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CORONARY CIRCULTION AND ISCHEMIC HEART DISEASES - Coggle Diagram
CORONARY CIRCULTION AND ISCHEMIC HEART DISEASES
Coronary Circulation*
Coronary Arteries:
Left Coronary Artery (LCA):
Divides into Left Anterior Descending (LAD) and Left Circumflex (LCX) arteries.
Right Coronary Artery (RCA):
Supplies right atrium, right ventricle, and parts of the left ventricle and septum.
Coronary Veins:
Great Cardiac Vein
drains the left heart.
Middle Cardiac Vein
drains the posterior heart.
Small Cardiac Vein
drains the right heart.
. Physiologic Anatomy of Blood Supply*
Epicardial Vessels:
Large arteries on the surface of the heart; provide primary blood supply.
Endocardial Vessels:
Smaller vessels within the heart muscle; supply the inner myocardium.
Collaterals:
Small, alternate pathways that can develop in response to chronic obstruction.
Microcirculation:
Smallest blood vessels involved in nutrient and gas exchange within the myocardium.
Causes of Death After Acute Coronary Occlusion*
Acute Myocardial Infarction (MI):
Necrosis of heart muscle due to prolonged ischemia.
Complications:
Arrhythmias (e.g., ventricular fibrillation), heart failure, shock.
Arrhythmias:
Most common cause of death (e.g., VF or asystole).
Reentrant Circuits:
Disrupt normal conduction.
Cardiogenic Shock:
Severe drop in cardiac output due to loss of myocardium.
Mechanical Complications:
Rupture of heart structures
(e.g., septum, free wall).
Pulmonary Edema:
Left ventricular failure leading to fluid accumulation in the lungs.
Decreased Cardiac Output - Systolic Stretch & Cardiac Shock*
Systolic Dysfunction:
Reduced myocardial contractility.
Decreased stroke volume leads to low cardiac output.
Systolic Stretch:
Overstretching of myocardium leads to decreased efficiency.
Starling’s Law:
Overstretch reduces contractile force.
Cardiogenic Shock:
Result of severe myocardial infarction or heart failure.
Low systemic perfusion despite high circulating volume.
Signs of Shock:
Hypotension, tachycardia, cold extremities, oliguria.
Stages of Recovery from Acute MI*
Stage 1 - Acute Phase (First 24-72 hours):
Inflammation, tissue necrosis, and risk of arrhythmias.
Monitoring and stabilization required.
Stage 2 - Subacute Phase (1-2 weeks):
Formation of granulation tissue.
Scar formation begins; risk of ventricular remodeling.
Stage 3 - Healing Phase (2 weeks - 6 months):
Scar tissue replaces necrotic tissue.
Gradual improvement in cardiac function.
Stage 4 - Chronic Phase (6 months+):
Full myocardial remodeling.
Long-term rehabilitation and lifestyle adjustments.
Function of Heart After Recovery from MI*
Cardiac Remodeling:
Changes in size, shape, and function of the heart post-infarction.
May result in dilated cardiomyopathy or hypertrophy.
Left Ventricular Dysfunction:
Decreased ejection fraction (EF) if extensive infarction.
Compensatory Mechanisms:
Increased sympathetic tone, renin-angiotensin activation to maintain perfusion.
Risk of Heart Failure:
Chronic heart failure due to reduced myocardial capacity.
Improved Function Post-therapy:
Cardiac rehab, medications (ACE inhibitors, beta-blockers), and lifestyle changes can improve long-term outcomes.
Surgical Treatment of Coronary Artery Disease (CAD)*
Coronary Artery Bypass Grafting (CABG):
Indicated for multi-vessel disease or left main coronary artery disease.
Uses grafts (e.g., saphenous vein, internal mammary artery) to bypass blocked coronary arteries.
Percutaneous Coronary Intervention (PCI):
Balloon angioplasty or stenting for single-vessel disease.
Often preferred in acute settings (e.g., STEMI).
Endarterectomy:
Surgical removal of plaque from arteries in rare cases.
Hybrid Procedures:
Combination of CABG and PCI for comprehensive treatment.
Post-surgical Care:
Monitoring for graft patency, prevention of restenosis, and rehabilitation.