Myocardial ischemia occurs when blood flow to the heart muscle is inadequate to meet its needs. The leading cause is atherosclerosis which blocks coronary arteries. There are three main types of angina that result from myocardial ischemia: classic angina precipitated by exertion, unstable angina occurring at rest, and variant angina caused by coronary artery spasm. Silent ischemia lacks symptoms but can be diagnosed via stress testing. Treatment aims to increase blood flow by dilating arteries or reduce workload by slowing the heart rate. Pharmacologic therapies include nitrates, beta blockers, calcium channel blockers, and aspirin.
1. Ischemic heart disease (IHD), also known as coronary artery disease, is caused by an imbalance between the heart's oxygen supply and demand, and is commonly seen in middle-aged men and post-menopausal women.
2. The major cause is coronary atherosclerosis, which causes plaque buildup in the coronary arteries and can lead to conditions like angina, acute myocardial infarction (MI), and sudden cardiac death.
3. Acute MI occurs when a coronary artery becomes blocked, causing localized heart muscle cell death from lack of oxygen. It is a medical emergency characterized by chest pain and changes in electrocardiogram (ECG) and cardiac enzyme levels.
Heart failure occurs when the heart is unable to pump enough blood to meet the body's needs. It results from conditions that damage or weaken the heart muscle such as hypertension, heart attack, or cardiomyopathy. Symptoms include dyspnea, fatigue, swelling, and weakness. Diagnosis involves chest x-rays, ECGs, and echocardiograms. Treatment focuses on managing symptoms with diuretics, ACE inhibitors, beta blockers, and addressing the underlying heart condition if possible through surgery or lifestyle changes.
Myocardial infarction, commonly known as a heart attack, occurs when the coronary arteries become blocked, cutting off the blood supply to parts of the heart muscle. This lack of oxygenated blood causes tissues in the myocardial muscles of the heart to die. A myocardial infarction is also referred to as a heart attack and results from prolonged lack of oxygen to the heart muscle cells.
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 describes its types, causes, symptoms, complications, diagnostic tests, and treatment options. Myocardial infarction is the death of heart muscle caused by a blockage in one of the coronary arteries that reduces blood flow. It can be anterior, posterior, or other regions. Risk factors include smoking, hypertension, age, and diabetes. Symptoms include chest pain and shortness of breath. Complications include heart failure, arrhythmias, and cardiac rupture. Diagnosis involves electrocardiograms, blood tests of cardiac enzymes, and imaging tests. Treatment includes medications like aspirin, beta-blockers, and statins as well as surgical procedures like coronary artery bypass grafting and angioplasty
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.
This document defines heart failure and discusses its key characteristics. It describes how heart failure occurs when the heart is unable to pump enough blood to meet the body's needs due to problems like abnormal heart muscle function or excessive loads on the heart. The document outlines the pathophysiology and progression of heart failure, including ventricular dilation and hypertrophy as compensatory mechanisms that ultimately fail. It also covers the clinical features, diagnostic tests, medical management, and nursing care considerations for patients with heart failure.
Study Material
Myocardial infarction (MI), commonly known as a heart attack. MI is a blockage of blood flow to the heart muscle. Myocardial infarction (MI) refers to tissue death (infarction) of the heart muscle (myocardium). It is a type of acute coronary syndrome, which describes a sudden or short-term change in symptoms related to blood flow to the heart. Myocardial infarction is a common presentation of coronary artery disease. The World Health Organization estimated in 2004, that 12.2% of worldwide deaths were from ischemic heart disease.
1. Ischemic heart disease (IHD), also known as coronary artery disease, is caused by an imbalance between the heart's oxygen supply and demand, and is commonly seen in middle-aged men and post-menopausal women.
2. The major cause is coronary atherosclerosis, which causes plaque buildup in the coronary arteries and can lead to conditions like angina, acute myocardial infarction (MI), and sudden cardiac death.
3. Acute MI occurs when a coronary artery becomes blocked, causing localized heart muscle cell death from lack of oxygen. It is a medical emergency characterized by chest pain and changes in electrocardiogram (ECG) and cardiac enzyme levels.
Heart failure occurs when the heart is unable to pump enough blood to meet the body's needs. It results from conditions that damage or weaken the heart muscle such as hypertension, heart attack, or cardiomyopathy. Symptoms include dyspnea, fatigue, swelling, and weakness. Diagnosis involves chest x-rays, ECGs, and echocardiograms. Treatment focuses on managing symptoms with diuretics, ACE inhibitors, beta blockers, and addressing the underlying heart condition if possible through surgery or lifestyle changes.
Myocardial infarction, commonly known as a heart attack, occurs when the coronary arteries become blocked, cutting off the blood supply to parts of the heart muscle. This lack of oxygenated blood causes tissues in the myocardial muscles of the heart to die. A myocardial infarction is also referred to as a heart attack and results from prolonged lack of oxygen to the heart muscle cells.
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 describes its types, causes, symptoms, complications, diagnostic tests, and treatment options. Myocardial infarction is the death of heart muscle caused by a blockage in one of the coronary arteries that reduces blood flow. It can be anterior, posterior, or other regions. Risk factors include smoking, hypertension, age, and diabetes. Symptoms include chest pain and shortness of breath. Complications include heart failure, arrhythmias, and cardiac rupture. Diagnosis involves electrocardiograms, blood tests of cardiac enzymes, and imaging tests. Treatment includes medications like aspirin, beta-blockers, and statins as well as surgical procedures like coronary artery bypass grafting and angioplasty
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.
This document defines heart failure and discusses its key characteristics. It describes how heart failure occurs when the heart is unable to pump enough blood to meet the body's needs due to problems like abnormal heart muscle function or excessive loads on the heart. The document outlines the pathophysiology and progression of heart failure, including ventricular dilation and hypertrophy as compensatory mechanisms that ultimately fail. It also covers the clinical features, diagnostic tests, medical management, and nursing care considerations for patients with heart failure.
Study Material
Myocardial infarction (MI), commonly known as a heart attack. MI is a blockage of blood flow to the heart muscle. Myocardial infarction (MI) refers to tissue death (infarction) of the heart muscle (myocardium). It is a type of acute coronary syndrome, which describes a sudden or short-term change in symptoms related to blood flow to the heart. Myocardial infarction is a common presentation of coronary artery disease. The World Health Organization estimated in 2004, that 12.2% of worldwide deaths were from ischemic heart disease.
Pericarditis is an inflammatory process of the pericardium caused by injury to pericardial cells. This leads to an accumulation of fluid, fibrin, and cells between the two layers of the pericardium, causing friction and pain. Clinical manifestations include sharp chest pain exacerbated by deep breathing that may radiate to the shoulders, as well as a pericardial friction rub heard on auscultation. Complications include arrhythmias, pericardial effusion, and cardiac tamponade. Treatment focuses on reducing inflammation and pain with NSAIDs.
Myocardial ischemia occurs when heart muscle does not receive enough oxygen due to narrowing of the coronary arteries. The main causes are atherosclerosis and coronary thrombosis. Symptoms include chest pain known as angina. Diagnosis involves ECG, stress testing, and cardiac catheterization. Treatment aims to increase blood flow through medications like nitrates and calcium channel blockers, or procedures like angioplasty and bypass surgery. Myocardial infarction results from prolonged ischemia and cell death. It can cause complications like heart failure and arrhythmias. Treatment focuses on restoring blood flow, managing pain and arrhythmias, and preventing further damage.
This document discusses various types of cardiomyopathies:
- Dilated cardiomyopathy is caused by an unknown etiology and results in left ventricular dilatation and systolic dysfunction. It is a common cause of heart failure.
- Hypertrophic cardiomyopathy involves abnormal thickening of the heart muscle and can lead to outflow obstruction. It is a common cause of sudden death in young athletes.
- Restrictive cardiomyopathy causes stiff ventricles and impaired ventricular filling due to disorders like amyloidosis. It presents with symptoms of right and left heart failure.
- Other rare types discussed include arrhythmogenic right ventricular dysplasia and obliterative cardiomyopathy. Diagnosis involves imaging and endomyocardial biopsy
The document discusses cardiomyopathy, which refers to diseases of the heart muscle. There are three main types - dilated, hypertrophic, and restrictive. Dilated cardiomyopathy involves an enlarged and weakened left ventricle. Causes include viral infections, toxins, and genetic factors. Symptoms range from fatigue to breathing difficulties. Diagnosis involves echocardiography, ECG, and cardiac catheterization. Treatment focuses on medications and lifestyle changes to manage symptoms.
1) Ischemic heart disease results from an imbalance between the heart's demand for oxygenated blood and the supply delivered by the coronary arteries, usually due to atherosclerotic plaque buildup.
2) It manifests as stable angina, unstable angina, myocardial infarction, or sudden cardiac death.
3) Myocardial infarction occurs when a blockage in a coronary artery results in prolonged ischemia and cell death in the heart muscle.
Pericardial effusion occurs when fluid accumulates in the pericardial cavity surrounding the heart. Normally up to 50 mL of fluid is present but the cavity can hold up to 2 L if the fluid builds up slowly. Fluid accumulation can negatively impact heart function. There are four main types of pericardial effusion: transudative, exudative, hemorrhagic, and malignant. The two main causes are an imbalance of fluid pressures that allows fluid to leave blood vessels, or inflammation/injury of the pericardium. Symptoms include chest pain, fever, fatigue, and shortness of breath. Fluid is collected via pericardiocentesis and tested based on
An aortic aneurysm is a localized sac or dilation formed at a weak point in the aortic wall. They most commonly occur in the abdominal aorta and can be caused by conditions like hypertension, atherosclerosis, and smoking. Aortic aneurysms are classified as either saccular or fusiform based on their shape and size. Untreated aneurysms risk rupture, which can cause massive hemorrhage and death. Surgical treatment involves replacing the diseased aortic segment with a synthetic graft to prevent rupture.
This document provides information about myocardial infarction (MI) or heart attack. It defines MI as death of heart muscle cells due to lack of oxygen, usually caused by a blockage in the coronary arteries. It lists risk factors for MI such as smoking, diabetes, hypertension, and family history. It describes the signs and symptoms of MI, diagnostic tests including ECG and cardiac enzymes, types of MI, and treatments including thrombolytics, angioplasty, medications, and lifestyle changes to prevent future heart attacks. The nursing management of MI focuses on reducing pain, improving perfusion, preventing complications, health education, and calling for help if symptoms worsen.
This document provides information on heart failure, including:
1. It defines heart failure as the inability of the heart to pump an adequate amount of blood to meet the body's needs.
2. It describes compensatory mechanisms the body uses in response to heart failure like increasing sympathetic activity and activating the renin-angiotensin system.
3. It discusses treatments for heart failure like diuretics, ACE inhibitors, beta-blockers, and cardiac glycosides which aim to reduce workload on the heart and improve contractility.
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.
Heart failure occurs when the heart is unable to pump sufficiently to meet the body's needs. It can be systolic, caused by the ventricles' inability to contract properly, or diastolic, caused by the ventricles' inability to relax and fill normally. Symptoms depend on whether the left or right ventricle is affected. Management involves risk factor control, lifestyle changes, diuretics, ACE inhibitors, beta blockers, and sometimes surgical procedures like defibrillators or transplantation for severe cases.
Chronic constrictive pericarditis is a condition where the pericardium thickens and scar tissue forms, restricting the heart's ability to fill with blood. It results from various causes like infections, surgery, radiation, or autoimmune disorders. On examination, elevated jugular venous pressure and equalization of cardiac filling pressures are seen. Imaging like echocardiograms and CT scans show thickened pericardium. Definitive treatment is surgical removal of the pericardium (pericardiectomy), which improves symptoms in most patients.
- Ischemic heart disease is caused by a reduced blood supply to the heart muscle due to coronary artery atherosclerosis. The heart requires constant blood flow to function properly but atherosclerotic plaques can block this blood flow.
- Symptoms range from stable angina (predictable chest pain) to unstable angina (increasing chest pain) to myocardial infarction (heart attack caused by severe blockage or clot).
- Risk factors include high blood pressure, high cholesterol, smoking, obesity, and lack of exercise. Proper management can reduce the risk of further heart problems.
Heart failure is caused by conditions that weaken the heart muscle such as coronary artery disease and hypertension. The body compensates through mechanisms like the renin-angiotensin system which cause fluid retention, edema, and increased cardiac workload worsening the failure. Treatment goals include reducing preload and afterload through diuretics and vasodilators, improving oxygenation, and increasing contractility. Medications target neurohormonal activation through ACE inhibitors, ARBs, beta-blockers and aldosterone blockade. For severe cases, devices like ICDs, CRT, LVADs and transplantation are used. Lifestyle changes and treating the underlying cause are also important.
Ischemic heart disease is caused by a decreased supply of oxygenated blood to the heart muscle, usually due to atherosclerotic narrowing of one or more coronary arteries. It results in an imbalance between myocardial oxygen supply and demand. Treatment involves aggressively modifying risk factors, stabilizing plaques, and restoring blood flow through revascularization or pharmacotherapy to balance oxygen supply and demand. Pharmacotherapy includes agents that reduce myocardial oxygen demand such as beta-blockers and calcium channel blockers, as well as those that increase supply such as nitrates, statins, and renin-angiotensin system inhibitors. Close monitoring is needed to optimize therapy and prevent complications.
This document discusses ischemic heart disease and coronary artery disease. Coronary artery disease is caused by atherosclerosis which develops due to risk factors like smoking, high blood pressure, high cholesterol, and diabetes. Clinical presentations include stable angina, unstable angina, non-ST elevation myocardial infarction, and ST elevation myocardial infarction. Treatment involves lifestyle modifications, medications like antiplatelets, anticoagulants, and statins, as well as procedures like percutaneous coronary intervention and coronary artery bypass grafting.
This document discusses peripheral arterial disease (PAD), which is usually caused by atherosclerosis and shares risk factors with coronary artery disease such as smoking, diabetes, hyperlipidemia, and hypertension. PAD can present as intermittent claudication (pain in the leg muscles brought on by walking) or critical limb ischemia (rest pain and tissue loss). Treatment depends on the severity and location of the disease. Other vascular conditions mentioned include aneurysms, arterial dissections, and various forms of arteritis.
Endocarditis is inflammation of the inner lining of the heart (endocardium) that usually involves the heart valves. It is commonly caused by bacteria like Staphylococcus that enter the bloodstream through invasive procedures or wounds in the mouth, respiratory tract, GI tract, or GU tract. Risk factors include prior heart damage, dental procedures, heart surgery, and certain medical devices. Symptoms include fever, weakness, weight loss, and chest pain. Diagnosis involves blood cultures, echocardiography, and imaging tests. Treatment consists of intravenous antibiotics for 4-6 weeks to eliminate the infecting bacteria.
This document summarizes ischemic heart disease and coronary artery disease. It discusses the coronary circulation and arteries, myocardial ischemia, coronary artery diseases including angina and myocardial infarction. It covers causes such as atherosclerosis, risk factors, signs and symptoms, diagnoses using tests like ECG, treatment including medications, angioplasty, bypass surgery and prevention strategies.
This document provides an overview of ischaemic heart disease (IHD). IHD is caused by a reduced blood supply to the heart muscle due to narrowed or blocked coronary arteries. The typical symptoms are chest pain or discomfort that is triggered by exertion or stress. A diagnosis involves evaluating risk factors like diabetes, high cholesterol, and family history, and conducting physical exams and diagnostic tests. Treatment focuses on lifestyle modifications and medications to improve blood flow and reduce risk factors for IHD.
Pericarditis is an inflammatory process of the pericardium caused by injury to pericardial cells. This leads to an accumulation of fluid, fibrin, and cells between the two layers of the pericardium, causing friction and pain. Clinical manifestations include sharp chest pain exacerbated by deep breathing that may radiate to the shoulders, as well as a pericardial friction rub heard on auscultation. Complications include arrhythmias, pericardial effusion, and cardiac tamponade. Treatment focuses on reducing inflammation and pain with NSAIDs.
Myocardial ischemia occurs when heart muscle does not receive enough oxygen due to narrowing of the coronary arteries. The main causes are atherosclerosis and coronary thrombosis. Symptoms include chest pain known as angina. Diagnosis involves ECG, stress testing, and cardiac catheterization. Treatment aims to increase blood flow through medications like nitrates and calcium channel blockers, or procedures like angioplasty and bypass surgery. Myocardial infarction results from prolonged ischemia and cell death. It can cause complications like heart failure and arrhythmias. Treatment focuses on restoring blood flow, managing pain and arrhythmias, and preventing further damage.
This document discusses various types of cardiomyopathies:
- Dilated cardiomyopathy is caused by an unknown etiology and results in left ventricular dilatation and systolic dysfunction. It is a common cause of heart failure.
- Hypertrophic cardiomyopathy involves abnormal thickening of the heart muscle and can lead to outflow obstruction. It is a common cause of sudden death in young athletes.
- Restrictive cardiomyopathy causes stiff ventricles and impaired ventricular filling due to disorders like amyloidosis. It presents with symptoms of right and left heart failure.
- Other rare types discussed include arrhythmogenic right ventricular dysplasia and obliterative cardiomyopathy. Diagnosis involves imaging and endomyocardial biopsy
The document discusses cardiomyopathy, which refers to diseases of the heart muscle. There are three main types - dilated, hypertrophic, and restrictive. Dilated cardiomyopathy involves an enlarged and weakened left ventricle. Causes include viral infections, toxins, and genetic factors. Symptoms range from fatigue to breathing difficulties. Diagnosis involves echocardiography, ECG, and cardiac catheterization. Treatment focuses on medications and lifestyle changes to manage symptoms.
1) Ischemic heart disease results from an imbalance between the heart's demand for oxygenated blood and the supply delivered by the coronary arteries, usually due to atherosclerotic plaque buildup.
2) It manifests as stable angina, unstable angina, myocardial infarction, or sudden cardiac death.
3) Myocardial infarction occurs when a blockage in a coronary artery results in prolonged ischemia and cell death in the heart muscle.
Pericardial effusion occurs when fluid accumulates in the pericardial cavity surrounding the heart. Normally up to 50 mL of fluid is present but the cavity can hold up to 2 L if the fluid builds up slowly. Fluid accumulation can negatively impact heart function. There are four main types of pericardial effusion: transudative, exudative, hemorrhagic, and malignant. The two main causes are an imbalance of fluid pressures that allows fluid to leave blood vessels, or inflammation/injury of the pericardium. Symptoms include chest pain, fever, fatigue, and shortness of breath. Fluid is collected via pericardiocentesis and tested based on
An aortic aneurysm is a localized sac or dilation formed at a weak point in the aortic wall. They most commonly occur in the abdominal aorta and can be caused by conditions like hypertension, atherosclerosis, and smoking. Aortic aneurysms are classified as either saccular or fusiform based on their shape and size. Untreated aneurysms risk rupture, which can cause massive hemorrhage and death. Surgical treatment involves replacing the diseased aortic segment with a synthetic graft to prevent rupture.
This document provides information about myocardial infarction (MI) or heart attack. It defines MI as death of heart muscle cells due to lack of oxygen, usually caused by a blockage in the coronary arteries. It lists risk factors for MI such as smoking, diabetes, hypertension, and family history. It describes the signs and symptoms of MI, diagnostic tests including ECG and cardiac enzymes, types of MI, and treatments including thrombolytics, angioplasty, medications, and lifestyle changes to prevent future heart attacks. The nursing management of MI focuses on reducing pain, improving perfusion, preventing complications, health education, and calling for help if symptoms worsen.
This document provides information on heart failure, including:
1. It defines heart failure as the inability of the heart to pump an adequate amount of blood to meet the body's needs.
2. It describes compensatory mechanisms the body uses in response to heart failure like increasing sympathetic activity and activating the renin-angiotensin system.
3. It discusses treatments for heart failure like diuretics, ACE inhibitors, beta-blockers, and cardiac glycosides which aim to reduce workload on the heart and improve contractility.
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.
Heart failure occurs when the heart is unable to pump sufficiently to meet the body's needs. It can be systolic, caused by the ventricles' inability to contract properly, or diastolic, caused by the ventricles' inability to relax and fill normally. Symptoms depend on whether the left or right ventricle is affected. Management involves risk factor control, lifestyle changes, diuretics, ACE inhibitors, beta blockers, and sometimes surgical procedures like defibrillators or transplantation for severe cases.
Chronic constrictive pericarditis is a condition where the pericardium thickens and scar tissue forms, restricting the heart's ability to fill with blood. It results from various causes like infections, surgery, radiation, or autoimmune disorders. On examination, elevated jugular venous pressure and equalization of cardiac filling pressures are seen. Imaging like echocardiograms and CT scans show thickened pericardium. Definitive treatment is surgical removal of the pericardium (pericardiectomy), which improves symptoms in most patients.
- Ischemic heart disease is caused by a reduced blood supply to the heart muscle due to coronary artery atherosclerosis. The heart requires constant blood flow to function properly but atherosclerotic plaques can block this blood flow.
- Symptoms range from stable angina (predictable chest pain) to unstable angina (increasing chest pain) to myocardial infarction (heart attack caused by severe blockage or clot).
- Risk factors include high blood pressure, high cholesterol, smoking, obesity, and lack of exercise. Proper management can reduce the risk of further heart problems.
Heart failure is caused by conditions that weaken the heart muscle such as coronary artery disease and hypertension. The body compensates through mechanisms like the renin-angiotensin system which cause fluid retention, edema, and increased cardiac workload worsening the failure. Treatment goals include reducing preload and afterload through diuretics and vasodilators, improving oxygenation, and increasing contractility. Medications target neurohormonal activation through ACE inhibitors, ARBs, beta-blockers and aldosterone blockade. For severe cases, devices like ICDs, CRT, LVADs and transplantation are used. Lifestyle changes and treating the underlying cause are also important.
Ischemic heart disease is caused by a decreased supply of oxygenated blood to the heart muscle, usually due to atherosclerotic narrowing of one or more coronary arteries. It results in an imbalance between myocardial oxygen supply and demand. Treatment involves aggressively modifying risk factors, stabilizing plaques, and restoring blood flow through revascularization or pharmacotherapy to balance oxygen supply and demand. Pharmacotherapy includes agents that reduce myocardial oxygen demand such as beta-blockers and calcium channel blockers, as well as those that increase supply such as nitrates, statins, and renin-angiotensin system inhibitors. Close monitoring is needed to optimize therapy and prevent complications.
This document discusses ischemic heart disease and coronary artery disease. Coronary artery disease is caused by atherosclerosis which develops due to risk factors like smoking, high blood pressure, high cholesterol, and diabetes. Clinical presentations include stable angina, unstable angina, non-ST elevation myocardial infarction, and ST elevation myocardial infarction. Treatment involves lifestyle modifications, medications like antiplatelets, anticoagulants, and statins, as well as procedures like percutaneous coronary intervention and coronary artery bypass grafting.
This document discusses peripheral arterial disease (PAD), which is usually caused by atherosclerosis and shares risk factors with coronary artery disease such as smoking, diabetes, hyperlipidemia, and hypertension. PAD can present as intermittent claudication (pain in the leg muscles brought on by walking) or critical limb ischemia (rest pain and tissue loss). Treatment depends on the severity and location of the disease. Other vascular conditions mentioned include aneurysms, arterial dissections, and various forms of arteritis.
Endocarditis is inflammation of the inner lining of the heart (endocardium) that usually involves the heart valves. It is commonly caused by bacteria like Staphylococcus that enter the bloodstream through invasive procedures or wounds in the mouth, respiratory tract, GI tract, or GU tract. Risk factors include prior heart damage, dental procedures, heart surgery, and certain medical devices. Symptoms include fever, weakness, weight loss, and chest pain. Diagnosis involves blood cultures, echocardiography, and imaging tests. Treatment consists of intravenous antibiotics for 4-6 weeks to eliminate the infecting bacteria.
This document summarizes ischemic heart disease and coronary artery disease. It discusses the coronary circulation and arteries, myocardial ischemia, coronary artery diseases including angina and myocardial infarction. It covers causes such as atherosclerosis, risk factors, signs and symptoms, diagnoses using tests like ECG, treatment including medications, angioplasty, bypass surgery and prevention strategies.
This document provides an overview of ischaemic heart disease (IHD). IHD is caused by a reduced blood supply to the heart muscle due to narrowed or blocked coronary arteries. The typical symptoms are chest pain or discomfort that is triggered by exertion or stress. A diagnosis involves evaluating risk factors like diabetes, high cholesterol, and family history, and conducting physical exams and diagnostic tests. Treatment focuses on lifestyle modifications and medications to improve blood flow and reduce risk factors for IHD.
This presentation provides a knowledge about Ischemic heart Disease, Ischemia, Mechanism of Action, signs and symptoms, Causes of Ischemia, Ischemia in different body parts, Angina, Myocardial Infarction, Artherosclerosis, Drugs used to treat ischemia and recent discovery related to Cardiac ischemia. An assignment for the subject, Advanced Pharmacology-I, 1st year M.Pharm, 1st semester.
1) Coronary artery disease and myocardial infarction are caused by atherosclerosis and plaque buildup in the arteries leading to ischemia. Unstable angina is a change in a previously stable pattern of chest pain and is part of the acute coronary syndrome continuum.
2) Myocardial infarction is caused by a blockage of blood flow to the heart muscle leading to cell death. It is diagnosed through electrocardiogram changes and cardiac biomarker levels. Complications include arrhythmias and heart failure.
3) Heart failure occurs when the heart can no longer pump sufficiently to meet the body's needs. It can be caused by conditions like coronary artery disease damaging the heart muscle. Types include left or right ventricular failure and
1) Coronary artery disease, including conditions like atherosclerosis, angina, acute coronary syndrome, and myocardial infarction, involve a reduction in blood flow to the heart muscles.
2) Atherosclerosis is a buildup of plaque in the coronary arteries that can restrict blood flow. Myocardial infarction occurs when an artery is completely blocked, killing a section of heart muscle.
3) Risk factors include age, family history, smoking, lack of exercise, obesity, high cholesterol, and conditions like hypertension and diabetes. Chest pain and other symptoms depend on the specific condition. Diagnosis involves electrocardiograms, cardiac enzyme tests, and other exams. Treatment focuses on restoring blood flow, reducing risk factors,
An acute myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow to the heart is blocked causing damage to heart muscle. Diagnosis involves ECGs, blood tests of cardiac markers, and symptoms like chest pain. Treatment focuses on restoring blood flow through medications and preventing further complications. Nursing interventions for an MI aim to support cardiac output and tissue perfusion, manage pain and activity levels, and provide education on lifestyle changes and medication management upon discharge.
The document provides information about cardiomyopathy including its definition, types (dilated, hypertrophic, restrictive), causes, signs and symptoms, risk factors, complications, diagnostic tests, and medical, nursing, and surgical management. It discusses the pathophysiology and details of each type of cardiomyopathy and emphasizes lifestyle changes that can help prevent cardiomyopathy.
Related with cardio vascular system. Angina is Retrosternal chest pain which if left untreated can cause the higher complications with respect to cardiac health of human body. May be this is simple chest pain but if exceeds can cause major damage # prevention is better than cure :-)
Internal Medicine Lecture 4 Chronic forms of ischemic heart disease.pdfSani42793
This document discusses chronic forms of ischemic heart disease. It defines ischemia as a lack of oxygen due to inadequate blood flow. Stable angina is characterized by episodes of chest pain or pressure brought on by exertion and relieved by rest. Coronary atherosclerosis causes ischemia by reducing blood flow through coronary arteries. Ischemia can also occur if oxygen demands are increased or oxygen supply is decreased. Chronic ischemia can lead to conditions like stable angina, unstable angina, heart failure, and sudden cardiac death. Noninvasive tests and coronary angiography are used to diagnose chronic ischemia.
1. The document discusses a demo class on myocardial infarction (MI) or heart attack. It defines MI as the death of heart muscle from interrupted blood supply.
2. Risk factors for MI include smoking, high blood pressure, high cholesterol, lack of physical activity, and more. Causes are typically coronary artery disease, blood clots, or coronary artery spasms.
3. Diagnostic tests discussed are electrocardiogram, stress test, echocardiogram, coronary angiography and more to evaluate symptoms, location, and extent of MI.
This document provides information about cardiac emergencies presented by Mrs. Shalini, an Assistant Professor of Nursing. It defines cardiac emergencies and lists the learning objectives. The major cardiac emergencies discussed include acute myocardial infarction, heart failure, sudden cardiac death, cardiac tamponade, hypertensive emergencies, and dysrhythmias. For each emergency, the document provides definitions, causes, signs and symptoms, diagnostic tests, management, and nursing care considerations.
Ischemic heart disease, also known as coronary artery disease, is caused by a reduced blood supply to the heart muscle due to narrowed or blocked coronary arteries. It can lead to chest pain called angina or a heart attack if a complete blockage occurs. Risk factors include smoking, high blood pressure, diabetes, and high cholesterol. Diagnosis involves electrocardiograms, echocardiograms, stress tests, and angiograms. Treatment includes medications to relieve symptoms and open blocked arteries as well as procedures like angioplasty and bypass surgery. Adopting a healthy lifestyle can help prevent ischemic heart disease.
Angina is a symptom of coronary artery disease that occurs when the heart muscle does not get enough oxygen-rich blood. It is usually felt as chest pain or discomfort when one engages in physical exertion or is exposed to stress. There are two main types - stable angina, which occurs predictably in relation to activity or stress, and unstable angina, which occurs unpredictably even at rest. Diagnosis involves electrocardiograms, stress tests, and coronary angiography to detect blockages in the arteries. Treatment focuses on lifestyle changes, medications to manage risk factors and symptoms, and procedures like angioplasty or bypass surgery in severe cases.
Ischemic heart disease, also known as coronary artery disease, is caused by a reduced blood supply to the heart muscle due to atherosclerosis or plaque buildup in the coronary arteries. The main symptoms include chest pain or angina on exertion. Diagnosis involves electrocardiograms, blood tests, and cardiac stress tests. Treatment focuses on controlling risk factors like high cholesterol, high blood pressure, diabetes and smoking through medications, lifestyle changes and procedures like angioplasty or bypass surgery to restore blood flow. Complications can include heart damage, heart attack and arrhythmias if not properly managed.
Anaesthetic considerations in cardiac patients undergoing nonomar143
1. The document discusses the perioperative management of patients with ischemic heart disease (IHD) and risk of perioperative myocardial infarction.
2. It defines myocardial ischemia and infarction and describes different types of angina and acute coronary syndromes.
3. The preoperative evaluation involves assessing cardiac history and risk factors, examination, investigations, and risk stratification to guide medical optimization and potential revascularization before elective surgery.
Coronary artery disease, also known as coronary heart disease, is caused by a narrowing of the coronary arteries due to atherosclerosis. This limits adequate blood flow to the heart muscle and can damage the heart tissue. Symptoms may include chest pain, arrhythmias, and heart failure. Risk factors include high cholesterol, smoking, hypertension, diabetes, obesity, and family history. Treatment involves lifestyle changes, medications, angioplasty, stents, or coronary artery bypass grafting depending on the severity of disease.
Cardiogenic shock is a condition of diminished cardiac output that severely impairs cardiac perfusion. In this condition in which the heart suddenly can't pump enough blood to meet the body's needs.
Cerebrovascular accident refers to a stroke, which occurs when blood flow to the brain is interrupted. The document discusses the causes, types, symptoms, risk factors, and diagnostic evaluation of strokes. It also summarizes hypertension, myocardial infarction, and coronary artery disease - all of which can increase the risk of strokes if not properly managed.
This document discusses acute coronary syndromes and ischemic heart disease. It begins with an overview of heart anatomy and physiology. It then defines acute coronary syndrome and myocardial infarction, describing signs and symptoms. Risk factors for ischemic heart disease are outlined. The document concludes with descriptions of nursing assessments, diagnoses, and interventions for patients with acute coronary syndromes or ischemic heart disease, focusing on pain management, improving perfusion, and reducing anxiety through education.
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The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms for those who already suffer from conditions like anxiety and depression.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise boosts blood flow, releases endorphins, and promotes changes in the brain which help enhance one's emotional well-being and mental clarity.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help boost feelings of calmness, happiness and focus.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms for those who already suffer from conditions like anxiety and depression.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms for those who already suffer from conditions like anxiety and depression.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
The document provides information about the Post Graduate Common Entrance Test to be held on July 1st, 2017 from 2:30 pm to 4:30 pm for various Masters programs. It lists instructions for candidates regarding filling the answer sheet correctly and details about the structure of the test, which will consist of 75 multiple choice questions worth 100 marks to be completed within 120 minutes. Candidates are advised to carefully read and follow the guidelines for appearing in the exam.
Civil Service 2019 Prelims Previous Question Paper - 2Eneutron
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
Civil Service 2019 Prelims Previous Question Paper - 1Eneutron
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
Civil Service 2018 Prelims Previous Question Paper - 2Eneutron
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
Civil Service 2018 Prelims Previous Question Paper - 1Eneutron
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
Civil Service 2017 Prelims Previous Question Paper - 2Eneutron
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms for those who already suffer from conditions like depression and anxiety.
Civil Service 2017 Prelims Previous Question Paper - 1Eneutron
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise stimulates the production of endorphins in the brain which elevate mood and reduce stress levels.
This document contains the question paper for SNAP 2013 along with the answers to the 150 multiple choice questions. It directs test takers to an online site to attempt previous SNAP papers and provides information about exam preparation resources available on the site such as daily practice questions, preparation strategies, coaching classes, and current affairs.
This document contains the question paper for SNAP 2014 along with the answers to the 150 multiple choice questions. It provides a link to attempt similar past year papers online and lists exam preparation resources for SNAP like daily practice questions, preparation strategies, coaching class recommendations, and current affairs.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
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Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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2. Study objectives
Understand the relationship between myocardial
ischemia and angina.
Distinguish among classic angina, unstable angina,
variant angina and silent ischemia.
Provide a rationale for pharmacologic and
nonpharmacologic therapy in angina and myocardial
ischemia.
Explain the mechanism of action for the nitrates, β-
blockers, calcium channel antagonists, aspirin and heparin
in treatment of angina.
Myocardial Ischemia
3. Myocardial Ischemia
Myocardial ischemia occurs when the blood flow
demands of the heart exceed the blood supplied by
the coronary arteries.
The leading cause of myocardial ischemia
is:
a) atherosclerosis or
b) blockage of coronary arteries due to the
accumulation of lipid plaques and/or thrombus .
Ischemia : Inadequate blood flow to a tissue or part of the body.
4. Pathophysiology of myocardial ischemia:
Under conditions of rest, myocardial oxygen supply and delivery
of nutrients through the coronary arteries should match the
metabolic requirements of the heart. When the metabolic
needs of the heart increase, the coronary blood flow must
increase accordingly.
The myocardial oxygen balance is affected by several
factors that :
• will increase the oxygen and nutrient demand of the
myocardium as: exercise, stress and cold.
• will increase coronary blood flow as cardiac metabolites and
nitric oxide.
Myocardial Ischemia
6. With age and progressive occlusion of coronary arteries, smaller
collateral vessels may begin to carry a greater proportion of blood
and provide an alternate means of perfusion for an area of
myocardium. These collateral blood vessels may run parallel to the
larger coronary arteries and be connected to other small coronary
vessels by vascular connections called anastomoses.
Development of collateral circulation may reduce or delay the
occurrence of symptoms from myocardial ischemia until the blockage
is very progressed.
The presence of extensively developed collateral circulation might
also explain why many older individuals often survive serious heart
attacks when younger individuals, who have not yet developed
collateral circulation, often do not.
Myocardial Ischemia
Pathophysiology of myocardial ischemia:
7. It is the major symptom of myocardial ischemia.
Angina pectoris most commonly presents as pain, pressure or a burning
sensation in the area of the sternum.
Myocardial Ischemia
Manifestation of myocardial ischemia:
Angina pectoris
1. Classic or exertional angina:
Pain is precipitated by increased workload on the heart. May be
caused by exercise, emotions, stress and cold exposure.
Symptoms may remain “stable” for a number of years or progress
in severity.
There are three types of Angina pectoris
8. 2. Unstable angina
Angina that occurs at rest.
Also referred to as “pre-infarct” angina since it is usually associated with
extensive blockage of coronary arteries. Coronary blood flow does not meet the
needs of the heart even at rest.
Requires intensive treatment and evaluation.
3. Variant angina (vasospastic angina, Prinzmetal’s angina)
Caused by vasospasm of the coronary arteries.
Usually associated with coronary artery disease but may result from excess
sympathetic activity.
Frequently occurs at night, at rest or during minimal exercise.
May be precipitated by stress, cold exposure or smoking.
Myocardial Ischemia
There are three types of Angina pectoris
9. Silent ischemia
is a particularly dangerous form of myocardial
ischemia as there is a lack of clinical symptoms,
i.e., ischemia without angina. Usually diagnosed
by exercise stress testing or Holter monitoring
Myocardial Ischemia
11. Treatment of myocardial ischemia and the resulting angina
can involve two strategies:
1. Increase coronary blood flow by dilating coronary arteries.
2. Reduce cardiac workload by reducing heart rate and/or
force of contraction
Rationale for treatment of myocardial ischemia:
Myocardial Ischemia
12. The treatment regimen may include :
1. nonpharmacologic treatment
2. pharmacologic therapies.
Myocardial Ischemia
Treatment of myocardial ischemia:
• Pacing of physical activity.
• Avoidance of stress (emotional, physiologic, cold).
• Reduction of risk factors for ischemic heart disease,
(hyperlipidemia, obesity, hypertension, diabetes, smoking, etc.)
Nonpharmacologic treatment
13. Mechanism of action:
• Dilate coronary arteries and increase myocardial blood flow.
• Dilate peripheral arteries and reduce afterload.
• Dilate peripheral veins and reduce preload.
Examples
Amyl nitrate, nitroglycerine, isosorbide dinitrite
Route of administration : Inhalation, sublingual, oral, transdermal, intravenous
Long-acting forms such as isosorbide dinitrite used for prophylaxis of angina
Short-acting forms such as sublingual nitroglycerin may be used during angina
attacks
Major adverse effects :include headache, hypotension. Tolerance may develop
rapidly.
Pharmacologic treatment
Treatment of myocardial ischemia:
Organic Nitrates
14. Mechanism of action:
Block myocardial β-adrenergic receptors.
Reduce heart rate and cardiac output (reduced myocardial
workload and oxygen demand).
Examples of β-Adrenergic Receptor Antagonists :
May be selective β1 (atenolol), or
nonselective β1 and β2 blockers (propranolol)
Major adverse effects :
include bradycardia, reduced cardiac output, pacemaker
depression and bronchoconstriction with nonspecific drugs
Pharmacologic treatment
Treatment of myocardial ischemia:
β-Adrenergic blockers
15. Mechanism of action:
• Block calcium channels in vascular smooth muscle.
• Dilate coronary arteries and increase myocardial blood flow.
• Dilate peripheral arteries and reduce afterload.
Examples: Dihydropyridines (nifedipine), verapamil, diltiazem
Dihydropyridines have greater specificity for relaxing vascular smooth muscle
Verapmail and diltiazem have greater effects on cardiac pacemaker tissues
Major adverse effects include headache, hypotension, reflex tachycardia; risk of
heart block of cardiac failure particularly with verapamil or diltiazem
Also used for hypertension and arrhythmia
Pharmacologic treatment
Treatment of myocardial ischemia:
Calcium channel blockers
Afterload :The force that the contracting heart must generate to
eject blood. Affected by peripheral vascular resistance and arterial
pressure.
16. • Prevent platelet aggregation.
• Use for prophylaxis of blood clots particularly in unstable angina.
Pharmacologic treatment
Treatment of myocardial ischemia:
Aspirin
17. Coronary angioplasty
• Uses a balloon catheter to open occluded blood vessels
• Usually performed under local anesthetic
• 5% mortality, high rate of vessel re-occlusion
• Use of metal “stents” in opened vessel reduces rate of occlusion
Surgical treatment
Treatment of myocardial ischemia:
Coronary artery bypass graft
• Revascularization procedure in which a blood vessel is taken from elsewhere in
the body and surgically sutured around a blocked coronary artery
• May involve multiple (one to five) blood vessels
• Re-occlusion of transplanted vessel is possible
18. Study objectives
• Understand the etiology of myocardial infarction.
• Distinguish the types of myocardial infarction that might occur.
• Understand the sequence of events that accompanies a myocardial infarction.
• List the major clinical and physiologic manifestations of myocardial infarction.
• Discuss the role of cardiovascular compensatory mechanisms in myocardial
infarction.
• Describe the complications that might arise from a myocardial infarction.
• Discuss the rationale for the various treatment aspects involved in myocardial
infarction.
Myocardial Infarction
20. Myocardial infarction or “heart attack” is an irreversible injury to and
eventual death of myocardial tissue that results from ischemia and
hypoxia.
Myocardial infarction is the leading killer of both men and women in the
United States.
Most heart attacks are the direct result of occlusion of a coronary blood
vessel by a lipid deposit. These lipid deposits may accumulate to the
point where they completely block a coronary vessel or, more
commonly, accumulated lipid plaques may break off from the vascular
endothelium and act as a thrombus that blocks a coronary artery at a
narrower point downstream. Prolonged vasospasm might also
precipitate a myocardial infarction in certain individuals.
Myocardial Infarction
21. Coronary blood flow and myocardial infarction
The location of a myocardial infarction will be largely
determined by which coronary blood vessel is occluded.
The two main coronary arteries supplying the myocardium
are:
a) the left coronary artery (which subdivides into the left
anterior descending and circumflex branches) and
b) the right coronary artery
Myocardial Infarction
22. The two main coronary arteries supplying the myocardium are:
1. the left coronary artery (which subdivides into the left anterior descending
and circumflex branches) and
2. the right coronary artery
Coronary Arteries for the heartCoronary Arteries for the heart
23. The left anterior descending artery supplies blood to the bulk of the
anterior left ventricular wall, while the left circumflex artery provides
blood to the left atrium and the posterior and lateral walls of the left
ventricle. The right coronary artery provides blood mainly to the right
atria and right ventricles.
Nearly 50% of all myocardial infarctions involve the left anterior
descending artery that supplies blood to the main pumping mass of the
left ventricle.
The next most common site for myocardial infarction is the right
coronary artery, followed by the left circumflex.
Myocardial Infarction
24. A myocardial infarction may be:
a) transmural, meaning it involves the full thickness of the
ventricular wall, or
b) subendocardial, in which the inner one third to one half of
the ventricular wall is involved.
Transmural infarcts tend to have a greater effect on cardiac
function and pumping ability since a greater mass of
ventricular muscle is involved.
Myocardial Infarction
25. 1. Severe chest pain and discomfort : Pressing or crushing sensation often
accompanied by nausea, vomiting, sweating and weakness due to
hypotension. A significant percentage of myocardial infarctions are “silent”
and have no symptoms.
2. Irreversible cellular injury: Generally occurs 20 to 30 minutes after the onset
of complete ischemia.
3. Release of myocardial enzymes such as creatine phosphokinase (CPK)
and lactate dehydrogenase (LDH) into circulation from myocardial
damaged cells.
Myocardial Infarction
Manifestations of myocardial infarction
26. 4.Electrocardiogram changes : Inversion of T wave, ST elevation, pronounced
Q waves.
5.Inflammatory response from the injured myocardium : Leukocyte infiltration,
increased white blood cell counts, fever.
6. Coagulative necrosis of the area of the myocardium affected by the
infarction.
7. Repair of damaged areas occurs by replacement with scar tissue and not
functional muscle tissue; therefore, some alteration in function is inevitable.
Manifestations of myocardial infarction
Myocardial Infarction
27. Depending on the extent of the area involved in a myocardial infarction, a
number of complications might arise, including:
1. Rupture of weakened myocardial wall. Bleeding into pericardium may
cause cardiac tamponade and further impair cardiac pumping function.
This is most likely to occur with a transmural infarction. Rupture of the
septum between the ventricles might also occur if the septal wall is
involved in the infarction.
2. Formation of a thromboembolism from pooling of blood in the ventricles.
3. Pericarditis : Inflammation due to pericardial friction rub. Often occurs 1 to
2 days after the infarction.
4. Arrhythmia : Common as a result of hypoxia, acidosis and altered
electrical conduction through damaged and necrotic areas of the
myocardium. May be life-threatening and lead to fibrillation.
Myocardial Infarction
Complications of myocardial infarction
28. 5. Reduced cardiac function : Typically presents with reduced myocardial
contractility, reduced wall compliance, decreased stroke volume and
increased left ventricular end diastolic volume.
6. Congestive heart failure may result if a large enough area of the
myocardium has been damaged such that the heart no longer pumps
effectively.
7. Cardiogenic shock : Marked hypotension that can result from extensive
damage to the left ventricle. The resulting hypotension will trigger
cardiovascular compensatory mechanisms that will further tax the
damaged myocardium and exacerbate impaired function. Cardiogenic
shock is associated with a mortality rate of 80% or greater.
Myocardial Infarction
Complications of myocardial infarction
29. As a result of the hypotension and hemodynamic changes that accompany
a myocardial infarction, the cardiovascular system initiates a number of
reflex compensatory mechanisms designed to maintain cardiac
output and adequate tissue perfusion:
1.Catecholamine release : Increases heart rate, force of contraction and
peripheral resistance.
2. Sodium and water retention.
3. Activation of renin–angiotensin system leading to peripheral
vasoconstriction.
4. Ventricular hypertrophy.
Unfortunately, these compensatory changes may increase oxygen demand
and workload on the infarcted heart and worsen overall cardiac function.
Myocardial Infarction
Compensatory mechanisms of myocardial infarction
30. A main goal of intervention for myocardial infarction is to limit the
size of the infarcted area and thus preserve cardiac function.
Early recognition and intervention in a myocardial infarction have
been shown to significantly improve the outcome and reduce
mortality in patients.
If employed in the early stages of myocardial infarction, antiplatelet-
aggregating drugs such as aspirin and clot-dissolving agents such
as streptokinase and tissue plasminogen activator may be very
effective at improving myocardial blood flow and limiting damage to
the heart muscle.
Myocardial Infarction
Rationale for therapy
31. Other drugs such as vasodilators, β -adrenergic blockers and ACE
inhibitors can also improve blood flow and reduce workload on the
injured myocardium and thus reduce the extent of myocardial
damage.
The development of potentially life-threatening arrhythmias is also
common during myocardial infarction as a consequence of hypoxia,
acidosis and enhanced autonomic activity and must be treated with
appropriate antiarrhythmic drugs.
Supportive therapies such as oxygen, sedatives and analgesics are
also utilized.
Myocardial Infarction
Rationale for therapy
32. 1. Oxygen : Used to maintain blood oxygenation as well as tissue and
cardiac O2 levels.
2. Aspirin : If administered when myocardial infarction is detected, the
antiplatelet properties of aspirin may reduce the overall size of the
infarction.
3. Thrombolytic therapy :If employed in the first 1 to 4 hours following the
onset of a myocardial infarction, these drugs may dissolve clots in
coronary blood vessels and re-establish blood flow.
4. Vasodilator drugs : Intravenous nitroglycerin can increase blood flow to
the myocardium and reduce myocardial work.
Treatment for myocardial infarction
Myocardial Infarction
33. 5.β -Blockers : Blunt the effect of catecholamine release on the
myocardium, reduce heart rate and myocardial work.
6. Pain management : Sublingual nitroglycerin, morphine if necessary
7. Antiarrhythmic drugs : To treat and prevent a number of potentially
life-threatening arrhythmias that might arise following a myocardial
infarction.
8. ACE inhibitors : the negative effects of vasoconstriction and salt and
water retention on the myocardium.
Treatment for myocardial infarction
Myocardial Infarction
34. a. Streptokinase : Derived from β -hemolytic streptococcus bacteria;
involved in the activation of plasmin
b. Anistreplase (APSAC) : Complex of human lys-plasminogen and
streptokinase; Administered as a prodrug
c. Alteplase (TPA): Recombinant tissue plasminogen activator
d. Urokinase : Endogenous human enzyme that converts
plasminogen to active plasmin
e. Routes of administration : Intravenous. for all of the above
f. Major unwanted effects : Internal bleeding, gastrointestinal
bleeding, stroke, allergic reactions
Myocardial Infarction
Thrombolytic Agents Used Clinically
35. a. Sublingual nitroglycerin : Potent vasodilator of coronary
arteries, also dilates
b. peripheral arteries and veins to reduce preload and
afterload on the heart
c. Morphine sulfate : Powerful opioid analgesic that also
provides a degree of
d. sedation and vasodilatation; although the opioid
analgesics have little effect on
e. the myocardium, they are powerful respiratory
depressants
Myocardial Infarction
Pain Management in Myocardial Infarction
36. • Inhibits the cyclo-oxygenase pathway for the synthesis of
prostaglandins, prostacyclins and thromboxanes.
• Inhibits aggregation of platelets and is effective in reducing
myocardial infarction, stroke and mortality in high-risk
patients.
Myocardial Infarction
Aspirin
37. Key terms
• Cardiac tamponade : Excessive pressure that
develops from the accumulation of fluid in the
pericardium.
• Pericarditis : Inflammation of the pericardium.
• Stroke volume : Volume of blood ejected from
each ventricle per beat.
• End-diastolic volume : Volume of blood remaining
in the ventricle at the end of systole (contraction).
Myocardial Infarction