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I’ve got severe pain in my chest, decrease Cardiac Work, start with, such…
I’ve got severe pain in my chest
Causes of Retrosternal Chest Pain
include
Heart-related causes
such as
Angina
is considered as
Referred Pain
due to
the involvement of a neural reflex pathway via the thoracic and cervical nerves
is defined as
pain perceived at a location other than the site of the painful stimulus/ origin
as a result
it is not felt in a specific spot
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Myocardial Infarction
Aortic Dissection
Pericarditis
Atrial Fibrillation
Lung-related causes
such as
Pulmonary embolism
Collapsed lungs
Pulmonary Hypertension
Tracheitis
Digestive causes
such as
Heartburn
Swallowing disorders
Gallbladder/pancreas problems
Esophageal cancer
Muscle & Bone causes
such as
Costochondritis
Sore muscles
Injured ribs
Bone cancer
Coronary Artery Disease
include some
Risk Factors
such as
Obesity
Diabetes
Hypertension
Hyperlipidemia
Smoking
Family History & Age
Myocardial infarctions
Has
Complication
Include
Left sided heart failure
Caused by
Weakend heart muscle is unable to pump blood
Cardiogenic shock
Rupture of infarcted wall
Extension of infarcts
Acute mitral regurgitation
Caused by
Infarction of papillary muscles
Arrhythmias
Such as
Fatal ventricular fibrillation
Mural thrombi and emboli
Pericarditis
Are
Irreversible coagulative necrosis due to ischemia caused by a totally occluded coronary artery (20-40 mins later).
Have patterns
Subendocardial
Transmural (4 hrs later)
Lead to
Tissue changes
Macroscopic
Well-defined soft yellow (3-7) days
Gelatinous and soft (10 days)
Pale - yellow (18-24 hrs)
Firm - pale gray (6 weeks)
Microscopic
Neutrophil infiltration and loss of nuclei (12-72 hrs)
Phagocytosis of dead cells by macrophages (3-7 days)
Wavy myocytes with loss of straitions and karyorrhyxis (1-4 hrs)
Granulation tissue formation (7-10 days)
Anatomy
The heart receives its own supply of blood from the
coronary arteries
two branches
Right Coronary Artery
including
sinu-atrial nodal branch
right marginal branch
atrioventricular nodal branch
Posterior interventricular artery
Left Coronary Artery
including
Circumflex branch
Anterior interventricular branch
draining deoxygenated blood from the myocardium into the cardiac chambers by
Coronary veins
throw
mainly
Coronary Sinus
Examples of these veins
Great Cardiac Vein
Middle Cardiac Vein
Small Cardiac Vein
or
Directly to the chambers
for examples
Anterior Cardiac Vein
Thebesian veins
Angina
what is it?
Type of chest pain caused by reduced blood flow to the heart
types
unstable angina
variant angina
stable angina
microvascular angina
clinical features
Pain in the neck shoulder and jaw
SOB
physical findings and examinations
pulse delay
physical findings of abnormal lipid metabolism
third and/or fourth heart sounds
A positive Levine sign
arteriovenous nicking upon ophthalmic examination
Anti-anginal drugs
are divided into
CCBs
are
Dihydropyridines
Amlodipine
Nifedipine
Non- Dihydropyridines
Verapamil
Diltiazem
Organic Nitrate
are
Nitroglycerin
ISDN
ISMN
Moa
Activate GC
Convert
GTP TO cGMP
Inactivate
MLCK-PO4
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Effects
Venous vasodilation
Arterial vasodilation
Collateral vasodilation
Side effects
Throbbing headache
Postural hypotenstion
Flusing
Reflex tachycardia
B-blockers
Moa
Block B1 receptors
Decrease CO+HR+BP+Contractility
Less oxygen demand
Decrease frequency + Severity of angina
Ex
Avoid
Pindolol
Propranolol
Use
Metoprolol
Atenolol
Threptic uses
MI --> Reduce EF
Stable angina
Initial therapy
Ranalozene
If all anti-anginal therapy failed
Inhibit late Na channals
Dyslipidemia drug management
Multiple types
Statins
Drugs are
Atrovastatins & Rousvastatins
Adverse effect
Increase the level of liver enzymes
Rhabdomyolysis
MOA
Inhibiting the HMG COA reductase
Fibrates
Drugs are
Fenofibrate & Gemfibrozil
MOA
binds to PPAR alpha and activates Lipoprotein lipase
Adverse effect
Gallstones
Niacin
one drug which is nicotinic acid
MOA
Decrease the level of HSL and hence decrease the immobilization of FFA
Adverse effect
Flushing
Bile Acid Sequestrants
Drugs are
Cholestyramine & Colestipol
MOA
Inhibit the reabsorption of bile acids
Adverse effect
Constipation
CAI
Drug is Ezetemibe
MOA
inhibit the entry of dietary chylomicrons through inhibiting the NPC1L1
No common adverse effect
PCSK9 inhibitor
Shock
is
a critical condition brought on by sudden drop in blood flow
leads to
cellular and tissue hypoxia
resulting in
cellular death and dysfunction of vital organs
Clinical features
Tachycardia
Tachypnea
Hypotension
Cold clammy extremities
Mottled skin
Oliguria
Types
Hypovolemic
caused by
Decreased blood volume
Septic
caused by
infections
Anaphylactic
caused by
allergic reaction
Neurogenic
caused by
damage of nervous system
Cardiogenic
causes
Pulmonary embolism
acute MI
Heart attack
Arrhythmia
Over doses of HTN drugs
risk factors
Age
Diabetes and obesity
Men more than women
Diagnosis
Medical history
Physical examination
Pulse and BP
Urination
Hand & feet
Diagnostic tests
Chest X-ray
Coronary angiography
which is
a type of X-ray used to check blood vessels
help in
Angioplasty
which is
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ECG
treatment of MI
Long term
FOLLOW-UP VISITS
review of symptoms
medication reconciliation
cardiovascular risk assessment
psychosocial status
Cardiac rehabilitation
Medical evaluation.
Physical activity
Lifestyle education\Support
ACTIVITY RECOMMENDATIONS
driving
physical activity
traviling
Emergency
sublingual nitroglycerin
adequate analgesia
oxygen by nasal prongs
aspirin
A 12-lead electrocardiogram (ECG) should also be performed
internal validity
reffering to the
quality of the study
Examination of
Biases
Selection
Information
Non-causal associations
Confounding
Causal associations
Atherosclerosis
what is it?
A vessel wall thickening caused by the accumulation of WBCs, fatty streak and proliferation of intimal- smooth muscle cell creating an athermatous plaque.
pathogensis
Step1: present of Irritant event
that will
Step2: damage the endotheium
makes the
step 3: LDL-C deposite inside the intima
that will
activiation of immune system (monocyte)
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complications
include
Embolism
Chronic narrowing of BV
leading to
ischemia
Acute occlusion
e.g,
MI
stroke
Aneurysm
decrease Cardiac Work
start with
such as
such as
includes
includes
like
including
ends with
Leading to :
