Myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to a part of the heart, causing damage to the heart muscle. Find a good presentation on Acute myocardial infarction here.
This document provides an overview of acute myocardial infarction (MI), also known as a heart attack. It discusses the definition, causes, risk factors, pathogenesis, classification, diagnosis and management of MI. The diagnosis involves taking a patient history, examining signs and symptoms, electrocardiography, serum analysis and echocardiography. Management is staged and involves pre-hospital, emergency department and post-discharge care, with a focus on reperfusing the blocked artery as quickly as possible, such as through percutaneous coronary intervention or thrombolytic therapy. The goal is to correctly identify the type of MI, treat the patient according to guidelines and manage any complications.
This document presents information on the management of myocardial infarction presented by several students. It discusses immediate management including oxygen, analgesics, antiemetics and aspirin. Early management within the first 12 hours includes analgesics, antithrombotic therapy with antiplatelet drugs like aspirin and clopidogrel as well as anticoagulants. It also discusses anti-anginal therapy and reperfusion therapy.
Myocardial infarction occurs when blood flow to the heart is obstructed, causing death of heart muscle tissue. It is usually caused by atherosclerosis leading to coronary artery occlusion. Risk factors include conditions like diabetes, smoking, high cholesterol, and family history. Symptoms include chest pain and potential complications are arrhythmias, heart failure, or cardiac rupture. Diagnosis involves cardiac enzyme and troponin levels, electrocardiogram, and other imaging tests. Treatment focuses on restoring blood flow, reducing risk factors, managing pain and symptoms, and monitoring for complications.
This document defines myocardial infarction and provides classifications. It discusses the epidemiology, risk factors, pathophysiology, diagnostic approach, and treatment strategies for myocardial infarction. Key points are that MI is sudden myocardial necrosis caused by ischemia. Classification includes STEMI and NSTEMI. Risk factors include age, smoking, diabetes, hypertension, and hyperlipidemia. Diagnosis involves ECG and biomarkers. Treatment focuses on dissolving thrombus with aspirin and anticoagulants, reducing atheroma with statins, and selecting an invasive or non-invasive strategy based on risk.
The document discusses acute coronary syndrome (ACS), which includes unstable angina, ST elevation myocardial infarction (STEMI), and non-ST elevation myocardial infarction (NSTEMI). ACS is characterized by new or worsening chest pain or discomfort due to reduced blood flow in the coronary arteries. The main causes are atherosclerotic plaque rupture and thrombosis formation, which can completely or partially block blood flow. Investigation and management involves ECG, cardiac biomarkers, risk stratification scores, antiplatelet and anticoagulant therapy, and often coronary angiography.
This document provides information on cardiac dysrhythmias or arrhythmias. It defines arrhythmias as abnormalities in heart rate, rhythm or impulse origin/conduction. Various types of arrhythmias are described including supraventricular arrhythmias like atrial fibrillation, ventricular arrhythmias like premature ventricular contractions, and bradyarrhythmias. Causes or risk factors of arrhythmias include age, family history, heart disease, medications and substances like caffeine. The document also discusses various inherited arrhythmia conditions.
Cardiovascular emergencies are life-threatening disorders that must be recognized immediately to avoid delay in treatment and to minimize morbidity and mortality. Patients may present with severe hypertension, chest pain, arrhythmia, or cardiopulmonary arrest
Pericarditis is an inflammation of the pericardium that commonly affects men aged 20-50. It has several causes including viral or bacterial infections, certain cancers, autoimmune diseases, or physical trauma. Symptoms include chest pain that increases with deep breathing or lying flat. Diagnosis involves electrocardiograms, echocardiograms, and blood tests. Treatment focuses on reducing inflammation with medications like aspirin, ibuprofen, or colchicine. Surgery may be required in severe cases to drain fluid or remove the pericardium.
This document provides an overview of acute myocardial infarction (MI), also known as a heart attack. It discusses the definition, causes, risk factors, pathogenesis, classification, diagnosis and management of MI. The diagnosis involves taking a patient history, examining signs and symptoms, electrocardiography, serum analysis and echocardiography. Management is staged and involves pre-hospital, emergency department and post-discharge care, with a focus on reperfusing the blocked artery as quickly as possible, such as through percutaneous coronary intervention or thrombolytic therapy. The goal is to correctly identify the type of MI, treat the patient according to guidelines and manage any complications.
This document presents information on the management of myocardial infarction presented by several students. It discusses immediate management including oxygen, analgesics, antiemetics and aspirin. Early management within the first 12 hours includes analgesics, antithrombotic therapy with antiplatelet drugs like aspirin and clopidogrel as well as anticoagulants. It also discusses anti-anginal therapy and reperfusion therapy.
Myocardial infarction occurs when blood flow to the heart is obstructed, causing death of heart muscle tissue. It is usually caused by atherosclerosis leading to coronary artery occlusion. Risk factors include conditions like diabetes, smoking, high cholesterol, and family history. Symptoms include chest pain and potential complications are arrhythmias, heart failure, or cardiac rupture. Diagnosis involves cardiac enzyme and troponin levels, electrocardiogram, and other imaging tests. Treatment focuses on restoring blood flow, reducing risk factors, managing pain and symptoms, and monitoring for complications.
This document defines myocardial infarction and provides classifications. It discusses the epidemiology, risk factors, pathophysiology, diagnostic approach, and treatment strategies for myocardial infarction. Key points are that MI is sudden myocardial necrosis caused by ischemia. Classification includes STEMI and NSTEMI. Risk factors include age, smoking, diabetes, hypertension, and hyperlipidemia. Diagnosis involves ECG and biomarkers. Treatment focuses on dissolving thrombus with aspirin and anticoagulants, reducing atheroma with statins, and selecting an invasive or non-invasive strategy based on risk.
The document discusses acute coronary syndrome (ACS), which includes unstable angina, ST elevation myocardial infarction (STEMI), and non-ST elevation myocardial infarction (NSTEMI). ACS is characterized by new or worsening chest pain or discomfort due to reduced blood flow in the coronary arteries. The main causes are atherosclerotic plaque rupture and thrombosis formation, which can completely or partially block blood flow. Investigation and management involves ECG, cardiac biomarkers, risk stratification scores, antiplatelet and anticoagulant therapy, and often coronary angiography.
This document provides information on cardiac dysrhythmias or arrhythmias. It defines arrhythmias as abnormalities in heart rate, rhythm or impulse origin/conduction. Various types of arrhythmias are described including supraventricular arrhythmias like atrial fibrillation, ventricular arrhythmias like premature ventricular contractions, and bradyarrhythmias. Causes or risk factors of arrhythmias include age, family history, heart disease, medications and substances like caffeine. The document also discusses various inherited arrhythmia conditions.
Cardiovascular emergencies are life-threatening disorders that must be recognized immediately to avoid delay in treatment and to minimize morbidity and mortality. Patients may present with severe hypertension, chest pain, arrhythmia, or cardiopulmonary arrest
Pericarditis is an inflammation of the pericardium that commonly affects men aged 20-50. It has several causes including viral or bacterial infections, certain cancers, autoimmune diseases, or physical trauma. Symptoms include chest pain that increases with deep breathing or lying flat. Diagnosis involves electrocardiograms, echocardiograms, and blood tests. Treatment focuses on reducing inflammation with medications like aspirin, ibuprofen, or colchicine. Surgery may be required in severe cases to drain fluid or remove the pericardium.
The document discusses acute coronary syndrome (ACS), including the clinical presentation, risk factors, diagnostic testing such as electrocardiograms and cardiac enzymes, and treatment approaches for ACS depending on whether it presents with ST-elevation myocardial infarction (STEMI) or non-ST-elevation ACS such as unstable angina or non-STEMI. For STEMI patients, reperfusion therapy through either fibrinolysis or primary percutaneous coronary intervention is recommended to open the blocked vessel within specific time goals in order to reduce mortality.
Myocardial infarction, or heart attack, occurs when blood flow to the heart is blocked, damaging heart muscle. It is usually caused by a blood clot forming in one of the coronary arteries. A heart attack can lead to damage or death of heart muscle depending on how much of the heart is affected and for how long. Diagnosis involves assessing symptoms, electrocardiogram changes, and cardiac enzyme levels. Treatment focuses on restoring blood flow through clot-busting drugs or angioplasty, along with medications, monitoring, and lifestyle changes to prevent future heart attacks.
This document provides an overview of acute coronary syndrome (ACS), which includes ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), and unstable angina (UA). It discusses the epidemiology, pathophysiology, clinical presentation, workup, and management of these conditions. Key points include that ACS is usually caused by rupture of an atherosclerotic plaque and thrombosis in a coronary artery. STEMI is characterized by ST elevation on ECG and elevated cardiac enzymes, while NSTEMI shows ST depression/T-wave inversion and elevated enzymes without ST elevation. UA presents with chest pain but normal cardiac enzymes and nonspecific ECG changes.
CARDIAC TAMPONADE ( Cardiac emergency) • Cardiac Tamponade is a life threatening complication caused by excessive accumulation of fluid in the pericardium. Or • Compression of all cardiac chambers due to excessive accumulation of pericardial fluid leading to compromised cardiac out put.
1. The document discusses the classification, diagnosis, and treatment of acute coronary syndromes including unstable angina and myocardial infarction.
2. Key points include definitions of unstable angina, NSTEMI, and STEMI; causes of acute coronary syndromes including plaque rupture and vasospasm; the importance of history, ECG, biomarkers in diagnosis; and the use of antiplatelet agents, beta blockers, nitroglycerin, and anticoagulants in treatment.
3. Primary percutaneous coronary intervention is recommended over thrombolysis when certain criteria are met for STEMI patients.
Unstable angina is a form of ischemic heart disease where a person experiences chest pain or discomfort that occurs at rest or with minimal exertion. It is caused by decreased blood supply to the heart muscle due to partial blockage of the coronary arteries. Diagnosis involves taking a medical history, electrocardiogram, cardiac enzyme tests, and stress testing. Treatment consists of blood thinners, nitroglycerin, blood pressure medications, and cholesterol-lowering drugs medically or early cardiac catheterization and angioplasty or bypass surgery if high risk.
Definition of shock
Initial Assessment of shock – ABC
Types of Shock
Stages of Shock
Physiologic Determinants of Shock
Common Features of Shock
Work-up of shock
General Approach to management of shock
M. Shareef, a 65-year-old male with diabetes and coronary artery disease, presented with chest pain, breathlessness, fever and vomiting for 6 hours. He was admitted to the ICU where an ECG showed signs of a myocardial infarction. His treatment included aspirin, clopidogrel, streptokinase, morphine and metoclopramide. As a known diabetic and heart disease patient, he requires lifestyle modifications and optimized medical management to control his risk factors and prevent further cardiac complications.
Cardiogenic shock is the failure of the heart to pump enough blood to meet the body's needs due to loss of contractile function. It most commonly occurs after a myocardial infarction which damages a significant portion of the left ventricle. Symptoms include low blood pressure, rapid breathing, decreased urine output, and confusion. Treatment involves oxygen, medications to improve contractility and reduce workload, and mechanical devices like IABP if needed. Nursing care focuses on monitoring circulation and tissue perfusion, managing devices, and addressing patient anxiety.
This document provides an overview of ischemic heart disease (IHD). IHD is caused by reduced blood flow to the heart muscle and includes conditions like angina and myocardial infarction. The main causes are atherosclerotic lesions in the coronary arteries leading to plaque buildup and blockages. Over time, plaques can rupture, causing blood clots that fully or partially block blood flow to the heart. This leads to insufficient oxygen delivery and cell death. The document outlines the pathogenesis and morphological changes that occur during angina and myocardial infarction as well as risk factors, diagnosis, and complications of IHD.
Ischemic heart disease is usually caused by atherosclerosis in the coronary arteries which limits blood supply to the heart. It has a spectrum of clinical manifestations from mild angina to myocardial infarction depending on the severity of ischemia. Angina pectoris is recurrent chest pain due to transient ischemia while a myocardial infarction occurs when ischemia is prolonged leading to cell death and scarring of heart muscle. Atherosclerosis develops from childhood and lifestyle factors influence its progression, with plaques vulnerable to rupture typically containing inflammatory cells, lipids, and a thin fibrous cap.
Acute coronary syndrome (ACS) refers to a spectrum of conditions caused by reduced blood flow in the coronary arteries. This includes ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), and unstable angina. ACS is usually caused by rupture of atherosclerotic plaque and subsequent thrombus formation, which occludes coronary arteries. Treatment involves antiplatelet therapy such as aspirin and a P2Y12 inhibitor, anticoagulation with heparin, fibrinolytic therapy for STEMI if PCI is not available, and revascularization when possible. Goals are to restore blood flow, prevent complications, and control symptoms.
A cardiac dysrhythmia (also called an arrhythmia) is an abnormal rhythm of your heartbeat. It can be slower or faster than a normal heart rate. It can also be irregular. It can be life-threatening if the heart cannot pump enough oxygen-rich blood to the heart itself or the rest of the body.
This document discusses aneurysms, which are abnormal bulges or ballooning in artery walls caused by weakness in the arterial wall. It defines different types of aneurysms including fusiform, secular, and dissecting aneurysms based on their size and shape. True aneurysms develop slowly from conditions like hypertension while false aneurysms are caused by traumatic artery wall breaks. The document also discusses aneurysms in different locations like the aorta, brain, and peripheral arteries and their potential causes, symptoms, diagnostic tests, and treatments including open repair surgery and endovascular repair.
This document discusses atrial fibrillation (AF), including its characteristics, prevalence, types, management, and pathophysiological mechanisms. Some key points include:
- AF is characterized by uncoordinated atrial activation and deterioration of atrial function. Prevalence increases with age, affecting over 8% of those over 80 years old.
- Types include paroxysmal, persistent, and permanent AF based on duration and frequency. Management may involve rate control, cardioversion, or rhythm control strategies.
- Pathophysiological mechanisms involve atrial fibrosis, dilation, and inflammation promoting reentrant wavelets within the atria leading to the uncoordinated activation seen in AF.
The document summarizes information about cardiac arrest, including its definition, diagnosis, causes, symptoms, treatment approach, and medications used. Cardiac arrest is defined as the sudden cessation of heartbeat and cardiac function resulting in loss of effective circulation. The diagnosis is based on a triad of loss of consciousness, loss of normal breathing, and loss of pulse. Causes include issues with the heart like congenital defects as well as heart attacks. Treatment focuses on early access to care, CPR, defibrillation, advanced life support, and follow up care using an ABCDE approach and medications like epinephrine, atropine, amiodarone, and lidocaine. Lifestyle changes like quitting smoking, diet,
This document provides an overview of shock, including its history, definitions, types, pathophysiology, signs and symptoms, and management. It discusses the four main types of shock - cardiogenic, obstructive, hypovolemic, and distributive - describing the insult, physiologic effects, and compensatory mechanisms for each. Treatment of shock focuses on the ABCDE approach - airway, breathing, circulation, disability, and exposure. Restoring adequate circulation through fluid resuscitation is key. The goals of treatment are to optimize oxygen delivery and achieve endpoints of resuscitation like urine output and hemodynamic parameters.
Myocarditis is an inflammatory disease of the heart muscle that is usually caused by viral infections. It can lead to dilated cardiomyopathy and heart failure. Viruses are the most common cause, with adenovirus now more prevalent than coxsackievirus. Myocarditis presents with symptoms of heart failure, chest pain, or arrhythmias. Diagnosis involves EKG, cardiac biomarkers, echocardiogram, cardiac MRI, and endomyocardial biopsy. Treatment focuses on managing arrhythmias and heart failure with medications, while immunosuppression may benefit some forms of myocarditis but not others.
The document discusses acute coronary syndrome (ACS), including the clinical presentation, risk factors, diagnostic testing such as electrocardiograms and cardiac enzymes, and treatment approaches for ACS depending on whether it presents with ST-elevation myocardial infarction (STEMI) or non-ST-elevation ACS such as unstable angina or non-STEMI. For STEMI patients, reperfusion therapy through either fibrinolysis or primary percutaneous coronary intervention is recommended to open the blocked vessel within specific time goals in order to reduce mortality.
Myocardial infarction, or heart attack, occurs when blood flow to the heart is blocked, damaging heart muscle. It is usually caused by a blood clot forming in one of the coronary arteries. A heart attack can lead to damage or death of heart muscle depending on how much of the heart is affected and for how long. Diagnosis involves assessing symptoms, electrocardiogram changes, and cardiac enzyme levels. Treatment focuses on restoring blood flow through clot-busting drugs or angioplasty, along with medications, monitoring, and lifestyle changes to prevent future heart attacks.
This document provides an overview of acute coronary syndrome (ACS), which includes ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), and unstable angina (UA). It discusses the epidemiology, pathophysiology, clinical presentation, workup, and management of these conditions. Key points include that ACS is usually caused by rupture of an atherosclerotic plaque and thrombosis in a coronary artery. STEMI is characterized by ST elevation on ECG and elevated cardiac enzymes, while NSTEMI shows ST depression/T-wave inversion and elevated enzymes without ST elevation. UA presents with chest pain but normal cardiac enzymes and nonspecific ECG changes.
CARDIAC TAMPONADE ( Cardiac emergency) • Cardiac Tamponade is a life threatening complication caused by excessive accumulation of fluid in the pericardium. Or • Compression of all cardiac chambers due to excessive accumulation of pericardial fluid leading to compromised cardiac out put.
1. The document discusses the classification, diagnosis, and treatment of acute coronary syndromes including unstable angina and myocardial infarction.
2. Key points include definitions of unstable angina, NSTEMI, and STEMI; causes of acute coronary syndromes including plaque rupture and vasospasm; the importance of history, ECG, biomarkers in diagnosis; and the use of antiplatelet agents, beta blockers, nitroglycerin, and anticoagulants in treatment.
3. Primary percutaneous coronary intervention is recommended over thrombolysis when certain criteria are met for STEMI patients.
Unstable angina is a form of ischemic heart disease where a person experiences chest pain or discomfort that occurs at rest or with minimal exertion. It is caused by decreased blood supply to the heart muscle due to partial blockage of the coronary arteries. Diagnosis involves taking a medical history, electrocardiogram, cardiac enzyme tests, and stress testing. Treatment consists of blood thinners, nitroglycerin, blood pressure medications, and cholesterol-lowering drugs medically or early cardiac catheterization and angioplasty or bypass surgery if high risk.
Definition of shock
Initial Assessment of shock – ABC
Types of Shock
Stages of Shock
Physiologic Determinants of Shock
Common Features of Shock
Work-up of shock
General Approach to management of shock
M. Shareef, a 65-year-old male with diabetes and coronary artery disease, presented with chest pain, breathlessness, fever and vomiting for 6 hours. He was admitted to the ICU where an ECG showed signs of a myocardial infarction. His treatment included aspirin, clopidogrel, streptokinase, morphine and metoclopramide. As a known diabetic and heart disease patient, he requires lifestyle modifications and optimized medical management to control his risk factors and prevent further cardiac complications.
Cardiogenic shock is the failure of the heart to pump enough blood to meet the body's needs due to loss of contractile function. It most commonly occurs after a myocardial infarction which damages a significant portion of the left ventricle. Symptoms include low blood pressure, rapid breathing, decreased urine output, and confusion. Treatment involves oxygen, medications to improve contractility and reduce workload, and mechanical devices like IABP if needed. Nursing care focuses on monitoring circulation and tissue perfusion, managing devices, and addressing patient anxiety.
This document provides an overview of ischemic heart disease (IHD). IHD is caused by reduced blood flow to the heart muscle and includes conditions like angina and myocardial infarction. The main causes are atherosclerotic lesions in the coronary arteries leading to plaque buildup and blockages. Over time, plaques can rupture, causing blood clots that fully or partially block blood flow to the heart. This leads to insufficient oxygen delivery and cell death. The document outlines the pathogenesis and morphological changes that occur during angina and myocardial infarction as well as risk factors, diagnosis, and complications of IHD.
Ischemic heart disease is usually caused by atherosclerosis in the coronary arteries which limits blood supply to the heart. It has a spectrum of clinical manifestations from mild angina to myocardial infarction depending on the severity of ischemia. Angina pectoris is recurrent chest pain due to transient ischemia while a myocardial infarction occurs when ischemia is prolonged leading to cell death and scarring of heart muscle. Atherosclerosis develops from childhood and lifestyle factors influence its progression, with plaques vulnerable to rupture typically containing inflammatory cells, lipids, and a thin fibrous cap.
Acute coronary syndrome (ACS) refers to a spectrum of conditions caused by reduced blood flow in the coronary arteries. This includes ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), and unstable angina. ACS is usually caused by rupture of atherosclerotic plaque and subsequent thrombus formation, which occludes coronary arteries. Treatment involves antiplatelet therapy such as aspirin and a P2Y12 inhibitor, anticoagulation with heparin, fibrinolytic therapy for STEMI if PCI is not available, and revascularization when possible. Goals are to restore blood flow, prevent complications, and control symptoms.
A cardiac dysrhythmia (also called an arrhythmia) is an abnormal rhythm of your heartbeat. It can be slower or faster than a normal heart rate. It can also be irregular. It can be life-threatening if the heart cannot pump enough oxygen-rich blood to the heart itself or the rest of the body.
This document discusses aneurysms, which are abnormal bulges or ballooning in artery walls caused by weakness in the arterial wall. It defines different types of aneurysms including fusiform, secular, and dissecting aneurysms based on their size and shape. True aneurysms develop slowly from conditions like hypertension while false aneurysms are caused by traumatic artery wall breaks. The document also discusses aneurysms in different locations like the aorta, brain, and peripheral arteries and their potential causes, symptoms, diagnostic tests, and treatments including open repair surgery and endovascular repair.
This document discusses atrial fibrillation (AF), including its characteristics, prevalence, types, management, and pathophysiological mechanisms. Some key points include:
- AF is characterized by uncoordinated atrial activation and deterioration of atrial function. Prevalence increases with age, affecting over 8% of those over 80 years old.
- Types include paroxysmal, persistent, and permanent AF based on duration and frequency. Management may involve rate control, cardioversion, or rhythm control strategies.
- Pathophysiological mechanisms involve atrial fibrosis, dilation, and inflammation promoting reentrant wavelets within the atria leading to the uncoordinated activation seen in AF.
The document summarizes information about cardiac arrest, including its definition, diagnosis, causes, symptoms, treatment approach, and medications used. Cardiac arrest is defined as the sudden cessation of heartbeat and cardiac function resulting in loss of effective circulation. The diagnosis is based on a triad of loss of consciousness, loss of normal breathing, and loss of pulse. Causes include issues with the heart like congenital defects as well as heart attacks. Treatment focuses on early access to care, CPR, defibrillation, advanced life support, and follow up care using an ABCDE approach and medications like epinephrine, atropine, amiodarone, and lidocaine. Lifestyle changes like quitting smoking, diet,
This document provides an overview of shock, including its history, definitions, types, pathophysiology, signs and symptoms, and management. It discusses the four main types of shock - cardiogenic, obstructive, hypovolemic, and distributive - describing the insult, physiologic effects, and compensatory mechanisms for each. Treatment of shock focuses on the ABCDE approach - airway, breathing, circulation, disability, and exposure. Restoring adequate circulation through fluid resuscitation is key. The goals of treatment are to optimize oxygen delivery and achieve endpoints of resuscitation like urine output and hemodynamic parameters.
Myocarditis is an inflammatory disease of the heart muscle that is usually caused by viral infections. It can lead to dilated cardiomyopathy and heart failure. Viruses are the most common cause, with adenovirus now more prevalent than coxsackievirus. Myocarditis presents with symptoms of heart failure, chest pain, or arrhythmias. Diagnosis involves EKG, cardiac biomarkers, echocardiogram, cardiac MRI, and endomyocardial biopsy. Treatment focuses on managing arrhythmias and heart failure with medications, while immunosuppression may benefit some forms of myocarditis but not others.
Heart is a muscular organ. Pathology of heart indicates any disorder of heart, a properly functioning heart is important to sustain a live because it pumps blood out to whole body providing oxygen and nutrients. Here I've discussed on two common cardiovascular pathological condition.
Coronary heart disease is a condition caused by an inadequate blood supply to the heart muscle. It occurs when there is an imbalance between the heart's oxygen supply and demand. The main coronary arteries supply blood to the heart and can become narrowed or blocked by atherosclerosis.
Risk factors include age, male sex, family history, smoking, high cholesterol, hypertension, diabetes and obesity. Symptoms range from stable angina to acute coronary syndromes like heart attack. Diagnosis involves evaluating the medical history, symptoms, electrocardiogram and cardiac enzyme levels. Treatment depends on the type and severity of coronary heart disease.
Acute coronary syndrome (ACS) refers to unstable angina and myocardial infarction and is usually caused by rupture of an atherosclerotic plaque leading to coronary artery thrombosis. It is characterized by prolonged chest pain and cardiac enzyme elevations. Diagnosis involves electrocardiogram showing ST segment changes and elevated troponin levels. Treatment focuses on reperfusion therapy, antiplatelets, anticoagulants, and lifestyle modifications to prevent future events. Prognosis depends on extent of myocardial damage, with in-hospital mortality over 10% and 5-year survival rates around 75% for those who survive the initial event.
Cardiac arrest an overview of defibrillation vs cardioversionUmair Sheikh
1. The document discusses cardiac arrest and the differences between defibrillation and cardioversion. It presents a case of a 60-year-old male patient who experienced sudden cardiac arrest due to pulseless ventricular tachycardia.
2. Key points from the literature review include that defibrillation is used to treat shockable rhythms like ventricular fibrillation and pulseless ventricular tachycardia during cardiac arrest. Cardioversion is used to treat tachyarrhythmias with a pulse like atrial fibrillation and atrial flutter in a synchronized manner.
3. The document reviews defibrillation and cardioversion techniques including energy levels, paddle positioning, algorithms for treatment, and complications. It emphasizes
This document summarizes guidelines for the classification, diagnosis, and management of acute coronary syndromes (ACS). It discusses:
1) ACS are classified as STEMI or NSTE-ACS including NSTEMI and UA based on biomarkers and ECG findings. STEMI criteria require ST elevation and often indicates coronary artery occlusion.
2) Risk factors, pathophysiology, presentation, diagnostic testing and goals of initial therapy are outlined for STEMI. Diagnosis relies on ECG changes, cardiac biomarkers and imaging. Management focuses on rapid reperfusion via fibrinolysis or primary PCI to limit infarct size.
3) Reperfusion therapy options of PCI versus fibrinolysis are compared, with PCI preferred when performed
1) Acute coronary syndromes (ACS) describe conditions caused by coronary plaque rupture and include ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), and unstable angina.
2) Plaque rupture triggers blood clot formation, which can partially or completely block blood flow to the heart. STEMI involves complete blockage, while NSTEMI and unstable angina involve partial blockages.
3) Diagnosis involves ECG, cardiac enzyme tests, and angiography. Treatment depends on diagnosis but commonly includes aspirin, blood thinners, beta-blockers, and procedures like thrombolysis or angioplasty to restore blood flow.
EMGuideWire's Radiology Reading Room: Stress-Induced CardiomyopathySean M. Fox
The Department of Emergency Medicine at Carolinas Medical Center is passionate about education! Dr. Michael Gibbs is a world-renowned clinician and educator and has helped guide numerous young clinicians on the long path of Mastery of Emergency Medical Care. With his oversight, the EMGuideWire team aim to help augment our understanding of emergent imaging. You can follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides or you can also use this section to learn more in-depth about specific conditions and diseases. This Radiology Reading Room pertains to Stress-Induced Cardiomyopathy and is brought to you by Jenna Pallansch, MD, Claire Lawson, NP, Shelby Hixson, PA, Emily Lipsitz, PA, Ashley Moore-Gibbs, DNP, Laszlo Littmann, MD, and John Symanski, MD.
This document provides an overview of shock, including its definition, types, physiology, and management. It discusses the key features and immediate treatment of hemorrhagic, neurogenic, septic, anaphylactic, cardiogenic, and obstructive shock through case examples. The main points are that shock results from inadequate tissue perfusion, early recognition and aggressive fluid/vasopressor resuscitation are critical to improving outcomes across different shock types.
(1) Acute coronary syndromes (ACS) describe conditions caused by coronary plaque rupture including ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), and unstable angina.
(2) ACS results from a cascade triggered by plaque rupture and thrombosis, potentially causing total coronary artery occlusion and myocardial infarction. Presentation varies from chest pain to pulmonary edema or confusion, especially in diabetics and the elderly.
(3) Diagnosis involves ECG, cardiac enzymes, and angiography. STEMI is treated with thrombolysis or primary angioplasty while NSTEMI/unstable angina receives antiplatelets, anticoagulants, and
This document discusses venous thrombosis and pulmonary embolism. It covers risk factors, pathophysiology, diagnostic evaluation, and treatment options. The main points are:
1. Venous thrombosis and pulmonary embolism are concerns in postoperative and ICU patients. Thrombi often form silently in leg veins and can break off and travel to the lungs.
2. Diagnostic evaluations include D-dimer, ventilation-perfusion scans, echocardiograms, angiograms. Imaging shows defects from clots blocking blood flow.
3. Treatment involves anticoagulation initially with heparin or low molecular weight heparin. Warfarin is used long-term. Thrombolytics or inferior v
Acute MI . family Medicine . 2022.pptxRasheedIbdah
1. Acute myocardial infarction (AMI), commonly known as a heart attack, results from prolonged ischemia and lack of oxygen to heart muscle cells causing cell death.
2. AMIs are classified based on ECG findings as ST-elevation MIs (STEMIs) or non-ST-elevation MIs (NSTEMIs) and by cause.
3. Risk factors include age, family history, smoking, diabetes, hypertension, and hyperlipidemia. Diagnosis involves ECG, cardiac enzyme levels, and imaging to determine location and severity.
Cardiac arrhythmias are caused by abnormalities in the heart's electrical impulses. This document focuses on tachyarrhythmias, or fast heart rhythms over 100 beats per minute. Tachyarrhythmias are classified as supraventricular or ventricular based on where they originate. Supraventricular arrhythmias like atrial fibrillation originate above the ventricles and have a regular heart rhythm, while ventricular arrhythmias originate in the ventricles and have an irregular rhythm. The document provides detailed information on the causes, mechanisms, ECG findings and treatment of various tachyarrhythmias including atrial fibrillation, atrial flutter, premature ventricular contractions and ventricular tachycardia.
Anaesthetic Management of a Patient with Ischaemic Heart DiseaseZareer Tafadar
This document discusses the anaesthetic management of patients with ischemic heart disease undergoing non-cardiac surgery. It begins by defining ischemic heart disease and outlining its various manifestations including stable angina, unstable angina, and myocardial infarction. It then discusses preoperative evaluation and risk stratification of these patients, including medical history, physical exam, ECG, stress testing, and coronary angiography. Intraoperative management focuses on minimizing myocardial ischemia through beta-blockers, tight blood pressure control, and avoidance of tachycardia or hypotension.
Myocardial infarction, or heart attack, results from ischemia and hypoxia causing irreversible damage to heart muscle. It is a leading cause of death in the US. Risk factors include atherosclerosis, hypertension, smoking, diabetes, and family history. Diagnosis involves cardiac biomarkers like troponin and CK-MB which are released from damaged heart tissue. Electrocardiograms and echocardiograms can also help detect heart muscle damage and complications from a heart attack.
1. ST elevation myocardial infarction (STEMI) occurs when there is ST elevation or new left bundle branch block on ECG due to acute coronary artery occlusion.
2. Diagnosis is based on symptoms, elevated cardiac biomarkers, and ECG changes showing ST elevation. Treatment involves stabilization, pain control, and reperfusion therapy.
3. Prognosis depends on factors like age, previous MI history, infarct location and size, and presence of heart failure or hypotension. Early reperfusion, beta-blockers, ACE inhibitors and risk factor modification can limit damage.
A rapid guide for short-term learning of electrocardiography history and the applications of electrocardiogram in cardiac monitoring and the diagnosis of heart pathologic conditions. Would be useful for the students who want to begin to learn this topic and the healthcare practitioners who need a review.
AMI is caused by formation of an occlusive thrombus at the site of a ruptured or eroded atherosclerotic plaque. It presents with chest pain and symptoms of ischemia. Investigations show changes on ECG, elevated cardiac enzymes, and echocardiogram may show regional wall motion abnormalities. Treatment involves oxygen, aspirin, anticoagulants, reperfusion with thrombolysis or PCI, and adjunctive therapies like beta blockers. Goals are to limit damage and prevent complications through risk factor modification and medical management.
This document defines myocardial infarction and describes its causes, symptoms, diagnosis, and treatment. A myocardial infarction occurs when blood flow to the heart is blocked, causing heart cell death. It causes chest pain and other symptoms like nausea and shortness of breath. Diagnosis involves EKGs, blood tests of cardiac enzymes, and cardiac catheterization. Treatment depends on the severity but may include clot-busting drugs, angioplasty, stents, or coronary bypass surgery to restore blood flow. Goals are to preserve heart function and prevent complications like arrhythmias or heart failure.
This document discusses the management of myocarditis. Myocarditis is inflammation of the myocardium that can be caused by infections, autoimmune disorders, or toxins. Clinical manifestations range from asymptomatic to cardiogenic shock. Diagnosis involves imaging like echocardiograms and cardiac MRI. Treatment includes supportive therapies like bed rest, diuretics, and oxygen. Specific antimicrobial therapy is only used if an organism is identified. Immunosuppressants may aid recovery in pediatric patients. Prognosis is complete recovery in around half of patients, while extensive damage can result in residual cardiac defects.
The thalamus is the large mass of gray matter in the dorsal part of the diencephalon of the brain with several functions such as relaying of sensory signals, including motor signals, to the cerebral cortex and the regulation of consciousness, sleep, and alertness.
Regional anesthesia is anesthesia affecting only a specific area of the body when the patient is conscious, e.g. foot, arm, lower extremities, insensate to stimulus of surgery or other instrumentation.
Preparation of case for living related renal transplant in pakistanDr. Muhammad Saifullah
In Pakistan, Living related renal transplant (LRRT) is the preferred renal transplant option. Although the number of cadevaric donors are on the rise but it is still in it`s infancy. In this presentation i have described the necessary requirements for LRRT.
Interior ballistics is a subfield of ballistics in which there is study of the propulsion of a projectile. In guns internal ballistics covers the time from the propellant's ignition until the projectile exits the gun barrel. The study of internal ballistics is important to designers and users of firearms of all types, from small-bore rifles and pistols, to high-tech artillery.
Insulin is a peptide hormone produced by beta cells of the pancreatic islets, and it is considered to be the main anabolic hormone of the body. It regulates the metabolism of carbohydrates, fats and protein by promoting the absorption of, especially, glucose from the blood into fat, liver and skeletal muscle cells.
High intensity focused ultrasound (HIFU) is an early stage medical technology that is in various stages of development worldwide to treat a range of disorders. The mechanism is similar to using a magnifying glass to focus sunlight. Focused ultrasound uses an acoustic lens to concentrate multiple intersecting beams of ultrasound on a target. Each individual beam passes through tissue with little effect but at the focal point where the beams converge, the energy can have useful thermal or mechanical effects. HIFU is typically performed with real-time imaging via ultrasound or MRI to enable treatment targeting and monitoring (including thermal tracking with MRI).
Electrolytes play a vital role in maintaining homeostasis within the body. They help to regulate heart and neurological function, fluid balance, oxygen delivery, acid–base balance and much more. Electrolyte imbalances can develop by the following mechanisms: excessive ingestion; diminished elimination of an electrolyte; diminished ingestion or excessive elimination of an electrolyte. The most serious electrolyte disturbances involve abnormalities in the levels of sodium, potassium or calcium.
Pre-registration house officer (PRHO), often known as a houseman or house officer, is a former official term for a grade of junior doctor that was, until 2005, the only job open to medical graduates in the United Kingdom who had just passed their final examinations at medical school and had received their medical degrees. The term "house officer" is still used to refer to FY1s and FY2s.
Chronic progressive sclerosing inflammatory dermatosis of unknown origin that results in white plaques with epidermal atrophy and scarring…… Lichen sclerosus. Penile Lichen sclerosus (LS) is the preferred term for Balanitis Xerotica Obliterans.
Bladder cancer is a disease of urinary bladder in which cells grow abnormally and have the potential to spread to other parts of the body. This is one of four parts of presentations on Bladder cancer. Please do go through the rest of the presentations too.
Bladder cancer is a disease of urinary bladder in which cells grow abnormally and have the potential to spread to other parts of the body. This is one of four parts of presentations on Bladder cancer. Please do go through the rest of the presentations too.
Bladder cancer is a disease of urinary bladder in which cells grow abnormally and have the potential to spread to other parts of the body. This is one of four parts of presentations on Bladder cancer. Please do go through the rest of the presentations too.
Bladder cancer is a disease of urinary bladder in which cells grow abnormally and have the potential to spread to other parts of the body. This is one of four parts of presentations on Bladder cancer. Please do go through the rest of the presentations too.
This document describes a case of a 48-year-old male patient presenting with right lumbar pain and swelling for 9 months and 3 months respectively. On examination, a non-tender cystic mass was palpable in the right lumbar region. Investigations including ultrasound and CT scan revealed a renal cyst. The document then provides an overview of renal cysts, discussing simple cysts, complicated cysts, and the Bosniak classification system for cystic renal masses. Based on imaging findings, the patient's cyst was likely a Bosniak Category II cyst.
- Arteriovenous grafts are used to create vascular access for hemodialysis when arteriovenous fistulae are not possible. Synthetic polytetrafluoroethylene (PTFE) grafts are commonly used.
- Grafts are created by surgically joining a vein to an artery using graft material. The brachial artery and distal vein are common sites.
- Long-term complications of vascular access grafts include thrombosis, infection, stenosis, aneurysm, high back pressure, and steal syndrome which can lead to limb ischemia.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
One health condition that is becoming more common day by day is diabetes.
According to research conducted by the National Family Health Survey of India, diabetic cases show a projection which might increase to 10.4% by 2030.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Hiranandani Hospital in Powai, Mumbai, is a premier healthcare institution that has been serving the community with exceptional medical care since its establishment. As a part of the renowned Hiranandani Group, the hospital is committed to delivering world-class healthcare services across a wide range of specialties, including kidney transplantation. With its state-of-the-art facilities, advanced medical technology, and a team of highly skilled healthcare professionals, Hiranandani Hospital has earned a reputation as a trusted name in the healthcare industry. The hospital's patient-centric approach, coupled with its focus on innovation and excellence, ensures that patients receive the highest standard of care in a compassionate and supportive environment.
4. Distribution of coronary blood
supply
Right Coronary Artery Left Coronary Artery
Right atrium
Right ventricle
SA node (85%)
AV node
Inter-atrial septum
Portion of left atrium
Postero-inferior 1/3 of Inter-
ventricular septum
Portion of posterior part of left
ventricle
Left atrium
Left ventricle
Most of the Interventricular
septum
Atrio-ventricular bundle and its
branches
5. ACUTE MYOCARDIAL INFARCTION
• Cardiac muscle
necrosis secondary
to protracted lack
of coronary
perfusion
• Usual etiology:
Thrombus at site of
vascular injury
6. OTHER ETIOLOGIES OF ACUTE
MYOCARDIAL INFARCTION
• Coronary embolus
• Coronary spasm
• Coronary anomoly
• Primary in situ thrombosis
• Vasculitis
• Hypotension
7. DETERMINANTS OF EXTENT OF DAMAGE
• Territory supplied
• Duration of occlusion
• Existence of collaterals
• Oxygen demand at time of occlusion
• Vasospasm
8. RISK FACTORS
Risk factors for atherosclerosis are generally risk factors for
myocardial infarction
Diabetes (with or without insulin resistance) – the single
most important risk factor for ischaemic heart disease (IHD)
Tobacco smoking
Hypercholesterolemia
Low HDL
9. High blood pressure
Family history of ischaemic heart disease (IHD)
Obesity
Age: Men at age 45 & Women at age 55
Hyperhomocysteinemia (high homocysteine, a toxic
blood amino acid that is elevated when intakes of
vitamins B2, B6, B12 and folic acid are insufficient)
Stress
Alcohol
Males are more at risk than females
12. Presenting Signs in Acute MI
• Appearance: Pallor, diaphoretic, anxious
• Vital Signs: Normal or abnormal BP and P
– Hypertension and tachycardia: SNS
– Hypotension and tachycardia:
• Cardiogenic shock
• Myocardial rupture
• Tachyarrhythmia
– Hypotension and bradycardia
• vagal stimulation
• Bradyarhythmia
13. Presenting Signs in Acute MI (Cont.)
• Lungs: Rales - CHF
• Heart: Displaced LV impulse
–S3
–S4
–Murmur of mitral regurgitation
–Murmur of ventricular septal
rupture
–Pericardial rub
14. DIAGNOSIS
The diagnosis of myocardial infarction can be
made after assessing
Patient's complaints and physical status
ECG changes
Coronary angiogram
Levels of cardiac markers
15.
16. ORDER OF ECG CHANGES IN AMI
Earliest: Increased R and T wave amplitudes; giant R wave and
Hyperacute T waves
Progressive ST elevation
Q waves appear
Loss of R waves
“T wave” inversion (because of change in ventricular repolarisation)
and it persists
26. LATERAL AMI
STE in I, aVL
*Note the ST depression in II, III, aVF consistent
with reciprocal changes, as well as in V2-V3 which
may represent a posterior MI
27.
28. INFERIOR AMI
STE in II, III, aVF
*Note the ST depression in I, aVL consistent with
reciprocal change, as well as in V1-V4 representing a
posterior MI
29.
30. POSTERIOR WALL AMI
ST Segment Depression in V1-V3 and posterior thoracic
leads with STE
31.
32. PLASMA MARKERS
CK-MB
Increases at 4-6 hours
Peaks at 12 hours
Normalizes in 48-72 hours
TROPONIN T & I
Increases at 4-6 hours
Remains elevated for 2
weeks
34. Cardiac Specific Troponins (cTnT, cTnI)
• Rise within 4-8 hours, remain elevated 7-14
days (T>I)
• 30% of patients with UAP show ↑ levels cTnT
or I, indicating increased risk of adverse
outcome
35.
36. OTHER TESTS
BLOOD leukocytosis, ESR and CRP is elevated
Chest X-ray Pulmonary edema
Echocardiography
Mural thrombi
Cardiac rupture
VSD
MR
Pericardial effusion
37. DIAGNOSIS OF MYOCARDIAL
INFARCTION (American college of cardiology
and the Europeon society of cardiology)
Elevated Troponins or CK-MB above 99th
centile with
one of the following
Ischemic symptoms
Development of Q-waves on ECG
Ischemic ECG changes (ST elevation/depression)
Coronary artery intervention
38. A. IMMEDIATE
MANAGEMENT
B. MAINTAINING
VESSEL PATENCY
C. PREVENTION
OF FURTHER
COMPLICATIONS
D. LATE
MANAGEMENT
Defibrillation
services
Resuscitation
Reperfusion
Detection and
Management of
acute
complications
Drugs
Adjunctive
therapy
Arrythmias
Ischemia
Acute circulatory
failure
Pericarditis
Mechanical
complications
Embolism
Impaired
ventricular function
Ventricular
aneurysm
Risk stratification
and management
Life style
modification
Drug therapy in
Secondary
Prevention
Mobilization and
Rehabilitation
40. REPERFUSION
Primary PCI is the treatment of choice
Thrombolysis (Greatest benefits if in 2 hours)
Streptokinase 1.5 Million Units in 100ml of N/S over 1 hour
Alteplase 15mg bolus then 0.75mg/kg in 30 mins (50mg)
followed by 0.5mg/kg in 60 min (35mg)
Major hazard is Cerebral Haemorrhage
DETECTION AND MANAGEMENT OF ACUTE
COMPLICATIONS
Arrythmias
Ischemia
Heart failure
41. Major Contraindications To the Use of
Thrombolytic Therapy
• Any previous history of hemorrhagic stroke
• History of stroke, dementia, or central nervous system
damage within 1 year
• Head trauma or brain surgery within 6 months
• Known intracranial neoplasm
• Suspected aortic dissection
• Internal bleeding within 6 weeks
• Active bleeding or known bleeding disorder
• Major surgery, trauma, or bleeding within 6 weeks
• Traumatic cardiopulmonary resuscitation within 3 weeks
42. Relative Contraindications To the Use of
Thrombolytic Therapy
• Oral anticoagulant therapy
• Acute pancreatitis
• Pregnancy or within 1 week postpartum
• Active peptic ulceration
• Transient ischemic attack within 6 months
• Dementia
• Infective endocarditis
• Active cavitating pulmonary tuberculosis
• Advanced liver disease
• Intracardiac thrombi
• Uncontrolled hypertension (systolic blood Pressure >180 mm Hg, diastolic blood pressure >
110 mm Hg
• Puncture of noncompressible blood vessel within 2 weeks
• Previous streptokinase therapy
43. Risks of Coronary Angiography: (all
are rare)
• Stroke
• Myocardial infarction
• Arrhythmia
• Renal failure
• Allergic reaction to contrast agent
44. B. MAINTAINING VESSEL PATENCY
• Anti-platelets
Aspirin 75-300mg daily and/or Clopidogrel 75mg daily
• Anti-coagulants
S/C Heparin 12,500 units twice daily
IV Heparin (within 48-72 hrs of thrombolysis)
Warfarin in Persistant A.Fibrillation & Extensive anterior
infarction
• Adjunctive therapy
B-Blockers Atenolol 5-10mg to dec. pain and arrythmias but
should be avoided in HF, AV Block and severe bradycardia
Nitrates S/L GTN 300-500 mcg in threatened MI and IV nitrates
(Nitroglycerin 0.6-1.2mg/hour or Isosorbide dinitrate are
useful in treating LVF and Ischemic pain relief.
45. C. FURTHER COMPLICATIONS AND THEIR
PREVENTION
1. ARRYTHMIAS (VF, VT, AF, AT, Heart blocks and
Ventricular ectopics)
Can be avoided by Pain relief, Rest and Correction of
hypokalemia
• Vent. Fib….5-10% cases…..prompt defibrillation
• Atrial Fib….transient and rarely requires treatment
….DC cardioversion, Digoxin or B-Blocker are
TOCs…..Patient can go into LVF so give
Anticoagulants
• AV block….Atropine 0.6mg IV + Temporary
pacemaker
46. 2. ISCHEMIA 50% cases known as post-infarct Angina
Managed as Unstable Angina
• IV nitrates (0.6-1.2mg/hour)
• IV heparin (1000 units/hour)…dose adjusted to PT
• LMWH
• GP IIb/IIIa receptor antagonists…..selected cases
3. ACUTE CIRCULATORY FAILURE in extensive myocardial
damage
4. PERICARDITIS (on 2nd
and 3rd
day)
Opiod based analgesics
Also called Post-Infarction syndrome/Dressler’s
syndrome…..fever, pericarditis and pleurisy (due to
auto-immunity)….may require High dose Aspirin,
other NSAIDS and Cortico-steriods.
47. 5. MECHANICAL COMPLICATIONS
Papillary muscle damage…..acute onset pulmonary
edema due to severe MR (PSM + S3)…..diagnosed by
doppler’s echocardiography and treated by
emergency mitral valve replacement
Ruptured IV septum…..Left to right shunt (PSM
radiating to right sternal border difficult to
distinguish from MR) …..diagnosed on doppler’s
echocardiography …..fatal condition
Ventricular rupture…..cardiac tamponade…..fatal
6. EMBOLISM risk is decreased by prophylactic ani-
coagulants and early mobilization
48. 7.IMPAIRED VENTRICULAR FUNCTION
Due to infarct expansion…..lead to progressive
dilataion of the infarcted area and hypertrophy of
the rest of the portion
8. VENTRICULAR ANEURYSM 10% cases
Leads to HF, Ventricular arrythmias, Mural thrombus
and systemic embolism
Echocardiography is diagnostic
Surgical removal improves the chances of survival
49. D. LATE MANAGEMENT
1. RISK STRATIFICATION
LV FUNCTION ISCHEMIA ARRYTHMIAS
•Physical findings …
tachycardia, S3,
Crackles at lung
bases and elevated
venous pressure
•ECG changes
•Size of heart and
Pulmonary edema
on CXR
•Post-infarct angina …
treat like unstable angina
•CABG
•Implantable cardiac
defibrillators
50. 2. LIFE STYLE MODIFICATION
Quit smoking (5 year mortality twice if you don’t
quit)
Regular exercise (20min/day for 3 days/week)
Diet control to decrease weight and lipid lowering
51. 3. DRUG THERAPY (Secondary prevention)
Statins…best results when level of LDL is greater than 3.2
mmol/L….Atovstatin 80mg OD
Anti-platelets…Aspirin/Clopidogrel
B-Blockers….but contra-indicated in Bradycardia, AV block,
hypotension and Asthma
ACE inhibitors….Enalapril 10mg BD, Ramipril 2.5-5mg BD
Angiotensin receptor antagonists….valsartan 40-160mg OD,
Candesartan 4-16mg OD
Control of HTN and DM
4. MOBILIZATION AND REHABILITATION start working in 4-6
weeks
55. ABCs of Treatment and Secondary
Prevention of AMI
• Aspirin-prophylactic Rx for recurrent ischemic events;
give for at least 3 mo. after AMI, probably indefinitely
• Beta blockers-prophylactic, for reduction of cardiac
mortality; Rx for 2 yr-indefinitely
• Converting enzyme inhibitors-all pts with LV
dysfunction to reduce risk of progressive heart failure
and death.
• Diet and lipid lowering Rx-statins have been shown to
reduce risk of subsequent MI, need for
revascularization and mortality (4S, Care)
• Exercise and rehabilitation-essential in restoration of
confidence and improvement in quality of life
56. PROGNOSIS
• 1/4th
of the patients suffering acute MI die in few
min due to any arrythmia
• Half of the MI deaths occur in 1st
24 hours
• 40% of the rest die in 1st
Month
• Anterior infarcts are worse than Inferior infarcts
• BBB and increased enzymes reflects that the
damage is extensive
• Increased mortality is associated with old
age,depression and social isolation
57. SURVIVAL CHANCES
After surviving an acute attack….
• 80 % Survive the 1st
year
• 75 % Survive upto 5 years
• 50% Survive upto 10 years
• 25% survive upto 20 years
Editor's Notes
NOTES FOR PRESENTERS
The key recommendation on cardiac rehabilitation says that:
‘Cardiac rehabilitation should be equally accessible and relevant to all patients after an MI, particularly people from groups that are less likely to access this service. These include people from black and minority ethnic groups, older people, people from lower socioeconomic groups, women, people from rural communities and people with mental and physical health comorbidities.’ (page 6, NICE guideline)
‘Healthcare professionals, including senior medical staff involved in providing care for patients after an MI, should actively promote cardiac rehabilitation’ (page 12, NICE guideline)
NOTES FOR PRESENTERS
‘A home based programme validated for patients who have had an MI that incorporates education, exercise and stress management components with follow-ups by a trained facilitator may be used to provide comprehensive cardiac rehabilitation’ (such as ‘The Edinburgh heart manual’; see www.cardiacrehabilitation.org.uk/heart_manual/heartmanual.htm) (page 12. NICE guideline)
Education should include issues such as:
when to return to work
driver and vehicle licensing agency guidelines
when it is safe to travel by air
sexual activity
how to use a perceived exertion scale to help monitor physiological demand
advice on competitive sport when relevant
advice to contact Civil Aviation Authority if the patient holds a pilot’s licence.
The exercise component should be designed to meet the needs of older patients or patients with significant comorbidity.
NOTES FOR PRESENTERS
The key recommendation on cardiological assessment says that:
‘All patients should be offered a cardiological assessment to consider whether coronary revascularisation is appropriate. This should take into account comorbidity.’ (page 7, NICE guideline)
The Guideline Development Group concluded that there was evidence of effectiveness of coronary revascularisation for secondary prevention in selected stable patients with non-acute coronary disease, and thus patients after MI who had not been considered for coronary revascularisation during the acute phase of management should be considered for further specialist cardiological assessment.