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Acute myocardial infarction (Pathophysiology (Decreased blood flow in the…
Acute myocardial infarction
More than 80% of acute myocardial infarcts are the result of coronary atherosclerosis with superimposed luminal thrombus. Uncommon causes of myocardial infarction include coronary spasm, coronary embolism, and thrombosis in nonatherosclerotic normal vessels.
Pathophysiology
Decreased blood flow in the coronary arteries
Activation of coagulation factors 7 and 10
Conversion of prothrombin to thrombin and fibrinogen to fibrin
Platelet aggregation
Thromboxane A2
Vasoconstriction
Platelet activation and resistance to fibrinolysis
Change in conformation at the glycoprotein IIa/IIb receptor
Platelet deposit at the site of broken plate
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Sudden occlusion of a major branch of a coronary artery shifts aerobic or mitochondrial metabolism to anaerobic glycolysis within seconds.
Reduced aerobic ATP formation stimulates glycolysis and an increase in myocardial glucose uptake and glycogen breakdown.
Decreased ATP inhibits Na + , K + -ATPase, increasing intracellular Na + and Cl − , leading to cell swelling
Activate pyruvate
Pyruvate is not readily oxidized in the mitochondria, leading to the production of lactate, a fall in intracellular pH, a reduction in contractile function, and a greater ATP requirement to maintain Ca 2+ homeostasis
Myocardial revascularization
Myocardial revascularization surgery is the gold standard in the treatment of a broad spectrum of coronary disease. The advantages of the surgery with extracorporeal circulation, such as surgery with extracorporeal circulation, such as in a still, bloodless field, led to the coronary surgery with CEC will become the technique of choice.
Phases
Induction of anaesthesia and establishment of complementary intraoperative monitoring measures
Placement of the patient and surgical drapes
Midline sternotomy or other appropriate technique
Removal and evaluation of vascular ducts
Heparinization and cannulation for cardiopulmonary bypass
Heparinization and cannulation for cardiopulmonary bypass
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Angie Lorena Pineda Cárdenas
