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Mukesh Shanker S.no. 22 KMC Manipal INDIA.
Atherosclerosis Vaso Spasm Aortitis Severe LV Hypertrophy Aortic Stenosis Severe Anemia Micro vascular Angina THE CAUSES :
Supply Demand INCREASED DEMAND Heart Rate, BP, Myocardial Contractility, LV Hypertrophy, AS etc. DECREASED SUPPLY Duration...
THE RISK  1 + 1 ≠ 2
HEART FAILURE & ARRYTHMIAS <ul><li>Myocardial dysfunction/ Altered conduction  </li></ul><ul><li>due to infarction or isch...
Stable Angina Unstable Angina / Subendocardial MI Transmural MI / Sudden Death Pathologic Basis Of Disease.
STABLE ANGINA:
<ul><li>Patients have </li></ul><ul><li>cardiac disease </li></ul><ul><li>But without resulting </li></ul><ul><li>limitati...
TREADMILL TEST : Monitor Symptoms, ECG, BP. Stop : chest pain, breathless; ST depression >2mV ; SBP >10mmHg ; Ventricular ...
TREADMILL TEST : Monitor Symptoms, ECG, BP. Stop : chest pain, breathless; ST depression >2mV ; SBP >10mmHg ; Ventricular ...
TREADMILL TEST : Monitor Symptoms, ECG, BP. Stop : chest pain, breathless; ST depression >2mV ; SBP >10mmHg ; Ventricular ...
ACUTE CORONARY SYNDROME:
ACUTE CORONARY SYNDROME:
<ul><li>Angina pectoris or equivalent ischemic discomfort with  </li></ul><ul><ul><li>At rest/ minimal exertion ; >10min. ...
 
 
Lateral Wall  Inferior Wall  Anterior Wall  ELECTROCARDIOGRAPHY:
<ul><li>ST segment Depression. </li></ul><ul><li>Transient elevation. </li></ul><ul><li>T wave inversion. </li></ul><ul><l...
<ul><li>ST segment Elevation. </li></ul><ul><li>R wave decreases. </li></ul><ul><li>Q wave Appear. </li></ul><ul><li>T wav...
<ul><li>ST segment Elevation. </li></ul><ul><li>R wave decreases. </li></ul><ul><li>Q wave Appear. </li></ul><ul><li>T wav...
<ul><li>Proteins Released from necrotic heart muscles. Seen in : </li></ul><ul><ul><li>NSTEMI </li></ul></ul><ul><ul><li>S...
<ul><li>BLOOD TESTS: </li></ul><ul><ul><li>Leukocytosis </li></ul></ul><ul><ul><li>ESR increased </li></ul></ul><ul><ul><l...
Assess Likelihood Of CHD : History & Examination High/Intermediate likelihood. Low likelihood Stable Angina Atypical/ othe...
 
 
 
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Ischemic heart disease, IHD, ihd, ischemic heart disease ischaemic attack myocardial infarction mi angina ecg electrocardiogram

IHD
Clinical Features & Investigations.
BY : MUKESH SHANKER, KMC Manipal. INDIA.

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Ischemic heart disease, IHD, ihd, ischemic heart disease ischaemic attack myocardial infarction mi angina ecg electrocardiogram

  1. 2. Mukesh Shanker S.no. 22 KMC Manipal INDIA.
  2. 3. Atherosclerosis Vaso Spasm Aortitis Severe LV Hypertrophy Aortic Stenosis Severe Anemia Micro vascular Angina THE CAUSES :
  3. 4. Supply Demand INCREASED DEMAND Heart Rate, BP, Myocardial Contractility, LV Hypertrophy, AS etc. DECREASED SUPPLY Duration of Systole, CAPP, Tone, HB, O₂ etc. THE PATHOPHYSIOLOGY :
  4. 5. THE RISK 1 + 1 ≠ 2
  5. 6. HEART FAILURE & ARRYTHMIAS <ul><li>Myocardial dysfunction/ Altered conduction </li></ul><ul><li>due to infarction or ischemia </li></ul>SUDDEN DEATH <ul><li>Ventricular arrhythmia, asystole </li></ul><ul><li>Massive myocardial infarction </li></ul>CHD
  6. 7. Stable Angina Unstable Angina / Subendocardial MI Transmural MI / Sudden Death Pathologic Basis Of Disease.
  7. 8. STABLE ANGINA:
  8. 9. <ul><li>Patients have </li></ul><ul><li>cardiac disease </li></ul><ul><li>But without resulting </li></ul><ul><li>limitation of </li></ul><ul><li>physical activity </li></ul><ul><li>Ordinary physical </li></ul><ul><li>activity does not </li></ul><ul><li>cause undue </li></ul><ul><li>fatigue, palpitation, </li></ul><ul><li>dyspnea, or Anginal </li></ul><ul><li>pain. </li></ul><ul><li>Patients have </li></ul><ul><li>cardiac disease </li></ul><ul><li>Slight limitation of </li></ul><ul><li>physical activity </li></ul><ul><li>Ordinary physical </li></ul><ul><li>activity results in </li></ul><ul><li>fatigue, palpitation, </li></ul><ul><li>dyspnea or Anginal </li></ul><ul><li>pain. </li></ul><ul><li>Patients have </li></ul><ul><li>cardiac disease </li></ul><ul><li>Marked limitation of </li></ul><ul><li>physical activity </li></ul><ul><li>Less than Ordinary </li></ul><ul><li>physical activity causes </li></ul><ul><li>fatigue, palpitation, </li></ul><ul><li>dyspnea or Anginal </li></ul><ul><li>pain. </li></ul><ul><li>Comfortable at Rest. </li></ul><ul><li>Patients have </li></ul><ul><li>cardiac disease </li></ul><ul><li>Inability to carry out </li></ul><ul><li>any physical activity </li></ul><ul><li>without discomfort. </li></ul><ul><li>Any physical activity </li></ul><ul><li>causes fatigue, </li></ul><ul><li>palpitation, dyspnea </li></ul><ul><li>or Anginal pain. </li></ul><ul><li>Symptoms at Rest. </li></ul>NYHA FUNCTIONAL CLASSIFICATION:
  9. 10. TREADMILL TEST : Monitor Symptoms, ECG, BP. Stop : chest pain, breathless; ST depression >2mV ; SBP >10mmHg ; Ventricular Tachyarrthmias. Flat /Down sloping is significant.
  10. 11. TREADMILL TEST : Monitor Symptoms, ECG, BP. Stop : chest pain, breathless; ST depression >2mV ; SBP >10mmHg ; Ventricular Tachyarrthmias. Flat /Down sloping is significant. MYOCARDIAL PERFUSION SCANNING : Stress Myocardial Radio nucleotide perfusion imaging. Using technetium 99m or thallium. Exercise or pharmacological. 2D ECHO Or CARDIAC MR Or CT .
  11. 12. TREADMILL TEST : Monitor Symptoms, ECG, BP. Stop : chest pain, breathless; ST depression >2mV ; SBP >10mmHg ; Ventricular Tachyarrthmias. Flat /Down sloping is significant. MYOCARDIAL PERFUSION SCANNING : Stress Myocardial Radio nucleotide perfusion imaging. Using technetium 99m or thallium. Exercise or pharmacological. 2D ECHO Or CARDIAC MR Or CT . CORONARY ARTERIOGRAPHY : Outlines the lumina. If patient symptomatic despite therapy. Before PCI / CABG.
  12. 13. ACUTE CORONARY SYNDROME:
  13. 14. ACUTE CORONARY SYNDROME:
  14. 15. <ul><li>Angina pectoris or equivalent ischemic discomfort with </li></ul><ul><ul><li>At rest/ minimal exertion ; >10min. Or </li></ul></ul><ul><ul><li>Severe and new onset Or </li></ul></ul><ul><ul><li>Crescendo pattern. </li></ul></ul><ul><li>Myocardial Infarction : </li></ul><ul><ul><li>Myocardial Ischemia </li></ul></ul><ul><ul><li>Myocardial Necrosis </li></ul></ul><ul><li>Elevated Cardiac Biomarkers. </li></ul><ul><li>ST Segment Elevation. </li></ul>UA : NSTEMI : STEMI :
  15. 18. Lateral Wall Inferior Wall Anterior Wall ELECTROCARDIOGRAPHY:
  16. 19. <ul><li>ST segment Depression. </li></ul><ul><li>Transient elevation. </li></ul><ul><li>T wave inversion. </li></ul><ul><li>R wave decreases. </li></ul><ul><li>No Q wave </li></ul>NSTEMI :
  17. 20. <ul><li>ST segment Elevation. </li></ul><ul><li>R wave decreases. </li></ul><ul><li>Q wave Appear. </li></ul><ul><li>T wave inversion. </li></ul><ul><li>ST segment normalize. </li></ul>STEMI :
  18. 21. <ul><li>ST segment Elevation. </li></ul><ul><li>R wave decreases. </li></ul><ul><li>Q wave Appear. </li></ul><ul><li>T wave inversion. </li></ul><ul><li>ST segment normalize. </li></ul>STEMI :
  19. 22. <ul><li>Proteins Released from necrotic heart muscles. Seen in : </li></ul><ul><ul><li>NSTEMI </li></ul></ul><ul><ul><li>STEMI. </li></ul></ul><ul><li>Preferred Biochemical Marker Is </li></ul><ul><li>cTnT & cTnI </li></ul>CARDIAC BIOMARKERS:
  20. 23. <ul><li>BLOOD TESTS: </li></ul><ul><ul><li>Leukocytosis </li></ul></ul><ul><ul><li>ESR increased </li></ul></ul><ul><ul><li>CRP increased </li></ul></ul><ul><li>CHEST X - Ray: </li></ul><ul><ul><li>Pulmonary Edema </li></ul></ul><ul><ul><li>Cardiomegaly </li></ul></ul><ul><li>ECHOCARDIOGRAPHY: </li></ul><ul><ul><li>Wall Motion Abnormality </li></ul></ul><ul><ul><li>Septal Defect </li></ul></ul><ul><ul><li>MR </li></ul></ul><ul><ul><li>Pericardial Effusion </li></ul></ul>OTHER INVESTIGATIONS:
  21. 24. Assess Likelihood Of CHD : History & Examination High/Intermediate likelihood. Low likelihood Stable Angina Atypical/ other cause. Investigation : ECG Cardiac Biomarkers Imaging. Treadmill Test Imaging ECG to rule out X Ray Others Assessment : Repeat Assess Risk Find a Cause Classify : UA NSTEMI STEMI Critical Not Critical Manage : Discharge Follow Up Treat Admit in CU & Treat +ve +ve +ve +ve THE CRITICAL PATHWAY FOR ED EVALUATION OF CHEST PAIN.
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IHD Clinical Features & Investigations. BY : MUKESH SHANKER, KMC Manipal. INDIA.

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