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8/9/2019 ISCHEMIC HEART DISEASE ppt.pptx
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ISCHEMIC HEART DISEASE
Presenter: Dr. Mounika
Moderator: Dr. Jayapal Rao
MD,HOD,Dept o Pat!olo"y
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ISCHEMIC
HEART DISEASE
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P#A$ O% ST&D'
(. $eed or study
). Deinition
*. Risk a+tors
. Pat!o"enesis
-. Ee+ts o Is+!eia
/. An"ina
0. MI
1.In2esti"ations
3. Copli+ations
(4.DD
((.Mana"eent
(). Con+lusion
(*. Hooeopat!i+
approa+!(. 5i6lio"rap!y
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$eed or study
EPIDEMO#O7':
IHD +auses ore deat!s and disa6ility
and in+urs "reater e+onoi+ +osts t!an
any ot!er illness in t!e de2eloped 8orld.
IHD is t!e sin"le ost iportant +ause o
preature deat! in de2eloped 8orld. It is
serious, +!roni+, lie9t!reatenin" illness.
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it! ur6ani;ation in t!e de2elopin" 8orld,
t!e pre2alen+e o risk a+tors or IHD is
in+reasin" rapidly in t!ese re"ions su+!
t!at a a
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Spe+iality o +ardia+ us+le=
$o ati"ue=
$o tetanus=
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5lood supply
T!e t8o +oronary arteries, let and ri"!t,
arise ro t!e let and ri"!t sinus o
>alsal2a, respe+ti2ely. In (4? o
indi2iduals t!e +ir+ulation is +onsidered as
@let doinant@ as t!e +ir+ule artery
"i2es o t!e posterior des+endin" artery.
In 34?, t!e +ir+ulation is ri"!t doinant ast!e posterior inter2entri+ular artery is "i2en
o ro t!e ri"!t +oronary artery
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Supply to !eart o++urs durin"Systole or Diastole=
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%a+tors t!at aintain +ir+ulation
Pupin" a+tion o !eart
Elasti+ re+oil o t!e arteriesB
Pressure "radient Respiration
Mus+ular eer+ise
Ee+t o "ra2ity
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%a+tors re"ulatin" nutrition
a+tion o !eart
O) supply
5lood pressure Teperature
Inor"ani+ ions
$euro!arones
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%a+tors inluen+in" +oronary
+ir+ulation
Mean aorti+ pressure
Cardia+ output Meta6oli+ a+tors
O) supply
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Condu+tion ner2e supply
Autor!yt!i+
Sypat!eti+ parasypat!eti+
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DEFINITION OF IHD
T!e orld Healt! Or"anisation !as
deined is+!aei+ !eart disease IHD as
yo+ardial ipairent due to i6alan+e
6et8een +oronary 6lood lo8 andyo+ardial reFuireents.
T!e ost +oon +ause o IHD is
at!eros+leroti+ +oronary arterydiseaseGCAD
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Aetiolo"y
MAJOR RISK FACTORS
CO$STIT&TIO$A#
A"e
Se 7eneti+
%ailial
A+Fuired
Hyperlipidaeia
Hypertension DM
Sokin"
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PATHOPH'SIO#O7' O%
M'OCARDIA# ISCHAEMIA
Myo+ardial is+!aeia o++urs as a result o
i6alan+e 6et8een O) supply and
deand.
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Etiopat!o"enesis
(.Coronary at!eros+lerosis:
Distri6ution:G S>D, T>D
#o+ation.
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). Superadded +!an"es in +oronary
at!eros+lerosis:
A+ute +!an"es
+oronary artery t!ro6osis
platelet a""re"ation
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*.$on at!eros+leroti+ +auses:
>asospas,
Arteritis E6olis
Traua
Aneurys Copression.
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A$7I$A
It is deri2ed ro t!e "reek 8ord
STRANGULATION.
It is a syndroe SENSE OF BAND
AROUND CHEST. Patient presses !is
sternu 8it! +len+!ed ist to lo+ate t!e
pain.
Pro"ressi2e +onstri+tion o +oronaryarteries +ardia+ pain +alled an"ina.
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T!e types o an"ina in+lude
(. Sta6le an"ina, ). &nsta6le an"ina,
*. Prin;etals an"ina
. Post inar+tion an"ina
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Stable angina or effort angina
Also +alled He6erdeens an"ina, it o++urs
on kno8n p!ysi+al eort, and is relie2ed
8it! rest, standin" or su6lin"ualnitro"ly+erine.
Modalities Teperature,
Eotions,
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Diurnal E2en soeties sokin", seual a+t,
s!a2in", strainin" at stool
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Soe +ases pain is a6sent ,An"ina9eFui2alent syptos 6reat!lessness,
ati"ue, syptos o de+reased +ardia+
output.
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>ariants:
Start9up or alk9 t!rou"! an"ina,
$o+turnal an"ina, De+u6itius an"ina,
Post Prandal an"ina,
Aunition a+tories.
Class New York Heart Association Functional Canadian Cardiovascular Society
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New York Heart Association Functional
Classification
Canadian Cardiovascular Society
Functional ClassificationI
Patients have cardiac disease but without
the resulting limitationsof physical activity.
Ordinary physical activity does not causeundue fatigue, palpitation, dyspnea, or
anginal pain.
Ordinary physical activity, such
as walking and climbing stairs,
does not cause angina. Anginapresent with strenuous or rapid
or prolonged exertion at work or
recreation.
IIPatients have cardiac disease resulting in
slight limitationof physical activity. They are
comfortable at rest. Ordinary physical
activity results in fatigue, palpitation,
dyspnea, or anginal pain.
Slight limitationof ordinary
activity. Walking or climbing
stairs rapidly, walking uphill,
walking or stair climbing after
meals, in cold, or when under
emotional stress or only during
the few hours after awakening.
IIIPatients have cardiac disease resulting Marked limitation of
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Patients have cardiac disease resulting
in marked limitationof physical activity.
They are comfortable at rest. ess than
ordinary physical activity causes
fatigue, palpitation, dyspnea, or anginal
pain.
Marked limitationof
ordinary physical activity.
Walking one to two blocks
on the level and climbing
more than one flight of
stairs in normal
conditions.
IVPatients have cardiac disease resulting
in inabilityto carry on any physical
activity without discomfort. !ymptoms
of cardiac insufficiency or of the anginalsyndrome may be present even at rest.
"f any physical activity is undertaken,
discomfort is increased.
Inabilityto carry on any
physical activity without
discomfort#anginal
syndrome may be presentat rest.
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P!ysi+al eaination in patients 8it!
an"ina pe+toris is oten noral. Ho8e2er,
t!ere ay 6e indi+ation o +oronary risk
a+tors like ant!elasa or ant!oas.
Palpation ay re2eal t!i+kened arteries
and redu+ed or a6sent pulses as si"ns o"eneralised at!eros+lerosis. #>
enlar"eent, S* or S "allop.
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INVESTIGATIONS
(. K9ray +!est or +ardioe"aly or
pulonary +on"estion. ). #ipid proile *.
5lood su"ar, seru uri+ a+id and urine
eaination Electrocariogra! "In -4? o patients
8it! an"ina, t!e restin" EC7 is noral
6et8een an"inal episodes. Durin" anan"inal episode transient ST9T depression
ay 6e noted 8!i+! disappears 8it! rest
or 8it! su6lin"ual nitro"ly+erine
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Prinzmetal angina
Also +alled 2ariant an"ina, it 8as
des+ri6ed 6y Prin;etal in (3-3. T!e pain
usually o++urs at rest at ni"!t or in t!e
early ornin" !ours. It is asso+iated 8it!ST ele2ation on t!e EC7, responds to
su6lin"ual nitro"ly+erine, and is +aused 6y
spas o t!e +oronary artery.
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Eer+ise stress testin" ay ail to indu+e
is+!aei+ +!an"es. T!e spas +an 6e
indu+ed 6y sokin", !yper2entilation .
T!e +ause o spas ay 6e in+reasedalp!a9adrener"i+ a+ti2ity durin" t!e early
ornin" !ours or platelet a""re"ation.
Coronary an"io"rap!y ay re2eal noral+oronary arteries.
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Unstale angina
Also +alled interediate +oronary
syndroe and Preinar+tion an"ina, it is a
serious or o an"ina and needs spe+ial
attention sin+e )4? o t!ese patients arelikely to de2elop atal or nonatal
yo+ardial inar+tion 8it!in ont!s.
T!ere is a !i"!er in+iden+e o let ain+oronary artery disease in t!ese patients.
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&nsta6le an"ina in+ludes i an"ina o
re+ent onset less t!an /4 daysL ii sta6le
an"ina 8it! syptos ore se2ere in
intensity, reFuen+y or duration and oreeasily pro2okedL iii an"ina at restL i2
an"ina ollo8in" yo+ardial inar+tion
8it!in days or 8eeks.
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ST9T depression in t!e EC7 is +oon...
A6out )-? o t!ese patients !a2e
+oronary artery t!ro6osis. In t!e ot!ers,
spas plays an iportant role. Patients!a2e asso+iated se2ere +oronary artery
o6stru+ti2e disease.
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Mana"eent
T!ro6olyti+ a"ents
PTCA
CA57
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P!st in"ar#ti!n angina
Soe patients 8it! yo+ardial inar+tion
de2elop an"ina ) days to 1 8eeks
ollo8in" t!e a+ute inar+tion. Most
patients !a2e ulti2essel disease or
partially re+analised +oronary arteries 8it!
residual yo+ardial is+!aeia.
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M$OCARDIA% INFARCTION
T!e area o us+le t!at !as eit!er ;ero
lo8 or so little lo8 t!at it +annot sustain
+ardia+ us+le un+tion pro+ess +alled
Ina+rtion.
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Myo+ardial inar+tion is a serious
+opli+ation o at!eros+leroti+ +oronary
!eart disease. In ost patients 1493-? it
results ro t!ro6oti+ o++lusion o t!einar+t9related 2essel. Myo+ardial
is+!aeia and ne+rosis set in 8it!in a6out
)494 inutes
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T!is o++urs as a 8a2e9ront startin" ro
t!e su6endo+ardial re"ion and
pro"ressin" to t!e su6epi+ardial re"ion.
T!e entire pro+ess usually takes / !ours
to +oplete. T!ereore any inter2ention or
liitin" inar+t si;e s!ould 6e initiated int!is @tie 8indo8@ o / !ours.
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Eti!&at'!genesis(
Me+!anis o Myo+ardial is+!eia:
Diinis!ed +oronary 6lood lo8, In+reased
yo+ardial deand, Hypertrop!y o !eart
8it!out in+rease in +oronary 6lood lo8.
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In"ar#ts ma) e transm*ral +ers*s
s*en,!#ar,ial in"ar#ts: Transural
ost +oon type 3-?. Su6endo+ardial
inar+t "enesis is due to redu+ed +oronaryperusion 8it!out +riti+al stenosis
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Transmural
Full thickness
Superimposed thrombus in
atherosclerosis
Focal damage
Sub-endocardial
Inner 1/3 to half of ventricular
wall Decreased circulating blood
volume( shock, !potension,
"!sed thrombus#
$ircumferential
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Types o inar+ts:
(. A++ to anatoi+al re"ion o let2entri+le: Anterior, lateral, septal,
+ir+uerential or +o6inations.
). A++ to de"ree o t!i+kness : Transural,
Su6endo+ardial.
*. A++ to a"eold, ne8 G !ealed res!.
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#o+ation o inar+ts:
Inar+ts are ost reFuently lo+ated in let
2entri+le . Ri"!t 2entri+le is less
sus+epti6le to inar+tion due to its t!in 8all
less eta6oli+ reFuireent.
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* +oon re"ions o MI:
(. Stenosis o let anterior des+endin" +oronary
artery is ost +oonG4? to -4?
). Stenosis o ri"!t +oronary arteryG*4? to 4?
*. Stenosis o let +ir+ule +oronaryarteryG (-? to )4?
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M!r&'!l!g)- Pat'!l!gi#al #'anges.
li"!t i+ros+opy
%irst 49/!rs9 Stre+!in" o i6res.
/9()!rs ater MI Coa"ulati2e
ne+rosis neutrop!ils 6e"ins
&p to * days N Coa"ulati2e ne+rosis,
neutrop!ils
(9) 8eeks N 7ranulation tissue * 8eeks N ine s+ar
) ont!s N dense s+ar
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T!e dis+oort ay 6e elt as
+opression o +!est or a 6urnin"
sensation, asso+iated 8it! aniety and
eelin" o ipendin" deat!. Continuin"dis+oort is a sypto o on"oin"
is+!aeia and e2ol2in" inar+tion. As t!e
inar+tion is +opleted, t!e pain aysu6side +opletely..
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In (-9*4? o patients t!e inar+tion ay "o un
re+o"nised 6e+ause o a6sen+e o typi+alsyptos. A6out -? o su+! patients !a2e
silent inar+tion. T!is is +oon in dia6eti+s
and elderly patients. In ot!ers, 6reat!lessness
as in a+ute let 2entri+ular ailure, syn+ope,
"iddiness, ati"ue, a6doinal pain, nausea
and 2oitin" and uneplained !ypotension
ay 6e t!e presentin" aniestation
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C%
Pain
Indi"estion
Appre!ension
S!o+k
Oli"uria
#o8 "rade e2er A+ute pulonary oedea
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P!ysi+al eaination re2eals a pale
patient 8!o is s8eatin", restless, in a"ony
due to pain, and tossin" in t!e 6ed in an
attept to "et relie. T!e pulse ay 6erapid or slo8, and re"ular or irre"ular.
5rady+ardia ay 6e a proinent eature
in t!e early !ours espe+ially in t!ose 8it!inerior 8all inar+tion
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5lood pressure ay 6e noral, lo8 or !i"!.
Aus+ultation ay re2eal S* or S "allop.
Paradoi+al splittin" o t!e se+ond !eart sound
ay 6e ade out. Ri"!t 2entri+ular inar+tion
ay result in in+reased
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Cardia+ reser2e
Maiu aount o +ardia+ output t!at
+an in+rease a6o2e noral. It is 44?
6lood per in ore t!an 6ody reFuires.
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INVESTIGATIONS
#eu+o+ytosis 8it! polyorp!onu+lear
rea+tion and !i"! ESR due to tissue
ne+rosis are present durin" t!e irst 8eek.
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Electrocariogra#$ic c$ange% "T!e earliest+!an"es are ST ele2ation o++urrin" 8it! t!e
onset o +!est pain. Q 8a2es appear 8!en
transural inar+tion o++urs. ST se"ent
+!an"es start re2ersin" early 8it!in )
!ours or so and T 8a2es 6e"in to "et
in2erted..
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Anterior 8all inar+tionis dia"nosed 6y
+!an"es in leads >( to >, #ateral6y +!an"es in #(, a>#, >- and >/,
and
Inerior 8all inar+tion6y +!an"es in #), #*and a>%
Posterior 8all #> inar+tion is dia"nosed 6y
ST depression, upri"!t T 8a2e and tall R8a2e in >( and >).
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T!e initial EC7 +!an"es ay 6e present
in only a6out -490-? o patients. In
ot!ers, a typi+al !istory and serial seru
en;ye +!an"es pro2ide dia"nosti+ !elp.Serial EC7sipro2e t!e dia"nosti+ yield
to 1-?.
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Serum enzymes"$e+rosis o yo+ardial
+ells releases en;yes in t!e 6lood.
S7OT AST starts to rise 8it!in a e8
!ours, rea+!in" a peak at ) !ours andde+linin" o2er t!e net 190) !oursL it is
not spe+ii+ or +ardia+ us+le in
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Seru +reatinine p!osp!okinase CP risesiediately to /!rs L it alls to noral 2alues
8it!in 1 !ours. T!is en;ye is also not
spe+ii+ or +ardia+ +ells and is present inskeletal us+le and 6rain tissue. T!e CP
isoen;ye, CP9M5, is ore spe+ii+ or
+ardia+ tissueL its le2els !a2e 6een related to
t!e etent o yo+ardial inar+tion.
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Seru #DH le2els in+rease late ater
yo+ardial inar+tion. T!e in+rease starts
durin" t!e irst day, peak le2els area+!ie2ed durin" t!e *rd or t! day, and
t!ey ay reain !i"! or (9(- days. #DH
+ardia+ isoen;ye #DH( is orespe+ii+.
Troponin le2el is in+reased in AMI to
/!rs and is a ore sensiti2e indi+ator oyo+ardial neurosis !i"! or 0 to (4 days.
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MANAGEMENT
Alost *49*-? o patients 8it! AMI die
due to arr!yt!ias, #> ailure and
+ardio"eni+ s!o+k. Hal o t!ese deat!s
o++ur in t!e irst (9) !ours ater onset o
syptos and 04914? in t!e irst )
!ours. %urt!er, t!e Tie 8indo8 or
sal2a"in" t!e is+!aei+ yo+ardiu atrisk o ne+rosis is a6out / !ours
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Re&er"*si!n
An o++ludin" t!ro6us is responsi6le or
yo+ardial inar+tion in alost 1-? o
patients. It is kno8n t!at t!e inar+tion is
+opleted ater se2eral !ours. An attepts!ould t!ereore 6e ade to reo2e t!e
o6stru+tion and a+!ie2e reperusion to re9
esta6lis! 6lood lo8 to t!e
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Cell in
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%or approiately *4 inutesater t!e
onset o e2en t!e ost se2ere is+!eia,
yo+ardial in
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T$ro!bol&tic agent%'2i;. streptokinase,
urokinase, a+etylated streptokinase, and
tPA. It a+!ie2es re+analisation in a6out
-4? o patients, re+analisation rates arereportedly !i"!er 0-?. A a
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All t!ro6olyti+ a"ents s!ould 6e "i2en 8it!in
9/ !ours ater t!e onset o +!est pain. Soe
o t!e +opli+ations t!at +an o++ur in+lude
reperusion arr!yt!ias and 6leedin".
T!ro6olysis is "enerally a2oided in patientsollo8in" re+ent operations, t!ose 8it! re+ent
+ere6ro2as+ular a++idents, t!ose 8!o !a2e
6leedin" diat!esis or ollo8in"+ardiopulonary resus+itation.
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T!ro6olyti+ a"ents !elp in redu+in"
s!ort9ter ortality and ipro2in" #>
un+tion. %ollo8in" t!ro6olyti+ t!erapy,intra2enous Herapin is "i2en or t!e net
)91 !ours to pre2ent reo++lusion..
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(TCA!as 6een used as a et!od o
reperusion 8it! a su++ess rate o 349
3-?.. It is a pro+edure o iense 2aluein patients 8it! +ardio"eni+ s!o+k, se2ere
#> ailure and lar"e anterior yo+ardial
inar+tion.
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I$DICATIO$S O% PTCA:
Coronary arterio"rap!y is indi+ated in (
patients 8it! +!roni+ sta6le an"ina
pe+toris 8!o are se2erely syptoati+despite edi+al t!erapy and 8!o are
6ein" +onsidered or re2as+ulari;ation,
i.e., a per+utaneous +oronary inter2entionPCI or +oronary artery 6ypass "ratin"
CA57
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patients 8it! trou6lesoe syptos t!at
present dia"nosti+ dii+ultiesin 8!o
t!ere is a need to +onir or rule out t!edia"nosis o IHD.
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Anastoosis o one or 6ot! o t!e internalaary arteries or a radial artery to t!e
+oronary artery distal to t!e o6stru+ti2e
lesion is +arried out. %or additionalo6stru+tions t!at +annot 6e 6ypassed 6y
an artery, a se+tion o a 2ein usually t!e
sap!enous is used to or a +onne+tion6et8een t!e aorta and t!e +oronary artery
distal to t!e o6stru+ti2e lesion.
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O++lusion o *eno)%"rats is o6ser2ed in(4)4? o patients durin" t!e irst
postoperati2e year, in approiately )?
per year durin" -9 to 09year . #on"9terpaten+y rates are +onsidera6ly !i"!er or
internal aary and radial artery
iplantations t!an sap!enous 2ein "rats
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Rupture o 2entri+le into peri+ardial sa+ +ausin"
+ardia+ taponade
Deep 2ein t!ro6osis in le"s +ausin"
pulonary e6olis
Peri+arditisdurin" assi2e inar+tion
Aneurys o 2entri+le 8it! t!ro6osis and
t!ro6o9e6oli+ p!enoenon
Dresslers syndroepost yo+ardial inar+tionsyndroe
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Dre%%ler+% %&nro!eo++urs a e8 days to/ 8eeks ollo8in" yo+ardial inar+tion
and is +!ara+terised 6y e2er,
Pleuroperi+arditis,
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In addition, patients 8it! asyptoati+is+!eia ater suerin" a yo+ardial
inar+tion are at "reater risk or a se+ond
+oronary e2ent. T!e 8idespread use oeer+ise EC7 durin" routine eainations
!as also identiied soe o t!ese
!eretoore unre+o"ni;ed patients 8it!asyptoati+ CAD
CHRO$IC IHD
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CHRO$IC IHD
Is+!ei+ Cardioyopat!y or Diuse
i6rosis in t!e yo+ardiu
+!ara+tersti+ally ound in elderly a"e"roup.CH% is "radually de2eloped
de+opensation o2er a period o years
GC!roni+ anaeia
SUDDEN CARDIAC DEATH AND
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SUDDEN CARDIAC DEATH AND
CARDIAC ARREST
It is estiated t!at in )4? or ore o
patients 8it! +oronary artery disease, t!e
irst presentin" eature ay 6e sudden
+ardia+ deat!, deined as deat! 8it!in e8inutes to ) !ours ater onset o
syptos. T!e usual +ause is 2entri+ular
i6rillation or +ardia+ asystole ando++asionally ele+troe+!ani+al
disso+iation.
Dierential Dia"nosis
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Dierential Dia"nosis
(. Peri+arditisHours to daysL ay 6eepisodi+ S!arpRetrosternal or to8ard
+ardia+ apeL ay radiate to let s!oulder
May 6e relie2ed 6y sittin" up and leanin"or8ard +ou"!, s8allo8in", lyin" in
letsided supine.
Peri+ardial ri+tion ru6
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Aorti+ disse+tion :A6ruptonset o
unrelentin" pain Tearin" or rippin"
sensationL knielikeAnterior +!est, otenradiatin" to 6a+k, 6et8een s!oulder
6lades.
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Pulonary e6olis:A6rupt onsetL
se2eral inutes to a e8 !ours Pleuriti+
Oten lateral, on t!e side o t!e e6olisDyspnea, ta+!ypnea, ta+!y+ardia, and
!ypotension, !aeoptysis.
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Esop!a"eal relu 9(4/4 in, 5urnin"Su6sternal, epi"astri+, orsened 6y
postprandial re+u6en+y.
Relie2ed 6y anta+ids. Esop!a"eal spas9 )*4 in ,Pressure,
ti"!tness, 6urnin" retrosternal, Can
+losely ii+ an"ina,
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Pepti+ ul+er9 Prolon"ed 5urnin"
Epi"astri+, su6sternal relie2ed 8it! ood or
anta+ids. A+id pepti+ disease: Early rn"
G a+id se+retions are not neutralised 6y
ood.
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Mus+uloskeletal disease9 >aria6le,A+!in"
o2eent
May 6e reprodu+ed 6y lo+ali;ed pressureon eainationG +!ondrosternal,
+osto+!ondral .
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Eotional and psy+!iatri+ +onditions
ti"!tness a+!in"L ay 6e leetin"
>aria6leL ay 6e retrosternal, Situationala+tors ay pre+ipitate syptos
Aniety or depression oten dete+ta6le
8it! +areul !istory
Pro"nosis
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Pro"nosis
Depends on:
(.$u6er o diseased 2essels
). De"ree o #> dysun+tion
MA$A7EME$T GADAPTATIO$
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MA$A7EME$T GADAPTATIO$
Myo+ardial is+!eia is +aused 6y adis+repan+y 6et8een t!e deand o t!e
!eart us+le or oy"en and t!e a6ility o
t!e +oronary +ir+ulation to eet t!isdeand. Most patients +an 6e !elped to
understand t!is +on+ept and utili;e it in
t!e rational pro"rain" o a+ti2ity.
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Many tasks t!at ordinarily e2oke an"inaay 6e a++oplis!ed 8it!out syptos
siply 6y redu+in" t!e speed at 8!i+!
t!ey are perored. Patients ustappre+iate t!e diurnal 2ariation in t!eir
toleran+e o +ertain a+ti2ities and s!ould
redu+e t!eir ener"y reFuireents in t!eornin", iediately ater eals, and in
+old or in+leent 8eat!er.
On o++asion it ay 6e ne+essary to
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On o++asion, it ay 6e ne+essary to
re+oend a +!an"e in eployent or
residen+e to a2oid p!ysi+al stress.Ho8e2er, 8it! t!e e+eption o anual
la6orers, ost patients 8it! IHD +an
+ontinue to un+tion erely 6y allo8in"ore tie to +oplete ea+! task. In
soe patients, an"er and rustration ay
6e t!e ost iportant a+tors
pre+ipitatin" yo+ardial is+!eia. I
t!ese +annot 6e a2oided, trainin" in
stress ana"eent ay 6e useul.
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A treadill eer+ise test to deterine t!e
approiate !eart rate at 8!i+! is+!ei+
EC7 +!an"es or syptos de2elop ay6e !elpul in t!e de2elopent o a spe+ii+
eer+ise pro"ra.
EKERCISES
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A re"ular pro"ra o isotoni+ eer+ise
Gus+les +ontra+t t!ere is o2eentt!at is 8it!in t!e liits o ea+! patients
t!res!old or t!e de2elopent o an"ina
pe+toris and does not e+eed 14? o t!e!eart rate asso+iated 8it! is+!eia on
eer+ise testin" s!ould 6e stron"ly
en+oura"ed.
A2oid Isoetri+ eer+isesGus+le
+ontra+t in+rease in tension 6ut does not
o2e
CO$C#&SIO$
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CO$C#&SIO$
C!est dis+oort is one o t!e ost
+oon +!allen"es or +lini+ians in t!e
oi+e or eer"en+y departent. T!edierential dia"nosis in+ludes +onditions
ae+tin" or"ans t!rou"!out t!e t!ora and
a6doen, 8it! pro"nosti+ ipli+ations t!at2ary ro 6eni"n to lie9t!reatenin".
% il t i t ti ll i
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%ailure to re+o"ni;e potentially serious
+onditions su+! as a+ute is+!ei+ !eart
disease, aorti+ disse+tion, tension
pneuot!ora, or pulonary e6olis
+an lead to serious +opli+ations,
in+ludin" deat!. Con2ersely, o2erly+onser2ati2e ana"eent o lo89risk
patients leads to unne+essary !ospital
adissions, tests, pro+edures, andaniety.
Hooeopat!i+ approa+!
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Hooeopat!i+ approa+!
P!ysiolo"i+al a+tion 6asis said 6y Dr.Ri+!ard Hu"!es:
A+onite: In all diseases o !eart
+!ara+terised 6y in+reased a+tion 8!enletside is +!iely
in2ol2ed.UG P!ysiolo"i+ally +ardia+
depressentG %ear, aniety, ental
restlessness
Dr. Clark:Rapidity o a+tion relie2ed
soeties so painul distressin" spas
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Arseni+: %or in+iden+e o +ardia+ +a+!ey.
$i"!ts are trou6led 6y oppression and
an"uis!.Dr. Clark: Ars.Iod: A+t on !eart us+le
arrestin" de"eneration restorin" 2itality.
Dr. 5oeri+k9 Sae +!ara+ter o
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pain as in An"inaU Ca+tus: Pain as i +onstri+ted 6y Iron
6andUG It is a stiulant on "an"lioni+
+entres in t!e +ardia+ 8alls.
Haeotoylon: Sense o +onstri+tion is+!ara+teristi+. Sensation as i 6ar lay
a+ross +!estU
#a+trode+tus. Ma+tans: Pi+ture o An"ina,+onstri+tion o +!est us+les.
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Hydro+yani+ a+id: Spasodi+
+onstri+tion ti"!tness in +!est, torturin"pain in +!est.
Ana+ardiu: Also !as 6and like
sensation.
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7lonine: $itro"ly+erineG palliati2e non
!ooeopat!i+ Ay.$itrosu:%or palliation in Coronary
spas.
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Ta6a+u: Pro2e t!e ost !ooeopat!i+dru" or An"ina pe+toris, Constri+tion o
!eart.G $ausea, 2oitin" ,deat! like pallor
Cap!or: As a !eart stiulant oreer"en+y use is ost satisa+tory
reedy.G +ollapse
>eratru: 5est !eart stiulant.
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I6eris:Posess ei+a+y in +ardia+diseases.akes at ) a 8it! palpitation.
Op!idia G$a
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Type A Personality: A""ressi2eness,
Copetiti2e dri2e, A6itiousness, Sense
o ur"en+y G risk a+tors odalities.En2ironental inluen+es. Helpul in
sele+tion o reedy.
5I5#IO7RAPH'
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5I5#IO7RAPH'
Tet6ook o pat!olo"y 6y Dr. Hars!o!an
API tet6ook o edi+ine
Harrisons Internal edi+ine.
Tet6ook o edi+al p!ysiolo"y 6y 7uyton
THAN,-U
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THA$'&