Mi cad


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Mi cad

  1. 1. ARTERIOSCLEROSIS – ATHEROSCLEROSIS – A general hardening of the arteries A a specific type of arteriosclerosis, refers to the accumulation of lipid in the walls of the arteries, gradually leading to an arteriosclerotic condition or a reduced blood flow
  2. 2. ATHerosclerosis <ul><li>Accumulation of plaque--progressively narrowing artery </li></ul><ul><li>Significant ‘lesions’ </li></ul><ul><ul><li>ischemia and LV dysfunction, </li></ul></ul><ul><li>Typical sites </li></ul><ul><ul><li>Lining of the coronary artery </li></ul></ul><ul><ul><li>Abrupt curvature or branching </li></ul></ul><ul><li>Active (unstable) or quiet (stable) </li></ul><ul><ul><li>unstable  fissure, rupture, and/or swell </li></ul></ul><ul><ul><li>cascade of events sudden/complete obstruction= MI </li></ul></ul>
  4. 5. Mycardial Infarction <ul><li>More than 1.5 million Americans have an MI each year </li></ul><ul><ul><li>Approximately 500,000 or 1/3 die </li></ul></ul><ul><li>Chance of event can be reduced </li></ul><ul><ul><li>Reduction/control of Risk Factors </li></ul></ul><ul><ul><li>Decreased total and LDL cholesterol  reduce plaque instability </li></ul></ul><ul><ul><li>Prolonged ischemia (>60 min) </li></ul></ul>
  5. 6. Disease Onset Different in Different populations and Related to Combination of Risk Factors <ul><li>Family History </li></ul><ul><li>Sex </li></ul><ul><li>Age </li></ul><ul><li>Hypertension </li></ul><ul><li>Hyperlipidemia </li></ul><ul><li>Smoking </li></ul><ul><li>Diabetes </li></ul><ul><li>Obesity </li></ul><ul><li>Physical Inactivity </li></ul>
  6. 7. PRIMARY ARTERIES & END ORGANS Heart Coronary Arteries Kidney Renal Arteries Brain Cerebral Arteries Legs Femoral & Abdominal Arteries
  7. 8. NATURAL HISTORY OF ATHEROSCLEROSIS Clean Artery Fatty Steaks Fibrous Plaque Clinical Lesion
  8. 9. Anatomy of Artery www.lef.org/magazine/mag2005
  10. 11. SUPPLY & DEMAND Supply of Blood To do the Work
  11. 12. Triad of Signs/Symptoms <ul><li>Burning </li></ul><ul><li>Pressure </li></ul><ul><li>Discomfort </li></ul><ul><li>Radiating down the left arm </li></ul>MI Signs/Symptoms 1) Severe, prolonged chest pain/pressure—radiate to the arms, back, neck, associated w/ sweating, nausea, or vomiting. 2) increased serum levels of cardiac enzymes:CK; CPK toponin 3) ECG changes in the leads overlying the area of infarction
  12. 13. DIFFERENCE BETWEEN ANGINA AND INFARCT ANGINA INFARCT Similar Symptoms < 15 min > 15 min Relieved by Nitro Not relieved by Nitro Relieved by Rest Not relieved by Rest
  13. 14. SUPPLY & DEMAND <ul><li>Prolonged ischemia (>60 min) </li></ul><ul><ul><li>irreversible cellular damage </li></ul></ul><ul><ul><li>muscle death </li></ul></ul><ul><ul><li>Necrosis  acute MI </li></ul></ul>
  14. 15. 2 Types of infarctions <ul><li>Transmural </li></ul><ul><ul><li>full thickness of ventricular wall </li></ul></ul><ul><li>Subendocarial </li></ul><ul><ul><li>limited to inner half of the myocardium </li></ul></ul><ul><li>Impact of mortality </li></ul><ul><ul><li>Left Ventricular damage  ejection fraction </li></ul></ul><ul><ul><li>Level of ischemia </li></ul></ul>
  15. 16. Exercise Impact <ul><li>Subnormal aerobic capacity (50-70% of predicated) </li></ul><ul><li>Reduced O2 transport is primarily due to diminished cardiac output </li></ul><ul><ul><li>decreased contractile, ejection fraction and SV </li></ul></ul><ul><li>Increased anginal symptoms </li></ul><ul><li>Chance of exercise-induced ventricular arrhythmias </li></ul>
  16. 17. Benefits of Exercise <ul><li>increased max O2 consumption (~20%) </li></ul><ul><li>improvement in Ve </li></ul><ul><li>reduce symptoms angina/HR/ BP </li></ul><ul><li>increased HR variability </li></ul><ul><li>decrease in weight, fat, BP, LDL </li></ul><ul><li>increase in HDL </li></ul><ul><li>improved psycho </li></ul>
  17. 18. EXERCISE EFFECTIVENESS <ul><li>Physical Work Capacity </li></ul><ul><li> Angina Threshold </li></ul><ul><ul><li> Claudication Thresholdz </li></ul></ul><ul><li> Secondary Event (20%) </li></ul><ul><ul><li> Survival from Secondary Event (20%) </li></ul></ul>
  18. 19. Assessment Flow-Mediated Dilation Pre
  19. 20. Fasting Four Hours after a High-Fat Meal 8-10% 4-5% Pre Pre Pre
  20. 21. Impact of Exercise Flow-Mediated Dilation = 8% Pre Pre Post 4.1 mm 4.7 mm
  21. 22. Faulx, et al, American Heart Journal 145:943-951, 2003 Iiyama, et al. American Heart Journal 132:779-782, 1996 Hashimoto, et al. International Journal of Obesity: Relar Metab D isord 22:477-484, 1998. Caballero, A.E., Obesity Research 11:1278-1289, 2003. Celermajer,et al. J Am Coll Cardiol 24:471-476, 1994.
  22. 23. Tsai, et al. Clinical Science 106:315-319, 2004 Anderson, et al, Atherosclerosis 154:475-483, 2001 Ceriello, et al, Circulation 106:1211-1218, 2002
  23. 24. Hamby et al, Diabetes Care 26:2119-2125, 2003 Watts, et al, Journal Pediatrics 144:620-625, 2004 Walsh, et al, JAP 95:20-25, 2003 EXERCISE IMPROVES ENDOTHELIAL FUNCTION
  24. 25. Overweight Men Lee et al, Am J Clin Nutr 69:373-380, 1999
  25. 26. -May take one or more meds after acute MI -Beta Blockers greatly reduced HR - No change in exercise response - Vasodilators - Diuretics -Ca Cblockers  may increase exercise tolerance (improve heart function) Medications
  26. 27. Intensity 40-80% of Vo2 max RPE: 11-15 Frequency: 3 x wk Duration: 20-40min Mode: Depends on individual, encourage PA in daily living Exercise Programming