SEMIO CH14 TRIGGER

MYOCARDIAL ISCHEMIA HAPPEN WHEN

MYOCARDIAL OXYGEN DEMAND > MYO° OXYGEN SUPPLY

NORMAL SITUATION : DEMAND / SUPPLY

DEMAND = SUPPLY

PENDANT EFFORT

DEMAND ↑ → CORONARY BLOOD FLOW ↑ → SUPPLY ↑

PATHOLOGICAL CORONARY ARTERY : SYMPTOM AT REST

BECAUSE DEMAND IS LOW → SUPPLY CAN BE SUFFICIENT → ASYMPTOMATIC

PATHOLOGICAL CORONARY ARTERY : SYMPTOM DURING EXERCISE

DEMAND ↑ BUT SUPPLY DOESNT ↑ ENOUGH → ISCHEMIA + CHEST PAIN + ANGINA

3 MAIN CAUSES OF SUPPLY ↓

CORONARY ATHEROSCLEROSIS

CORONARY VASOSPASM

THROMBUS

3 CAUSES OF DEMAND ↑

TACHYCARDIA

ARTERIAL HYPERTENSION

VENTRICULAR HYPERTROPHY

MOST COMMON CAUSE OF ISCHEMIC HEART DISEASE

CORONARY ATHEROSCLEROSIS

ANGINA DEF

CHEST PAIN DUE TO PARTIAL ISCHEMIA

INFRACTION DEF

TISSUE DEATH DUE TO TOTAL ISCHEMIA

NECROSIS + TOTAL ISCHEMIA ASSOCIATED W/ ?

ACUTE MYOCARDIAL INFRACTION

TRIGGER STABLE PLAQUE + EXERCISE

STABLE ANGINA

UNSTABLE ANGINA →

UNSTABLE PLAQUE + FISSURE + THROMBUS

DIFFERENCE UNSTABLE ANGINA VS ACUTE MYOCARDIAL INFRACTION →

UNSTABLE ANGINA → REVERSIBLE + NO NECROSIS

A.M.I → IRREVERSIBLE + NECROSIS

STABLE ANGINA → PAIN DURATION ?

LESS THAN 20 MINUTES

LES 2 ACUTE CORONARY SYNDROME (ACS)

UNSTABLE ANGINA / ACUTE MYOCARDIAL INFRACTION

ACS → PAIN DURATION ?

MORE THAN 30 MINUTES

DIFFERENCE IN “HOW PAIN STARTS” → STABLE ANGINA VS ACS

STABLE ANGINA → PAIN STARTS DURING EXERCISE

ACS → AT REST / EXERCISE

DIFFERENCE “HOW PAIN STOPS” STABLE ANGINA VS ACS

STABLE ANGINA → PAIN STOPS WITH REST + VASODILATATOR → NITROGLYCERIN

ACS → PAINS DOESNT STOP WITH REST + NITROGLYCERIN

ECG STABLE ANGINA

CAN BE NORMAL

CAN ALSO SHOWS T WAVE INVERSION

ECG UNSTABLE ANGINA

ST CHANGES

ECG AMI

DEEP Q

T WAVE INVERSION ASSOCIATED W/

ISCHEMIA

ST ELEVATION ASSOCIATED W/

ACUTE INJURY

Q WAVE ASSOCIATED W/

NECROSIS

2 ENZYMES THAT ARE CARDIAC MARKERS

TROPONIN

CPK

WHAT MAKES ENZYMES ↑ ? SO ITS ASSOCIATED W/ ?

MYOCARDIAL NECROSIS → MYOCARDIAL ENZYMES ↑

AMI → ONLY THAT CAUSES NECROSIS

TRIGGER TROPONIN ↑ / CPK ↑ ?

MYOCARDIAL NECROSIS → ACUTE MYOCARDIAL INFRACTION

TRIGGER STABLE ANGINA IN 3

ISCHEMIA

NO NECROSIS

ENZYME NORMAL

TRIGGER UNSTABLE ANGINA IN 3

ACUTE ISCHEMIA

NO NECROSIS

ENZYME NORMAL

TRIGGER A.M.I IN 3

ACUTE ISCHEMIA

NECROSIS

ENZYME ++

3 BENEFITS OF NITROGLYCERIN ON STABLE ANGINA

→ VASODILATATOR

→ IMPROVE BLOOD / O2 FLOW

→ LESS PAIN

TO “REOPEN” A NARROW ARTERY MECHANICLY WE CAN DO ?

ANGIOPLASTY

TO KEEP THE ARTERY OPEN AFTER ANGIOPLASTY ?

STENT

CREATE A NEW ROUTE AROUND A BLOCKED ARTERY ?

CABG (BYPASS)