Platelet adhesion & aggregation and fibrin deposition

Precipitating Factors Preexisting conditions: Diabetes mellitus

Predisposing Factors Treatment: Lifestyle: Rest & modification Age: >45 years (61 y/o) Gender: MALE Family lifestyle history of CHD

Formation of atherosclerotic plaque in the Hypertension coronary artery Lifestyle: High-fat diet Blood volume circulated into the myocardial tissue will be decreased, causing ischemia Smoking Sedentary lifestyle

Signs & Symptoms: Chest pain that usually happens during work but relieved by rest Dx test: Coronary angiography ECG

Pharmacologic: Nitroglycerin Antiplatelets Antilipedemics Beta blockers Surgical: CABG PTCA Good prognosis Etiology: Atherosclerosis Plaque continues to form Thrombosis/embolism Coronary stenosis/spasm Complete occlusion of the coronary artery Platelet aggregation If treated

If NOT treated cholesterol Low HDL X-ray

O2 deprivation of myocardial tissueslevels ofin shifting from Increased results LDL cholesterol aerobic to anaerobic metabolism

Accumulation of free acid and Macrophages releaselacticradicals that decrease in LDL oxidize cellular pH

Acidosis causes the myocardium to become Exposure of to lysosomal effects within the vulnerable subendothelial tissue to blood components to conduction disorders cell, and leads& endothelial cell loss

67

If ischemia is longer than 45 minutes, irreversible myocardial cell damage & necrosis occurs

Signs & Symptoms:

Pharmacologic management: Thrombolytic therapy within 3 hours of onset to restore vessel patency & minimize necrosis Nitroglycerin to relieve chest pain Morphine to relieve pain Aspirin for platelet inhibition IV heparin to promote patency in affected artery Lidocaine, epinephrine combat dysrhythmias Medical-surgical management: PTCA CABG Stent insertion to

As myocardial cells necrose, intracellular enzymes will be released

Atypical chest pain unrelieved by rest & nitroglycerin Nausea & dizziness Shortness of breath/difficulty of breathing Unexplained anxiety, weakness or fatigue

ACUTE MYOCARDIAL INFARCTION

If treated

Palpitations, diaphoresis or paleness

Fair prognosis

Infarcted area may compromise ventricular contractile function

Dx test: Coronary angiography ECG Radionuclide imaging

Decreased cardiac output

Cardiac enzyme tests (Troponin I, CK-MB, LDH, Myoglobin, AST)

Blood that should be pumped into the systemic circulation back up into the left atrium and into the lungs
Signs & Symptoms: Dyspnea, orthopnea Fatigue Crackles, cough hemoptysis non-productive

Shifting of intravascular fluid into the interstitium of the lung & pulmonary edema occurs

LEFT-SIDED HEART FAILURE

68 If treated
A

If NOT treated
B

If NOT treated

B Signs & symptoms: Fever Bacteria will colonize in the fluid Alveoli will be inflamed

Pharmacologic management: O2 administration Loop diuretics Intravenous nitrates (glycerol nitrate) Digoxin ACE inhibitors Beta-blockers Morphine Lifestyle modification

Crackles; non-productive cough Dx tests: Sputum AFB Pharmacological management: Antipyretics Mucolytics O2 administration Antibacterial therapy

Lung consolidation

Alveolar collapse

Low O2 saturation & decreased tissue perfusion

Poor prognosis Fair prognosis DEATH

69

70