ischaemic heart disease
DESCRIPTION
. Ischaemic Heart Disease. 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. Risk Factors. 1- age. - PowerPoint PPT PresentationTRANSCRIPT
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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.........
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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.
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Minor risk factors1- Hypothyrodism.2- obesity.3- Sedentary life.4-Intellectual professional.5- Contraceptive pills.
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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.
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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
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Clinical PictureI.I. Pain:Pain:- Site- Radiation.- Character: burning..suffocation. stop all activities.- Precipitation:- Relief.- Duration.
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- Associated Symptoms: Dyspnea . Palpitation. Dizzness.
Fainting.Sweating.
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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
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II. Surgery:III. Preventive:1- Avoid precipitating factors.2- Control Risk factors.N.B . During Attack
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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.
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Clinical Picture:Clinical Picture:A.A.Symptoms:Symptoms:- Prolonged cardiac pain:- Anxiety - Nausea . Vomiting- Breathlessness.- Syncope: Silent MI......elder....arrythmias
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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
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InvestigationInvestigation1) ECG:-- Early - Late: - Advanced : 2) Blood test:- Cardiac enzymes: Cardiospecific isoform of CK :CK- MB Troponin T and I
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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:
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