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MYOCARDIAL ISCHAEMIA - Coggle Diagram

- - - - REDUCE AVAILABILITY OF NUTRIENTS
      - REDUCE REMOVAL OF METABOLIC WASTE
      - LIMITS TISSUE OXYGENATION -- LOWERED ATP
- - - - ISCHAEMIA !!
        
        LIMITS O2
        
        LESS ATP
        
        USE ANAEROBIC RESPIRATION AS COMPENSATION
        
        SUCCESS
        
        REVERSIBLE ISCHAEMIA
        
        FAILED
        
        IIREVERSIBLE ISCHAEMIA
        
        2 more items...
  - - - Degrees of superimposed acute plaque change
      - THROMBOSIS
      - Chronic progressive atherosclerotic narrowing of epicardial coronary arteries
      - SPASM
- - - - THROMBOSIS & VASOCONSTRICTION
        
        SEVERE REDUCTION IN CORONARY BLOOD FLOW
  - - - INDUCE ABRUPT THROMBOTIC OCCLUSION
        
        MYOCARDIAL NECROSIS
  - - - FATAL VENTRICULAR ARRYTHMIA
- - - - IMBALANCE IN CORONARY PERFUSION
    - - PHYSICAL ACTIVITY
      - EMOTIONAL EXCITEMENT
      - PSYCHOLOGICAL STRESS
    - - DEEP, POORLY LOCALIZED PRESSURE
      - SQUEEZING
      - BURNING SENSATION
  - - - PHYSICAL ACTIVITY
      - HEART RATE
      - BLOOD PRESSURE
  - - - SEVERE ANGINA
      - CHEST DISCOMFORT
- - - - IHD
        
        CLINICAL MANIFESTATIONS :-
        
        PROGRESSIVE NARROWING OF LUMEN --> STENOSIS
        
        ACUTE PLAQUE EROSION
        
        RUPTURE W/ THROMBOSIS
        
        SIGNIFICANT CORONARY ARTERY DISEASE
        
        FIXED LESION THAT OBSTRUCT VASCULAR CROSS-SECTIONAL AREA FOR > 75%
        
        SYMPTOMS
        
        ANGINA
        
        INADEQUATE BLOOD FLOW (EVEN AT REST)
        
        COLLATERAL CIRCULATION
        
        PROTECT AGAINST MI
        
        FORMATION OF COLLATERAL VESSELS TO REPLACE BLOCKED VESSELS
  - - - DISTRIBUTION OF ATHEROMATOUS PLAQUES
      - STRUCTURE OF ATHEROMATOUS PLAQUES
      - NO OF ATHEROMATOUS PLAQUE
      - DEGREE OF OBSTRUCTION OF ATHEROMATOUS PLAQUE
    - - UNSTABLE ANGINA
      - ACUTE MI
      - SUDDEN DEATH
        
        HOW IT HAPPENS??
        
        Unpredictable, abrupt conversion of STABLE ATHEROSCLEROTIC PLAQUE --> UNSTABLE
        
        BY:-
        
        SUPERFICIAL EROSION
        
        FISSURING
        
        RUPTURE
        
        DEEP HEMORRHAGE
        
        FACTORS OF ACUTE CORONARY SYNDROMES
        
        THROMBUS
        
        CLASSIFICATION
        
        TOTAL OCCLUSION
        
        PARTIAL
        
        EMBOLIZATION
        
        ACUTE PLAQUE CHANGE
        
        CATEGORIES
        
        RUPTURE
        
        exposed thrombogenic plaque constituents
        
        EROSION
        
        exposed subendothelial basement membrane to blood
        
        HEMORRHAGE
        
        into atheroma --> vol expand
        
        INFLAMMATION
        
        T cells --> TNF // IL-6 // IFN-gamma --> activate endothelial cells & macrophages
        
        CRP = predicts probability of damage in angina pt
        
        ENDOTHELIAL CELLS --> CAMs // selectins
        
        VASOCONSTRICTION
        
        COMPROMISE LUMEN SIZE
        
        INCREASE LOCAL MECHANICAL FORCE
        
        POTENTIATE PLAQUE DISRUPTION
        
        STIMULATE BY :-
        
        CIRCULATING ADRENERGIC AGONIST
        
        LOCALLY RELEASED PLATELET CONTENTS
        
        ENDOTHELIAL CELL DYSFX W/ IMPAIRED SECRETION OF NO & ENDOTHELIN
        
        MEDIATORS FR PERIVASCULAR INFLAMMATORY CELLS