Embed Size (px)
Citation preview
Cardiology [email protected] 3
Etilogy- Most ischaemic heart disease is
caused by atherosclerosis of the coronary artereries.
- Initially there is sudden sever narrowing or closure of large coronary arteries and\ or narrowing of coronary artery end branches.
- Covering plaques.........
Cardiology [email protected] 4
Risk FactorsRisk Factors1- age.2- Gender.3- Serum cholesterol: VLDL....LDL...HDL.4- Hypertension; endothelial damage.5- Cigarate smoking; nicotine-----catecholamine-----
epinephrine-----endothelial damage----lipolysis.
6- Diabetes; disturbed lipid metabolism.
Cardiology [email protected] 5
Minor risk factors1- Hypothyrodism.2- obesity.3- Sedentary life.4-Intellectual professional.5- Contraceptive pills.
Cardiology [email protected] 6
Clinical ConsequencesClinical Consequences
A- Angina PectorisDef. Clinical syndrome characterized by
attack of pain due to ischaemia of the heart muscle, generally due to obstruction or spasm of coronary arteries.
Cardiology [email protected] 7
TypesTypes1- Stable: occurs under similar circumstances,
and with similar frequency over time.2- Un-stable:- Recent onset.- Increased severity and frequency .- Angina at rest or with minimal exertion.3- Variant:- At rest. - Spasm of coronary artery. -Not
precipitated by increase myocardial 02 demand
Cardiology [email protected] 8
Clinical PictureI.I. Pain:Pain:- Site- Radiation.- Character: burning..suffocation. stop all activities.- Precipitation:- Relief.- Duration.
Cardiology [email protected] 9
- Associated Symptoms: Dyspnea . Palpitation. Dizzness.
Fainting.Sweating.
Cardiology [email protected] 10
Clinical Picture:- Sings and symptoms: Pallor...tachycardia....hypertension.Investigation:- ECG: normal in 50%.- Stress ECG: Depression of st segment.
Ventricular Arrhythmias.- Cardiac Catheterization : arteriography.- Echocardiography: regional wall abnor. Ex
and rest.Cardiology [email protected] 11
TherapyTherapyAiming for :- Decrease myocardial oxygen demand.- Increase myocardial o2 supply.I. Medical Treatment:- Nitrates. Vosodilat.... Myo.02 sup- overload.... Myo o2 deman- Beta bolckers: - Calcium channel blockers- Antiplatelets: reduce incidence of MI
Cardiology [email protected] 12
II. Surgery:III. Preventive:1- Avoid precipitating factors.2- Control Risk factors.N.B . During Attack
Cardiology [email protected] 13
Myocardial InfarctionMyocardial InfarctionDef. Def. It is a medical condition that occurs
when the blood supply to the heart is interrupted , and the myocardium is deprived of its blood supply ‘” therefore oxygen “’ for a significant amount of time.
Pathogenesis:- Formation of occlusive thrombus at the
site of rupture or erosion of atherosclerotic plaques in coronary artery.
Cardiology [email protected] 14
Clinical Picture:Clinical Picture:A.A.Symptoms:Symptoms:- Prolonged cardiac pain:- Anxiety - Nausea . Vomiting- Breathlessness.- Syncope: Silent MI......elder....arrythmias
Cardiology [email protected] 15
II.SignsII.Signs::- Signs of sympathatic activities: pallor, sweating, tachycardia- Signs of vagal activation: vomiting...bradycardia.- Signs of impaired myocardial
function: hypotension.Narrow pulse pressure.- Signs of tissue damage. fever
Cardiology [email protected] 16
InvestigationInvestigation1) ECG:-- Early - Late: - Advanced : 2) Blood test:- Cardiac enzymes: Cardiospecific isoform of CK :CK- MB Troponin T and I
Cardiology [email protected] 17
TherapyA- Immediate Therapy: - High flow oxygen.- Aspirin 300 mg.- ECG monitoring.B) Acute perfusion therapy:1- Thrombolysis:Help restore coronary potency.Preserve ventricular function.Improve survival.Cardiology [email protected] 19
2) Primary percutaneous coronary intervension:
C) Adjunctive Therapy:- Beta blockers relief pain ------reduce
arrythmias.- Nitrates: Nitroglycerin:
Cardiology [email protected] 20
Cardiology [email protected] 21
