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Cardiac disease
 

Cardiac disease

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    Cardiac disease Cardiac disease Presentation Transcript

    • CARDIAC DISEASE CLINICAL BIOCHEMISTRY
    •  
    • Learning Objectives
      • Explain the etiology of Myocardial infarction (MI).
      • List out the symptoms of MI.
      • Elaborate the tests to investigate the disease.
    • Myocardial Infarction
      • Heart attack= MI= death of heart muscle from the sudden blockage of a coronary artery by blood clot
      • Blockage; injury; chest pain & pressure; muscle death; scar tissue.
    •  
    •  
    •  
    • Etiology
      • Atherosclerosis with occlusive or partially occlusive thrombus formation
    •  
    • Symptoms of MI
      • 1) Chest pain
      • Squeezing, aching, burning or sharp pain
      • More than 30 min: infarction
      • Associated with nausea, vomiting, dyspnea,
      • fatigue or palpitations
      • Atypical chest pain common in diabetes and
      • elderly patients
      • 2) Shortness of breath
      • Anginal equivalent or symptom of heart failure
      • Due to elevated end-diastolic pressure; lead to elevated pulmonary pressure
      • 3) Atypical presentations
      • Common and lead to misdiagnoses
      • Abdominal discomfort or jaw pain may present
      • Elderly patient may present with altered mental status
      • Women present more common atypical symptoms
    • Physical Examination of MI
      • Low grade fever
      • Hypo or hypertension
      • 4 th heart sound (S4) may be heard
      • Dyskinetic cardiac bulge
      • Systolic murmur can be heard
      • Cool, clammy skin and diaphoresis
      • Signs of CHF
    • Risk Factors
      • 1) Non modifiable risk factors
      • Family history of premature coronary heart disease
      • 2) Modifiable risk factors
      • Smoking
      • Diabetes mellitus
      • Hypertension
      • Dyslipidemia
      • Obesity
      • Sedentary life
      • Psychosocial stress
      • Poor oral hygiene
      • 3) Non atherosclerotic causes
      • Vasculitis
      • Coronary emboli
      • Congenital coronary anomalies
      • Coronary trauma
      • Coronary spasm
      • Drugs
      • Factors that increase O2 requirement & decrease O2 delivery
    • Lab Investigation
      • Cardiac enzymes
      • Troponin levels
      • Myoglobin levels
      • Lipid profile
      • ECG
    • Cardiac Enzymes
      • Creatine kinase: 3 isoenzymes
      • CK-MB: mainly in heart
      • Serial measurement of CK-MB for diagnosis MI
      • CK-MB: increase within 3-12 hours of onset, peak values within 24 hours, return baseline after 48-72 hours
      • High sensitivity & specificity (but not as high as Trop T)
    • Troponin
      • Greater sensitivity & specificity
      • Role in diagnostic and prognostic
      • Positive troponin levels virtually diagnostic of MI
      • Trop T: increase within 3-12 hours from onset, peak at 24-48 hours, return baseline over 5-14 days
    • Myoglobin
      • Urine myoglobin: rise within 1-4 hours from onset
      • High sensitive but not specific
      • Useful in early detection of MI in the ED
    •  
    •  
    • Treatment of MI
      • Restoration balance between oxygen supply and demand
      • Pain relief
      • Prevent and treat complications
    • QUESTIONS :
      • Discuss in a group;
      • (1) Information about Myocardial infarction.
      • Discussion must include the etiology, symptoms, physical examination and risk factor.
      • (2) Elaborate the tests to investigate the disease.
    • Thank You