GOVT BILASA GIRLS P G COLLEGE BILASPUR By

GOVT. BILASA GIRLS P. G. COLLEGE BILASPUR By Dr. Seema Mishra Department of Home Science

ISCHAEMIC HEART DISEASE Ischaemic heart disease also known as Myocardial ischaemia or coronary artery disease is a condition in which fatty deposits (atheroma) accumulate in the cells lining the wall of coronary arteries, these deposits build up gradually and irregularly in the large branches of the two main coronary arteries which encircle the heart and are the main source of its blood supply, this process is called Atherosclerosis which leads to narrowing or hardening of the blood vessels supplying blood to the heart muscles, this results Ischaemia (inability to provide adequate oxygen)to heart muscle and this can cause damage to heart muscle. complete occlusion of the blood vessels leads to Heart attack. (Myocardial infraction)

DEFINATIONS Hypercholesterolemia (literally: high blood cholesterol) is the presence of high levels of cholesterol in the blood. It is not a disease but a metabolic derangement that can be secondary to many diseases and can contribute to many forms of disease, most notably cardiovascular disease. It is closely related to the terms "hyperlipidemia" (elevated levels of lipids) and "hyperlipoproteinemia" (elevated levels of lipoproteins). Hypertriglyceridemia - In medicine, hypertriglyceridemia denotes high (hyper-) blood levels (-emia) of triglycerides, the most abundant fatty molecule in most organisms. It has been associated with atherosclerosis, even in the absence of hypercholesterolemia (high cholesterol levels). It can also lead to pancreatitis in excessive concentrations. Very high triglyceride levels may also interfere with blood tests; hyponatremia may be reported spuriously (pseudohyponatremia). A related term is "hyperglyceridemia" which refers to a high level of all glycerides, including monoglycerides, diglycerides and triglycerides.

EFFECT ON CORONARY ARTERY DUE TO HYPERCHOLESTROLEMIA AND HYPERTRIGLYCERIDEMIA

CUT SECTION

DEVELOPING OF IHD Hypercholesterolemia and hypertriglyceridemia are the one of major risk factors for developing IHD. How IHD is produced? Almost always due to atheroma and its complications, atheromatous plaques begin to appear in the 2 nd and 3 rd decade of life. The nature and composition of these plaques changes as they evolve. A mature fibrolipid plaque has a core of lipid, surrounded by smooth muscle cells and is separated from arterial lumen by a thick cap of collagen rich fibrous tissue. Such plaque may rapture or fissure allowing blood to enter and disrupt the arterial wall. This may compromise the lumen of the vessel and often precipitate thombosis and local vasospasm. Plaque rupture may lead to rapid growth of the lesion or occlusion of the vessel and is thought to be the cause of most acute coronary syndrome.

ROLE OF CHOLESTEROL & TRIGLYCERIDE IN THE DEVELOPMENT OF ATHEROSCLESROSIS Cholesterol & triglyceride are the main form of fat carried in the blood stream. Fats are water insoluble so can’t travel easily through blood, with the help of lipoprotein digested fat travel from liver is carried to various parts of body. FORMATION OF ATHEROMA Hyperlipidemia & excess of modified lipoprotein fraction Endothelial injury or destruction of arteries. In the intima oxidised LDL is formed , sticks to blood vessel Monocytes turns in to macrophages promote contraction of the vessels. Formtion of foam cells. Development of lipid pool. Smooth muscle proliferation, wall becomes thickened, hardened narrowing the lumen. Fatty streaks formed. Transitional plaque. Mature plaque. This cause stop the supply of blood & oxygen to heart which result ischaemic heart disease.

KINDS OF LIPOPROTEIN PRESENT IN BLOOD In blood fats are travel with the help of lipoprotein. There are 4 types of lipoprotein: Chylomicrons – They carry triglyceride, monoglyceride, glycerols, small amount of cholesterol & phospholipid. VLDL – Transport triglyceride but mainly endogenous triglyceride formed in liver. VLDL travels through blood vessels to unload fat throughout the body, empty VLDL becomes LDL – Main carrier of cholesterol, LDL pieces get stuck to blood vessels wall narrowing them. HDL – Reverse transport of cholesterol from tissue throughout the body back to the liver for excretion as biliary cholesterol.

DESIRABLE LIPID LEVELS IN BLOOD TOTAL CHOLESTEROL - < 200 mg/dl. HDL CHOLESTEROL - >40 mg/dl LDL CHOLESTEROL - <150 mg/dl VLDL CHOLESTEROL <40 mg/dl TRIGLYCERIDE <150 mg/dl TOTAL CHOLESTEROL = LDL+HDL+VLDL = TRIGLYCERIDE/5 LDL = TOTAL CHOLESTEROL-(VLDL+HDL) The risk of IHD increases slowly as serum cholesterol values rises from 200 to 250 mg/dl. Hypercholesterolemia occurs when cholesterol level exceeds 250 mg/dl. Hypertriglycerdemia occurs when its levels exceeds 200 mg/dl.

References www. wikipedia. org. www. wrongdiagnosis. com B. SHRILAXMI- DIET THERAPY