Please enable JavaScript.

Coggle requires JavaScript to display documents.

Ischemic Heart Disease (acute coronary syndromes (situational triggers…

- - - - coronary perfusion pressure
      - coronary vascular resistance
        
        external compression
        
        intrinsic regulation
        
        local metabolites
        
        endothelial factors
        
        neural innervation
- - - - stenosis (narrowing) >70%: blood flow is adequate at rest, but becomes challenging with stress
      - stenosis (narrowing) >90%: insufficient needs at rest
- - - - variant angina
      - silent angina
      - unstable angina
      - postprandial angina
      - stable angina
        
        symptoms
        
        tachycardia
        
        increased BP
        
        mitral valve regurgitation
        
        diaphoresis
        
        nausea
        
        fatigue
        
        weakness
        
        chest pain
        
        discomfort
        
        tightness
        
        burning
        
        heaviness
        
        pressure
    - - ECG
      - stress testing
        
        exercise
        
        pharmacological
      - nuclear imaging
      - echocardiography
      - coronary angiography
    - - restore O2 balance
        
        pharmacology
        
        revascularization
        
        coronary artery bypass graft
        
        lifestyle factors like exercise
        
        cleaning out coronary arteries
  - - - 35+
        
        CAD
        
        plaque disruption with thrombotic occlusion, due to:
        
        wall stress (high HR, high BP)
        
        flexing of artery
        
        augmenting catecholamine-induced platelet aggregation
        
        coronary spasm
        
        theories
        
        hypersensitivity of a-receptors
        
        loss of sensitivity
        
        hyper-contraction
        
        autonomic imbalance
        
        spontaneous
        
        cold
        
        emotional stress
        
        alcohol withdrawal
        
        vasoconstriction medications
        
        illicit drugs (cocaine)
        
        smoking
        
        coronary spasm
      - <35
        
        cardiomyopathies
        
        congenital heart disease
        
        structurally normal heart with ion channel disorders, conduction disease
        
        anomalous coronaries (coronary blood vessels are "bent")
        
        myocarditis
- - - - partial occlusion
      - no necrosis
      - no change in serum biomarkers
    - - partial occlusion
      - necrosis
      - change in serum biomarkers
    - - full occlusion
      - necrosis
      - change in serum biomarkers
  - - - going aerobic to anaerobic
      - dropped pH to break down cell
      - less ATP, so pumps fire rapidly (pumps are impaired)
    - - systolic dysfunction
        
        destruction of myocytes
        
        wall motion abnormalities (loss of synchronous contraction)
        
        hypokinetic = low wall motion
        
        akinetic = no wall motion
        
        dyskinetic = instead of contracting as an inward movement, the heart bulges
        
        diastolic dysfunction = not relaxing the way it should, so there is blood pooling, elevated ventricular filling pressure
      - ventricular remodelling
        
        thinning of infarcted tissue
        
        increased wall stress
        
        increased likelihood of aneurysm
    - - early
        
        1-2m = metabolic changes, dec. function
        
        10m = 50% decrease in ATP
        
        20-24m = irreversible cell injury occurring
        
        1-3h = wavy myofibrils
        
        4-12h = edema, hemorrhage
        
        18-24h = coagulation necrosis
        
        2-4d = total necrosis
      - late
        
        5-7d = clearing of necrotic myocardium
        
        7+ days = ventricular remodelling (thinning, dilation)
        
        7w = deposit collagen to form scar tissue
  - - - dyspnea (difficult, laboured breathing)
      - diaphoresis
      - cool, clammy skin
      - anxiety
      - dizziness
      - palpitations
    - - nausea
      - vomiting
      - weakness
  - - - echocardiography
      - stress test
      - angiography
  - - - pain control with oxygen and morphine, pharmacology
    - - intravenous alteplase (tPA)
      - bolus injection of reteplase (rPA) and tenecteplace (TNK-tPA)
      - stimulates natural fibrinolytic system by activating plasminogen to form plasmin, which cleaves fibrin cross-links and breaks down thrombus
    - - angioplasty
      - stenting
      - coronary artery bypass graft
    - - drugs
      - exercise
      - nutrition
      - stress reduction
      - behaviour change
- - - - shortness of breath with exercise
      - chest pain
      - dizziness
      - blackouts
      - palpitations
      - asymptomatic?
    - - manage symptoms
        
        medications (beta blocker tablets)
        
        modify lifestyle
      - ensure family members are checked (genetics)
      - assess risk of sudden death
        
        if LOW: avoid intense exercise
        
        if HIGH: recommended to use implantable cardioverter defibrillator (ICD)
  - - - inherited (less common)
      - viral illness
      - drugs
      - alcohol
    - - same as those for hypertrophic cardiomyopathy, and both can lead to SCD
    - - ECG
      - echocardiography
    - - medications
      - pacemaker
      - ICD