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IHD classification (WHPO):-

- 1. Acute blood flow arrest

- 2. Stenocardia

- 3. Myocardial infarction

- 4. Heart failure

- 5. Cardiac rhythm disorders

IHD clinical picture:-

- Angina pectoris: (chest pain on exertion, in cold weather or emotional situations)

- Acute chest pain: acute coronary syndrome, unstable angina or myocardial infarction("heart attack", severe chest pain unrelieved by rest associated with evidence of acute heart damage)

- Heart failure: (difficulty in breathing or swelling of the extremities due to weakness of the heart muscle)

IHD diagnostics:-

- ECG

- Echocardigraphy

- Coronarography

- Ventriculography

IHD treatment:-

- Non-invasive surgical treatment

- (could help to turn up the heart on working in conditions of decreased coronary circulation)

- Percutaneus coronary intervention (PCI) (balloon angioplasty or coronary stenting)

- Open heart operation

IHD invasive treatment:-

- The best revascularization – is full revascularization

Indications for IHD surgery treatment:-

- Both PCI and CABG are more effective than medical management at relieving symptoms Rihal C, Raco D, Gersh B, Yusuf S (2003)

- CABG is superior to PCI in multivessel coronary disease (SoS trial)

- Patients treated with CABG had lower rates of death and of death or myocardial infarction than treatment with a coronary stent

IHD surgery treatment:-

- Coronary-aortic bypass grafting (CABG)

- LIMA –to - LAD grafts

Indications for CABG:-

- Significant left main coronary artery stenosis.

- Left main equivalent: significant (70 %) stenosis of the proximal LAD and proximal left circumflex arteries.

- 3. Three-vessel disease.

- 4. Two-vessel disease with significant proximal LAD stenosis and either ejection fraction <0.50 or demonstrable ischemia on noninvasive testing.

- 5. One- or 2-vessel stenosis without significant proximal LAD stenosis, but with a large area of viable myocardium and high-risk criteria on noninvasive testing

-.

- 6. Disabling angina despite maximal noninvasive therapy, when surgery can be performed with acceptable risk.

2004 ACC/AHA CABG guidelines:-

- Disease of the left main coronary artery (LMCA)

- Disease of all three coronary vessels (LAD,LCX and RCA).

- Diffuse disease not amenable to treatment with a PCI.

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