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CORONARY HEART DISEASE (CHD) - Coggle Diagram
CORONARY HEART DISEASE (CHD)
ECG
ELECTROCARDIOGRAM
Medical test that measures the electrical activity of the heart.
NORMAL ECG
QRS Complex
Spread of electrical impulse through the ventricles
Represent ventricular depolarization
P-wave
Spread of the electrical impulse across atria from SA node.
Represent atrial depolarization
T-wave
Represent ventricular repolarization
PR Interval
Electrical impulse spreads over atrium through AV node and Bundle of His
ST Segment
Isoelectric point. No change in electrical activity
QT Interval
Depolarization and repolarization of the ventricles
U-wave
Hypothesise to be Purkinje repolarization
WHY ECG IS DONE
To determine how long the electrical impulse takes to pass through the heart.
Shows if the electrical activity is normal, slow, fast or irregular
To find out if parts of the heart are too large
ELECTROCARDIOGRAPH
A machine used for electrocardiography
DIAGNOSTIC METHOD TO CONFIRM CHD
NUCLEUR STRESS TEST
PROCEDURE
Similar to an exercise stress test but adds image to the ECG recordings
Uses radioactive dye and an imaging machine to create pictures showing the blood flow to the heart
Test measures blood flow while you are at rest and when you are exerting yourself
CARDIAC CATHETERIZATION
PROCEDURE
Catheter is inserted into a blood vessel in the arm/leg/groin area and guided to the heart
Contrasting dye is injected into the blood vessel through the catheter
PREMATURE CHD
MAJOR RISK FACTORS
Men > 45 years old, women > 55 years old
Cigarette smoking
High blood pressure > 140/90
HDL cholesterol < 40 mg/dL
First-degree male relatives with CHD < 55 years old
First-degree female relatives with CHD < 65 years old
HIGHEST RISK FACTORS
Already developed CHD
Already developed arteriosclerosis
BIOCHEMICAL TESTS
HIGH-SENSITIVITY C-REACTIVE PROTEIN TEST
hs-CRP test help determine risk of heart disease before having symptoms
higher hs-CRP level > risk of heart attack, stroke and CVD
LIPOPROTEIN (a) TEST
Is a type of LDL cholesterol determined by genes.
increase amount of Lp(a) are associated with inflammation in arteries wall
CHOLESTROL TEST
Include measurement of:
total cholesterol
(normal < 200 mg/dL),
LDL
(normal <130 mg/dL), HDL (normal > 40 mg/dL) and
triglycerides
(normal < 150 mg/dL)
WHAT IS
CHD
CHD develops when coronary arteries that supply oxygen and blood to the heart become too narrow.
ANGINA
Angina is the chest pain, discomfort or ache caused by reduced blood flow to the heart. Angina is the symptom of CHD and often described as squeezing, pressure, heaviness or pain in chest.
CLASSIC SYMPTOMS
ANGINA
Dizziness, fatigue, nausea and SOB
CHD
Angina, cold sweats, dizziness, SOB, nausea and fatigue
STABLE ANGINA
Also called angina pectoris, the most common type of angina. It is a predictable pattern of chest pain. Stable angina occurs when the heart muscle doesn't get the oxygen it needs to function properly
RISK FACTOR
High blood cholesterol
High blood pressure
Smokers
Physical inactivity
Heredity - include race
Obesity and overweight
Gender
Increasing age
Stress
Alcohol
Diabetes
OTHER ALTERNATIVE PROCEDURE
CORONARY ANGIOPLASTY
Catheter with a balloon at the end is put into the blood vessel of arm or groin.
Have many advantages over CABG: fewer risk, not require a large cut, shorter recovery time
STENTING
Stent (made of metal mesh) is placed in the newly widened part of the artery permanently to lower the risk of re-narrowing
DRUG-ELUTING STENT
Stent that are coated with the medicines that are slowly released into the artery
ATHERECTOMY
A catheter with a rotating shaver on its tip is inserted into the artery to cut away the plaque
LASERS
Similar to angioplasty except the catheter has a laser tip that opens the blocked artery.
MINIMALLY INVASIVE CABG:
MIDCAB AND OPCAB
Median sternotomy incision is avoided
STATIN DRUG: ATORVASTATIN
CONTRAINDICATED
Previously allergic to other statin medicine
Pregnant women
Breastfeeding mom
Patient who have severe liver disease
SIDE EFFECTS
Muscle aches and pain
Constipation
Diarrhea
Nosebleed, cold-like symptom or sneezing
MOA
Blocking enzyme HMG COA reductase
Reduce LDL
Reduce VLDL, serum triglyceride and IDL
Increase HDL
Reduce cholesterol and fat deposition on the arteries wall
Prevent narrowing of arteries and blocked blood flow to the heart
Reduce risk of angina
ISOSORBIDE MONONITRATE
MOA
This drug acts as a donor of nitric oxide (NO). NO causes a relaxation of vascular smooth muscle via the stimulation of guanylyl cyclase and the subsequent increase of cGMP concentration
CONTRAINDICATIONS
Drug allergy
Severe anemia
Severe hypotension
Elevated intracranial pressure
SIDE EFFECTS
Headache, flushing, orthostatic hypotension, syncope and reflex tachycardia
INDICATION
Prophylactic treatment of angina pectoris
BETA BLOCKER DRUG (PROPRANOLOL)
SIDE EFFECTS
Slower heart rate, SOB, fatigue, low blood pressure and nausea
CONTRAINDICATIONS
Patients who have asthma or chronic COPD
Taking certain other cardiac drugs such as CCB
Patients who have certain types of abnormal heart beat
MOA
Blocking the effects of hormone epinephrine
Slow the heartbeat with less force
Reduce the oxygen demand of the heart
Reduce the frequency of angina attack
OTHER DRUGS FOR CHD
ACE - i/ARBs
Captopril
Candesartan
NITRATE
Nitroglycerin
CALCIUM CHANNEL BLOCKER
Amlodipine
ARBs
Candesartan
ASPIRIN
CORONARY BYPASS SURGERY
AIM
To increase blood flow
To cure heart disease
To ease symptoms
TYPE
Depend on how many arteries are blocked; Single, double, triple and quadruple bypass
PROCEDURE
Take healthy blood vessel from another area of the patient's body to bypass the damaged arteries
Take from leg, arm or chest and connect it below and above the blocked arteries in the heart