Mapa mental

MR. MOHAMED PASSING HARD TIME

SM1 23 Inglés

Contenido del mapa

REFERRED PAIN IN ANGINA
- LEFT SHOULDER
- DOWN THE LEFT ARM
  - SYMPATHETIC NERVE FIBERS JOIN SPNAL CORD AT LEVEL T1-T4
    - BRAIN NOT ABLE TO DISTINGUISH BETWEEN SOMATIC AND SYMPATHETIC
      - PAIN FELT AT LEVEL OF T1-T4 DERMATOMES SUPPLIED BY INTERCOSTAL NERVES
- NECK
- JAW
- MECHANISM
ANATOMY
- HEART VALVES
  - TRICUSPID
    - ORIFICE
      - fits tips of three fingers
      - surrounded by fibrous ring
      - behind sternum at 4th intercostal space
    - VALVE
      - ANT CUSP
        between infundibulum of the right ventricle and tricuspid orifice
      - POST CUSP
        inferior wall of the right venticle
      - SEPTAL CUSP
        close to the interventricular septum
  - MITRAL
    - ORIFICE
      - fits tips of two fingers
      - surrounded by a fibrous ring that gives attachment to mitral valve cusps
      - át the level of the 4th COSTAL CARTILAGE
    - VALVE
      - ANT CUSP
        larger and lies anterior and to the right
      - POST CUSP
        smaller lies posterior and to the left
  - SEMILUNAR VALVES
    - AORTIC
      - A
        one cusp ant (right)
        left posterior
        posterior cusp
    - PULMONARY
      - p
        right ant
        left ant
        one post cusp
- SURFACE ANATOMY of HEART
- SURFACE ANATOMY OF VALVES
- BLOOD VESSELS
  - CORONARY ARTERIES
    - RIGHT CA
      - ORIGIN
        Anterior sinus of the aorta
      - right coronary groove
        curves on the lower border of the heart and run to the left in the posterior part of the coronary groove to reach the posterior interventricular groove
      - supplies
        right atrium
        most of right ventricle
        part of left ventricle
        the diaphragmatic surface
        part of IV septum
        SA node
        60% of pop
        AV node
        80% of pop
    - LEFT CA
      - ORIGIN
        left posterior aortic sinus
      - course
        left coronary groove
        curves round the left margin to become cirmunflex artery
      - supplies
        left atrium
        most of left ventricle
        part of right ventricle
        Most of interventricular septum
        anterior 2/3 including av bundle
        SA
        40% of pop
        AV
        20% of pop
CARDIOMYOPATHY
- Dilated
- Hypertrophic
  - idiopathic hyptertrophic subaortic stenosis
  - hypertrophic obstructive cm
- Restrictive
ISCHAEMIC HEART DISEASES
- Gradual incomplete coronary occlusion
  - Atherosclerotic
    - effects on heart
      - abnormal cardiac rhythm
      - left sided heart failure
      - ANGINA PECTORIS
        TYPES
        STABLE ANGINA
        MOST COMMON
        caused by an imbalance in coronary perfusion
        chest pain occurs with increased cardiac demand
        ST segment depression
        PRINZMETAL ANGINA
        Caused by coronary artery vasospasm without obstructive lesions
        pain often at rest
        relieved by vasodilators
        transient ST segment elevation
        transmural ischemia
        UNSTABLE (CRESCENDO) ANGINA
        caused by nonocclusive thrombus in an area of coronary atherosclerosis
        occurs at rest
        high risk of MI
- Sudden complete coronary artery occlusion
  - Myocardial infarction
    - HAS LIPIDS
      - RISK FACTORS
      - HEREDITARY
      - AGE
      - SEX
      - LIPIDEMIA
      - INCREASED WEIGHT
      - ARTERIAL PRESSURE
      - INACTIVITY
      - DIABETES
      - SMOKING
    - PRESENTATIONS OF MI
      - Chest pain  Nausea,vomiting,sweating  Epigastric pain  Hypotention or shock  LVF or pulmonary oedema  Arrhythmias  Syncope  Painless MI  Sudden death
ACUTE MYOCARDIAL INFARCTION
- erosion and rupture of coronary artery plaques, activation of platelets, and thrombi.
  - ranges from unstable angina to extensive tissue necrosis in acute myocardial infarction
- DIAGNOSIS
  - ✔History → acute, severe and prolonged chest pain
  - ECG
  - SERUM CARDIAC MARKERS
    - an initial rise and subsequent fall of certain enzymes/proteins serum concentration
    - FEATURES FOR AN IDEAL MARKER
      - absolutely heart specific
      - should not be detectable in negative pateints
      - highly sensitive to detect even minor heart damage.
      - differentiate reversible from irreversible damage.
      - allow monitoring of reperfusion therapy
      - estimation of infarct size and prognosis.
      - stable
      - measurement rapid, easy to perform, quantitative, and cost effective.
    - Enzymes
      - CL-MB
    - CARDIAC PROTEINS
      - Myoglobin
      - Troponin T
      - Troponin I
      - Cardiac myosin light chains
General Therapy
- MONA
  - MORPHINE
  - OXYGEN
  - NITROGLYCERIN
  - ASPIRIN