Zusammenfassung der Ressource
Ischemic Heart Disease
- Epidemiology
- Developed western world
- Risk factors
- Hypertension
- Hyperlipidemia
- Smoking
- Diabetes
- Age
- Male sex
- Other
Anmerkungen:
- Sedentary lifestyle, obesity, oral contraceptives, type A personality /perfectionist/, stress
- Myocardial infarction
- Pathogenesis
- Coronary artery thrombosis
- Myocardial necrosis
Anmerkungen:
- 20 to 30 minutes after vessel occlusion
- Morphology
- Gross
- 0-12 hrs no change
- 18-24 hrs slight pallor
- 24-72 hrs pallor
- 4-7 days hyperemic rim
- 10 days yellow, soft, shrunken
- 7 weeks firm pale scar
- Histology
- 4-12 hrs early coagulative necrosis
- 18-24 hrs neutrophil infiltrate
- 24-72 hrs complete coagulative necrosis and heavy neutrophile infiltrate
- 4-7 days macrophages and early granulation tissue
- 10 days prominent granulation tissue
- 7 weeks fibrosis
- Clinical features
- Severe, crushing, central chest pain
- Lasts for hours
- Not relieved by nitroglycerine
- Silent - elderly, diabetes mellitus
- Diagnosis
- ECG changes
- Q waves
- ST segment abnormalities
- T wave inversion
- Lab evaluation
- CK-MB 2 to 4 hrs, peak 18 hrs
- Lactate Dehydrogenase 24 hrs, peak 72 hrs
- Troponins (T and I)
- Complications
- Sudden death
- Cardiac arrhythmias
- Left ventricular failure
- Cardiogenic shock
- Rupture of free wall, septum,
pappilary muscle
- Thromboembolism
- Dressler's syndrome
Anmerkungen:
- weeks-few months later pericarditis
- Pathogenesis
- >75% coronary artery stenosis
- Changes in plaque morphology
- Fissuring
- Hemorrhage
- Plaque ruptures
- Coronary artery thrombosis
- Coronary artery vasospasm
- Occlusion of lumen- emboli, vasculitis, dissection
- Angina pectoris
- Stable angina
- Clinical features
- Episodic chest pain
- Associated with exertion
- Relieved by rest
- Pathogenesis
- Fixed atherosclerotic narrowing
- Inadequate myocardial oxygen supply
- Treatment
- Reduce demand - rest
- Vasodilator
- Unstable angina
- Clinical features
- Increased attack frequency
- Increased attack intensity
- Precipitated by less exertion
- Pathogenesis
- Acute plaque change
- Prinzmetal angina
- Clinical features
- Pain at rest
- Pathogenesis
- Coronary artery spasm
- Sudden death
- Arrhythmia
- Ruptured infarct (Cardiac tamponade)
- Chronic ischemic heart disease
- Clinical features
- Progressive congestive heart failure
- Arrhythmias
- Morphology
- Moderate to severe coronary artery disease
- Heart enlarged
- Multiple areas of myocardial fibrosis