The lumen of the channel narrows in coronary arteries due to the development of fat-rich plaques in the vessel walls. With time, this narrowing may get to the point that oxygen-rich blood is unable to get to the heart's tissues, leading to ischemia and, eventually, myocardial tissue infarction, or death. On the other hand, acute vessel obstruction can result from vessel plaques that "rupture," discharging fatty contents into coronary channels. The patient in the vignette had coronary artery bypass grafting (CABG) to open up a patent, unobstructed coronary blood channel. Although the right coronary artery distribution on his ECG displays signs of an infarction (Q waves in inferior leads), the chamber wall movement of his echocardiography appears normal, indicating that either the damage is not severe or is offset by surrounding myocardial tissue. This conclusion is supported by a normal cardiac ejection fraction. His ECG shows indications of LV hypertrophy, which is most likely the result of chronic hypertension. It shows the deepest S wave in leads V1 or V2 and the greatest R wave in leads V5 or V6, both of which equal more than 35 mm. His prescriptions include aspirin for antiplatelet therapy, metoprolol as a beta-blocker, lisinopril as an ACE inhibitor, and simvastatin as an HMG-CoA reductase inhibitor. In individuals with a history of myocardial ischemia, each of these drugs has been shown to be beneficial in preventing further cardiovascular events.
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