Outline :
Outline
Slide 3:
Definition Epidemiology Irreversible necrosis of cardiac myocyte 2 0 to prolonged ischemic ( extention of ACS ( unstable angina, NSTEMI)) 1.5 million cases of MI each year and CVD cause 12million deaths each year High risk among African American and white population in US Male predominance and premenopausal women are protected (E2) Incidence increases with age
Slide 4:
Aetiological factors Risk factors Atheromatous plaque > cracked and ruptured > thrombus (occlusive or partially) Coronary artery embolism Congenital anomaly Coronary artery vasculitis – kawasaki disease in child Dissecting aneurysm w coronary occlusion Non-modifiable Age, Sex, FH Modifiable Smoking and obestity DM, HPT,Dyslipidemia Non atherosclerotic causes Vasculitis Coronary embolism, trauma, spasm (histamine, serotonin) Drugs- coccaine Congenital Factor increase O2 requirement / decrease O2 supply Others Homocysteine Peripheral vascular D Stress
Pathophysiology :
Pathophysiology Imbalance btwn O2 supply and O2 demand > Cellular ischemia Atherosclerotic causes: Stable angina- fixed narrowing, thus arterial lumen must reduced by 90% -cellular ischemia at rest, 50%- exercise Unstable angina- fissuring of AP > platelet accumulation > transient thrombotic occlusion > platelet release VasoC factors (TXA2n serotonin) + endothelial dysfunction> compromise flow Perfusion must be restored w/in 40-60m, or lead to irreversible injury due to severe ATP depletion > increased extracellular ca conc , lactic acidosis and free radical
Clinical manifestation:
Clinical manifestation Symptoms Signs Chest pain Site- central and substernal Onset-sudden/exertion Character- tight, compress, squeez , ache, burn, sharp Radiation- left arm n neck*back Associated w Timing- over 20 mins Exacerbate n relieve- exertion n GTN SOB-ischemia> EDP / systolic and diastolic dysF > pulmonary P Sweating, palpitation, fatigue , N, V (sympathetic overdrive) Risk factors assesment Sign of hyperlipedemia Evidence of DM, TD, Gout, tar stained Bradycardia - CO, arrhythmia BP LGF Normal JVP, JVP- HF 4 th heart sound, 3 rd – HF Pericardial friction rub MR/ VSD Bibasal crackles
Investigation :
Investigation Blood I maging
Differential diagnosis:
Differential diagnosis
Treatment and management:
Treatment and management
Complication :
Complication
Prognosis :
Prognosis