944143 634377681641247500


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944143 634377681641247500

  1. 1. Prepared by:malek ahmad
  2. 2. Definition and epidemiologyAetiological factors and Risk factorsPathophysiologySign and symptomsInvestigationDifferential diagnosisTreatment and managementComplicationsPrognosis
  3. 3. Definition Irreversible necrosis of cardiac myocyte 20 to prolonged ischemic (extention of ACS ( unstable angina, NSTEMI)) Epidemiology 1.5 million cases of MI each year and CVD cause 12million deaths each year High risk among African American and white population in US Male predominance and premenopausal women are protected (E2) Incidence increases with age
  4. 4. Aetiological factors Risk factors Atheromatous plaque >  Non-modifiable  Age, Sex, FH cracked and ruptured >  Modifiable thrombus (occlusive or  Smoking and obestity partially)  DM, HPT,Dyslipidemia  Non atherosclerotic causes Coronary artery embolism  Vasculitis Congenital anomaly  Coronary embolism, trauma, spasm (histamine, serotonin) Coronary artery vasculitis  Drugs- coccaine  Congenital – kawasaki disease in  Factor increase O2 child requirement / decrease O2 supply Dissecting aneurysm w  Others coronary occlusion  Homocysteine  Peripheral vascular D  Stress
  5. 5.  Imbalance btwn O2 supply and O2 demand > Cellular ischemia Atherosclerotic causes:  Stable angina- fixed narrowing, thus arterial lumen must reduced by 90% -cellular ischemia at rest, 50%- exercise  Unstable angina- fissuring of AP > platelet accumulation > transient thrombotic occlusion > platelet release VasoC factors (TXA2n serotonin) + endothelial dysfunction> compromise flow Perfusion must be restored w/in 40-60m, or lead to irreversible injury due to severe ATP depletion > increased extracellular ca conc, lactic acidosis and free radical
  6. 6. Symptoms Signs Chest pain  Sign of hyperlipedemia  Site- central and substernal  Evidence of DM, TD, Gout,  Onset-sudden/exertion tar stained  Character- tight, compress, squeez, ache, burn, sharp  Bradycardia- CO,  Radiation- left arm n neck*back arrhythmia  Associated w  BP  Timing- over 20 mins  LGF  Exacerbate n relieve- exertion n GTN  Normal JVP, JVP- HF SOB-ischemia> EDP / systolic  4th heart sound, 3rd – HF and diastolic dysF > pulmonary  Pericardial friction rub P  MR/ VSD Sweating, palpitation, fatigue , N, V (sympathetic overdrive)  Bibasal crackles Risk factors assesment
  7. 7. Blood Imaging • Troponin T(s:3- • Full thickness MI- ant n inf lead> 12h)(p:24-48h) STE, T wave inversion and +QwaveCardiac (r:5-14d) ECG • Subendocardial MI- ST and T wave change, no Q waveenzyme • CK-MB (s:3-12h) • Post MI- no Q wave, tall R wave in VI (p:24h) (r:2-3d) • RV + inf infarct-STE in V3 n V4 • Urine myoglobin • Heart size, +- CHF +- pulmonary edema FBC • Anemia, leukocytosis CXR • Concomitant disease • Exclude DD • Chemistry profile: • Extent of infarction creatinine ECHO • Assess complication- MR, pericardialothers • Lipid profile effusion, LV rupture • CRP-inflamation marker Cardiac cathetherization
  8. 8. Anxiety disordersAortic dissection / Aortic sternosischolecystitisEsophageal spasm, esophangitis, GERDMyocarditis, pericarditisPneumothorax, pulmonary embolism
  9. 9. Medical care Surgical care Others• Tx based on: • Percutaneous • Diet control i- Restore balance coronary • Minimize activity ii-Pain relief- intervention- • Consultation opiates and STEMI, cardiogenic • Coronary antiemetics shock, whom rehabilitation iii-Prevent and Tx thrombolysis of Cx failed, high • Health education• Thrombolysis- bleeding tendency • Exercise stress test aspirin, alteplase, • Urgent coronary streptokinase artery graft• Nitrates bypass- whom• B-blockade angioplasty failed, patient with• ACE inhibitors mechanical• Anticoagulant- complication-VSD, heparin LV, PM rupture
  10. 10. SupraV Arrhythmias- arrhythmia, Sinus VF +- VTachy heart block brady/tachy, AF, A tachy CHF- systolic / Recurrent Cardiogenic diastolic ischemia shock dysfuntion Acute MR- Pericarditis, Ventricularinferopost MI due ventricular rupture at IVS/ to ischemia, aneurysm, mural LV free wallnecrosis, rupture thrombi, HPT
  11. 11. 5-10% survivor die within 1st year after MI AMI- Half of allassociated w patients w MI 30% of rehospitalizedmortality rate within 1 year Variable n depend to extent of infarct, residual LV function, revascularization