Mr Mohamed passing a hard time

acute plaque changes
1. haemorrhage
2. thrombus formation over plaque
  1. Pathogenesis of thrombos
    1. virchow's triad
      1. abnormal blood flow
        turbulent flow
        aneurysms
        stasis
        long flights
        bed ridden patients
      2. hypercoagulable state
        primary
        factor V leiden
        prothrombin mutations
        DIC
        oral contraceptives
      3. endothelial dysfunction
        hypertension
        atherosclerosis
        smoking
        increased homocysteine
Ischemic Heart Disease
1. types
  1. angina
    1. stable angina
      1. pain during exertion
        relieved by GTN or rest
      2. ST segment depression
      3. more than 70% stenosis of coronary artery
    2. unstable angina
      1. pain during rest and exertion
        not relieved by nitroglycerine
      2. ST segment depression
        subendocardial ischemia
      3. due to non occlusive thrombus formation on plaque
    3. prinzmetal angina
      1. spasm of coronary artery
      2. ST segment elevation
    4. treatment
      1. atenolol
        B-blocker
      2. Isosorbide dinitrate
        nitrates
      3. Aspirin
      4. Glyceryl trinitrate (GTN)
        vasodilators.
  2. myocardial infarction
    1. types
      1. STEMI
        100% stenosis
        transmural infarction
      2. NSTEMI
        incomplete occlusion
        subendocardial infarction
    2. Causes
      1. atherosclerotic vascular disease
      2. vasospasm
      3. vasculitis
      4. thromboembolism
    3. signs and symptoms
      1. dyspnea
      2. chest pain
      3. diaphoresis
      4. cardiac referred pain
        common sites
        neck, jaws, shoulders, arms, and stomach
        areas of the body surface which send sensory impulses to the same levels of the spinal cord that receive cardiac sensation
      5. cold sweats
    4. Investigations
      1. ECG
      2. blood tests
      3. Lipid profile.
      4. Cardiac biomarkers
    5. Complications
      1. <4 h
        cardiogenic shock
        CHF
      2. 4-24 h
        arrhythmias
      3. months
        dessler's syndrome
        ventricular aneurysm
        mural thrombus
      4. 1-3 D
        fibrinous pericarditis
      5. 4-7 D
        rupture of ventricular free wall
        rupture of papillary muscle
      6. shocks
        cardiogenic shock
        low blood perfusion to tissues resulting in cellular injury and inadequate tissue function
        signs
        Anxiety
        Distended jugular veins
        Cool, clammy and mottled skin
        types
    6. epidemilogy
      1. one of four deaths are attributed to heart attacks
    7. risk factors
      1. Age
      2. Diabetes
      3. Smoking
    8. Family history
      1. First concern are first and second degree relatives.
    9. Hypertension
    10. physical examination
      1. Jugular Venous Pressure (JVP)
        causes of high JVP
        Heart failure.
        Constrictive pericarditis
2. Management of IHD
  1. acute setting of MI
    1. STEMI
      1. Aspirin
      2. Morphine
      3. oxygen supplementation
      4. Reperfusion
        angioplasty
        done after doing angiography
        opens blocked arteries and restores normal blood flow
        thrombolytics
        re-establish perfusion following occlusion of an artery by thrombus
        MOA
        activate plasminogen
        Contraindications
        cerebral vascular lesion
        Suspected aortic dissection
        side effects
        bleeding
        drugs
        streptokinase
        obtained fromStreptococci
        alteplase
        Obtained by recombinant DNA technology
    2. NSTEMI
      1. antithrombotics
      2. ACE inhibitors
      3. nitrates
      4. B-blockers
  2. antianginal drugs
    1. nitrates
    2. B blockers
    3. CCBs
      1. for Variant angina
  3. Lifestyle modification
    1. diet
    2. smoking cessation
    3. physical activity
    4. alcohol intake reduction
    5. weight management
retrosternal pain
1. Gastrointestinal problems
2. respiratory problems
3. cardiac problems
causes of non compliance
1. complicated regimens
2. adverse events of medications
3. Literacy
4. poor doctor-patient relationship
support groups
1. Members with the same issues can come together for sharing coping strategies,

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Mr Mohamed passing a hard time

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	Created by Salma MK about 7 years ago