This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Atherosclerosis – the most important etiologic factor
PPathogenetic events, and clinical complications of athogenetic events, and clinical complications of atherosclerosis in the coronary arteriesatherosclerosis in the coronary arteries
Myocardium becomes ischemic within 10 Myocardium becomes ischemic within 10 d f l id f l iseconds of coronary occlusionseconds of coronary occlusion
Working Working cells remain viable for up to 20 cells remain viable for up to 20 minutesminutes–– Anaerobic mechanisms kick inAnaerobic mechanisms kick in
Lactic acidLactic acidLactic acidLactic acid
Free radical damage, especially after reperfusionFree radical damage, especially after reperfusion
3/4/2015
5
Ischemic episodeIschemic episode
SeveritySeverity
DurationDuration
FrequencyFrequency
Pain
Ischemia
CAD classificationCAD classificationStable anginaStable anginaU t bl iU t bl iUnstable anginaUnstable anginaAtypical anginaAtypical angina (Prinzmetal)(Prinzmetal)Myocardial infarctionMyocardial infarctionAtherosclerotic Atherosclerotic myocardiosclerosismyocardiosclerosismyocardiosclerosismyocardiosclerosisSilent ischemiaSilent ischemiaSudden cardiac deathSudden cardiac death
3/4/2015
6
Stable anginaStable angina
Chest pain with exertionChest pain with exertionpp
May radiate, may have diaphoresis, SOB, pallorMay radiate, may have diaphoresis, SOB, pallor
Relief with rest or nitratesRelief with rest or nitrates
Increased О2
demand
Decreased О2
delivery
Morphological substrateMorphological substrate
3/4/2015
7
Treatment for Stable AnginaTreatment for Stable Angina
Invasive, but nonsurgical technique to Invasive, but nonsurgical technique to reduce frequency and severity of chest reduce frequency and severity of chest discomfortdiscomfort May also be used during evolving MIMay also be used during evolving MI
Procedure performed under fluoroscopic Procedure performed under fluoroscopic guidance in cardiac cath labguidance in cardiac cath labguidance in cardiac cath labguidance in cardiac cath lab Balloon inflation may be repeated until lesion is Balloon inflation may be repeated until lesion is
reduced or eliminatedreduced or eliminated
Stents may be placed at time of procedureStents may be placed at time of procedure
Most common cardiac surgeryMost common cardiac surgeryIndicated for patients who do not respond to Indicated for patients who do not respond to medical management of CAD or when disease medical management of CAD or when disease progression is evidentprogression is evidentTo be bypassed vessels should have proximal To be bypassed vessels should have proximal lesions with > 70% occlusionlesions with > 70% occlusionMost effective when good ventricular functionMost effective when good ventricular functionMost effective when good ventricular function Most effective when good ventricular function remains and ejection fraction is more than 40remains and ejection fraction is more than 40--50%50%Requires Cardiopulmonary bypass during Requires Cardiopulmonary bypass during surgerysurgery
Post infarction anginaPost infarction angina (20(20--30 %)30 %)
3/4/2015
15
PrognosisPrognosis of MIof MI
Acute MI is associated with a Acute MI is associated with a 30% mortality rate30% mortality rate; half of ; half of the deaths occur prior to arrival at the hospital.the deaths occur prior to arrival at the hospital.p pp p
An additional An additional 55--10%10% of survivors of survivors die within the first yeardie within the first yearafter their MI.after their MI.
Approximately Approximately half of all patientshalf of all patients with an MI are with an MI are rehospitalized within 1 yearrehospitalized within 1 year of their index event.of their index event.
Overall, Overall, prognosis is highly variableprognosis is highly variable and depends largely and depends largely on the extent of the infarct, the residual LV function, and on the extent of the infarct, the residual LV function, and whether the patient underwent revascularization.whether the patient underwent revascularization.
Screening of different forms Screening of different forms of CADof CAD
Stress testStress test CoronaryCoronaryangiographyangiography
ElectroElectro--cardiogramcardiogram
3/4/2015
16
ARTERIAL HYPERTENSIONARTERIAL HYPERTENSION
Blood pressure levels*Blood pressure levels*
SystolicSystolic DiastolicDiastolic LevelLevel
120120 8080 OptimalOptimal
< 130< 130 < 85< 85 NormalNormal
130130--139139 8585-- 8989 Normal borderlineNormal borderline
Coarctation of aortaPolyarteritis nodosa (or other vasculitis)Increased intravascular volumeIncreased cardiac outputRigidity of the aortaNeurologic (Psychogenic)Increased intracranial pressureSleep apneaAdrenocortical hyperfunction