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SGD 1: Acute Myocardial Infarction

SGD 1: Acute Myocardial Infarction. PATHOLOGY. Chest Pain. An unpleasant sensation in the anterior wall of the thorax actual or potential tissue damage mediated by specific nerve fiber to the brain - conscious appreciation may be modified by various factors.

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SGD 1: Acute Myocardial Infarction

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  1. SGD 1: Acute Myocardial Infarction

  2. PATHOLOGY

  3. Chest Pain • An unpleasant sensation in the anterior wall of the thorax • actual or potential tissue damage • mediated by specific nerve fiber to the brain - conscious appreciation may be modified by various factors.

  4. Braunwald and Goldman, Primary Cardiology 2nd ed

  5. Braunwald and Goldman, Primary Cardiology 2nd ed

  6. Chest Pain (dark red = most typical area, light red = other possible areas)

  7. Atherogenesis • Developmental process of atheromatous plaques.

  8. Pathogenesis of Atherosclerosis • Fatty Streak • Leukocyte recruitment • Foam Cell formation • Microvessels • Plaque evolution

  9. Atherothrombosis • Arterial Remodelling • Rupture of Fibrous cap • Arterial Occlusion • More fibrous lesion

  10. Risk Factors • Age (55 y/o) • Male • Occupational stress • 40 pack years • Heavy alcoholic beverage drinker • HPN (2003) • Usual BP 130-80 • Highest BP 170/100 • Nifedipine 30 mg – irregular intake • Family Hx of DM, HPN, Premature CAD • Cigarette Smoking • HPN (BP> 140/90 mmHg or on antihypertensive medication) • Low HDL, Low LDL • DM • Family Hx of premature CHD • CHD in male first degree relatives<55y/o • CHD in female first degree relatives<65y/o • Lifestyle risk factors • BMI = > 30 kg/m² • Physical inactivity • Atherogenic diet • Age (male>55y/o, female >65y/o) • Sex (Male>Female) • Stress

  11. Clinical Features of Angina • Described as heaviness, pressure, squeezing, smothering, or choking, and only rarely as frank pain. • Levine’s sign – localization of pain by the pain: placing his hand (clenched fist) over the sternum to indicate sqeezing, central, substernal discomfort. • Crescendo-decrescendo (2-5 min) • Radiates to either shoulder and to both arms (ulnar surface of the forearm and hand). • Also arise in or radiate to the back, interscapular region, root of the neck, jaw teeth and epigastrium.

  12. Types of Angina Pectoris

  13. New York Heart Association Functional Classification • Px have cardiac disease but without the resulting limitations of physical activity does not cause undue fatigue, palpitation, dyspnea or anginal pain • Px have cardiac disease resulting in slight limitation of physical activity. They are comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea, or anginal pain.

  14. New York Heart Association Functional Classification III. Px have caridac disease resulting to marked limitation of physical activity. They are comfortable at rest. Less than ordinary physical activity causes fatigue, palpitation, dyspnea, or anginal pain. IV. Px have cardiac disease resulting in inability to carry on any physical activity without discomfort. Symptoms of cardiac insufficiency or of anginal syndrome may be present even at rest. If any physical activity is undertaken, discomfort is increased.

  15. Canadian Cardiovascular Society Classification of Angina I. No angina with ordinary activity. Angina with strenuous, rapid, or prolonged exertion II. Slight limitation of ordinary activity; angina when walking up stairs briskly, or walking on a cold or windy day III. Marked limitation; angina when walking at normal pace up flight of stairs, or walking 1-2 blocks distance IV. Angina on minimal exertion or at rest

  16. WHO Criteria for AMI Classic WHO Criteria: two (probable) or three (definite) of the following criteria are satisfied: • Clinical history of ischemic type chest pain lasting for more than 20 minutes • Changes in serial ECG tracings • Rise and fall of serum cardiac biomarkers such as CK-MB fraction and troponin Revised (2000) Cardiac troponin rise accompanied by either typical symptoms, pathological Q waves, ST elevation or depression or coronary intervention are diagnostic of MI.

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