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Chronic Ischemic Heart Disease PDF
Chronic Ischemic Heart Disease PDF
Angina Pectoris
Myocardial Infarction
Chronic Ischaemic Heart Disease
LEARNING OBJECTIVE
At the end of the lecture student will be able to
understand and describe the:
Angina pectoris
Acute coronary syndrome
Myocardial infarction
Infarct modification with time
Sudden cardiac death
Chronic Ischaemic Heart Disease
SYNDROMES of IHD
Depending on the degree & character of the coronary
obstruction dived into 4 syndromes
THROMBUS
• Total occlusion
• Partial
• Embolization
Thrombosis can give occlusion of vessel
VASOCONSTRICTION
• Circulating adrenergic agonists, i.e., α
• Platelet release products, e.g., ADP
• Endothelially released factors, such as endothelin
ANGINA PECTORIS
• Paroxysmal (sudden)
• Recurrent
•
• Reduced perfusion, but NO infarction
• THREE TYPES
– STABLE: relieved by rest or nitro
– PRINZMETAL: SPASM is main feature, responds to nitro, S-T
elevation
– UNSTABLE (crescendo, PRE-infarction, Q-wave angina): perhaps
some thrombosis, perhaps some non transmural necrosis, perhaps
some embolization, but DISRUPTION of PLAQUE is universally
agreed upon
MYOCARDIAL INFARCTION
• Transmural vs. Subendocardial (inner 1/3)þ
• DUH! EXACT SAME risk factors as atherosclerosis
• Most are TRANSMURAL, and MOST are caused by coronary artery
occlusion
• In the 10% of transmural MIs NOT associated with atherosclerosis:
– Vasospasm
– Emboli, e.g., mural thrombus
– UNexplained
MYOCARDIAL RESPONSE
PROGRESSION OF NECROSIS
Gross changes in
Myocardial Infarction
RE-PERFUSION
• Thrombolysis
• PTCA
• CABG
• REPERFUSION “INJURY”
– Free radicals
– Interleukins
AMI DIAGNOSIS
• SYMPTOMS
• EKG 1) Q-waves, 2) T-wave inversion, 3) ST-T elevation
• DIAPHORESIS
• (10% of MIs are “SILENT” with Q-waves)þ
• CKMB gold standard enzyme
• Troponin-I, Troponin-T better
• CRP predicts risk of AMI in angina patients
COMPLICATIONS
• Wall motion abnormalities
• Arrhythmias
• Rupture (4-5 days)
• Pericarditis
• RV infarction
• Infarct extension
• Mural thrombus
• Ventricular aneurysm
• Papillary muscle dysfunction (regurgitation)
• CH
END
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