Please enable JavaScript.
Coggle requires JavaScript to display documents.
CHEMICAL PATHOLOGY: Heart Failure & MI - Coggle Diagram
CHEMICAL PATHOLOGY:
Heart Failure & MI
Acute Cardiac Presentations
Sudden Death(due to dysrhythmia)
Dyspnoea
Chest Pain(due to ischaemia/pericarditis)
IHDs Pathophysiology
Due to
atherosclerosis
>
Atherosclerotic plaque
Rupture into lumen>platelet aggregation>clot>
MI
>Lethal dysrhythmia
narrow vessel>stable/unstable angina .
Risk Factors
: Dyslipidemia & Insulin resistance
CCF
Physiological Adaptations
Response>Fluid Overload
ANP/BNP>oppose A-II action
A-II opposed action>water loss, decrease sympathetic tone>decrease afterload
ANP & BNP produced by stretched ventricles
Response>Tissue Hypoperfusion
Increase cardiac afterload>increase BP
Activates RAA system: Aldosterone, Ang II ,ADH
Biomarkers
N-Terminal proBNP
unaffected by CCF treatment
Differentiate cardiac dyspnoea from other causes
Longer half life
BNP
Reduce fluid overloaded
Reduce hypertrophy
Short half life(Neprilysin)+
Causes
HPT
Restrictive H.D
IHD
High Output Cardiac Failure, Heart Valvular Disease ,Cardiomyopathy
Pulmonary congestion & oedema
Treatment
Reduce Afterload
ACE Inhibitors
NPI
ARNI
Beta Blockers
Aldosterone receptor inhibitor
spironolactone
Reduce Preload
Increase Fluid excretion>Loop (Furosemide) & Thiuzide Diuretics
Decrease fluid & salt
Increase Cardiac Contractility>Cardiac glycosides>
Digoxin
-(Digitalis)
Increase vagal stimulation>decrease Heart rate
Toxicity>Hyperkalaemia,cardiac failure>treat with anti-digoxin antibody
Digitalis inhibits action of cardiac myocite membrane Na+/K+ATPase Pump
Long term
>Valve replacement surgery,bypass,thyroid ablation
MI
Cardiac Biomarkers
CK&CK-MB
Time=rise within
6 hrs
, drops again in
3-4 days
Specificity:
CK-MB is cardiac specific
Detects re-infarction
CTnT &CTnI
Time:
4-6 hrs
after MI> Elevated for 10-14 days
Cut off for +Trop T>99th centile of normal range
Markers for Myocardial damage
Myoglobin
Time=rapid rise within
1 hr,
peaks within
10hrs
,undetectable after
36hrs
Very Sensitive & not specific
Rules out
current MI
Management
Morphine
(Analgesia)
Heparin
(anticoagulation)
Aspirin
(Antiplatelet adhesion)
Revascularization:
angioplasty&Bypass
O2
if dyspnoeic
Diagnosis
2/3 of:
Diagnostic changes"STEMI"=
Cardiac Biomarkers
Clinical Symptomatology