Ischemic Heart Disease

Epidemiology
1. Developed western world
2. Risk factors
  1. Hypertension
  2. Hyperlipidemia
  3. Smoking
  4. Diabetes
  5. Age
  6. Male sex
  7. Other
    Anotações:
    - Sedentary lifestyle, obesity, oral contraceptives, type A personality /perfectionist/, stress
Myocardial infarction
1. Pathogenesis
  1. Coronary artery thrombosis
  2. Myocardial necrosis
    Anotações:
    - 20 to 30 minutes after vessel occlusion
2. Morphology
  1. Gross
    1. 0-12 hrs no change
    2. 18-24 hrs slight pallor
    3. 24-72 hrs pallor
    4. 4-7 days hyperemic rim
    5. 10 days yellow, soft, shrunken
    6. 7 weeks firm pale scar
  2. Histology
    1. 4-12 hrs early coagulative necrosis
    2. 18-24 hrs neutrophil infiltrate
    3. 24-72 hrs complete coagulative necrosis and heavy neutrophile infiltrate
    4. 4-7 days macrophages and early granulation tissue
    5. 10 days prominent granulation tissue
    6. 7 weeks fibrosis
3. Clinical features
  1. Severe, crushing, central chest pain
  2. Lasts for hours
  3. Not relieved by nitroglycerine
  4. Silent - elderly, diabetes mellitus
4. Diagnosis
  1. ECG changes
    1. Q waves
    2. ST segment abnormalities
    3. T wave inversion
  2. Lab evaluation
    1. CK-MB 2 to 4 hrs, peak 18 hrs
    2. Lactate Dehydrogenase 24 hrs, peak 72 hrs
    3. Troponins (T and I)
5. Complications
  1. Sudden death
  2. Cardiac arrhythmias
  3. Left ventricular failure
  4. Cardiogenic shock
  5. Rupture of free wall, septum, pappilary muscle
  6. Thromboembolism
  7. Dressler's syndrome
    Anotações:
    - weeks-few months later pericarditis
Pathogenesis
1. >75% coronary artery stenosis
2. Changes in plaque morphology
  1. Fissuring
  2. Hemorrhage
  3. Plaque ruptures
3. Coronary artery thrombosis
4. Coronary artery vasospasm
5. Occlusion of lumen- emboli, vasculitis, dissection
Angina pectoris
1. Stable angina
  1. Clinical features
    1. Episodic chest pain
    2. Associated with exertion
    3. Relieved by rest
  2. Pathogenesis
    1. Fixed atherosclerotic narrowing
    2. Inadequate myocardial oxygen supply
  3. Treatment
    1. Reduce demand - rest
    2. Vasodilator
2. Unstable angina
  1. Clinical features
    1. Increased attack frequency
    2. Increased attack intensity
    3. Precipitated by less exertion
  2. Pathogenesis
    1. Acute plaque change
3. Prinzmetal angina
  1. Clinical features
    1. Pain at rest
  2. Pathogenesis
    1. Coronary artery spasm
Sudden death
1. Arrhythmia
2. Ruptured infarct (Cardiac tamponade)
Chronic ischemic heart disease
1. Clinical features
  1. Progressive congestive heart failure
  2. Arrhythmias
2. Morphology
  1. Moderate to severe coronary artery disease
  2. Heart enlarged
  3. Multiple areas of myocardial fibrosis

Próximo

Descrição

Resumo de Recurso

Semelhante

	Criado por Bayarmaa Purevdorj quase 9 anos atrás