Ischemic Heart Disease

Bayarmaa Purevdorj
Mind Map by Bayarmaa Purevdorj, updated more than 1 year ago
Bayarmaa Purevdorj
Created by Bayarmaa Purevdorj about 4 years ago
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Mind Map on Ischemic Heart Disease, created by Bayarmaa Purevdorj on 03/19/2016.
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Resource summary

Ischemic Heart Disease
1 Epidemiology
1.1 Developed western world
1.2 Risk factors
1.2.1 Hypertension
1.2.2 Hyperlipidemia
1.2.3 Smoking
1.2.4 Diabetes
1.2.5 Age
1.2.6 Male sex
1.2.7 Other

Annotations:

  • Sedentary lifestyle, obesity, oral contraceptives, type A personality /perfectionist/, stress
2 Myocardial infarction
2.1 Pathogenesis
2.1.1 Coronary artery thrombosis
2.1.2 Myocardial necrosis

Annotations:

  • 20 to 30 minutes after vessel occlusion
2.2 Morphology
2.2.1 Gross
2.2.1.1 0-12 hrs no change
2.2.1.2 18-24 hrs slight pallor
2.2.1.3 24-72 hrs pallor
2.2.1.4 4-7 days hyperemic rim
2.2.1.5 10 days yellow, soft, shrunken
2.2.1.6 7 weeks firm pale scar
2.2.2 Histology
2.2.2.1 4-12 hrs early coagulative necrosis
2.2.2.2 18-24 hrs neutrophil infiltrate
2.2.2.3 24-72 hrs complete coagulative necrosis and heavy neutrophile infiltrate
2.2.2.4 4-7 days macrophages and early granulation tissue
2.2.2.5 10 days prominent granulation tissue
2.2.2.6 7 weeks fibrosis
2.3 Clinical features
2.3.1 Severe, crushing, central chest pain
2.3.2 Lasts for hours
2.3.3 Not relieved by nitroglycerine
2.3.4 Silent - elderly, diabetes mellitus
2.4 Diagnosis
2.4.1 ECG changes
2.4.1.1 Q waves
2.4.1.2 ST segment abnormalities
2.4.1.3 T wave inversion
2.4.2 Lab evaluation
2.4.2.1 CK-MB 2 to 4 hrs, peak 18 hrs
2.4.2.2 Lactate Dehydrogenase 24 hrs, peak 72 hrs
2.4.2.3 Troponins (T and I)
2.5 Complications
2.5.1 Sudden death
2.5.2 Cardiac arrhythmias
2.5.3 Left ventricular failure
2.5.4 Cardiogenic shock
2.5.5 Rupture of free wall, septum, pappilary muscle
2.5.6 Thromboembolism
2.5.7 Dressler's syndrome

Annotations:

  • weeks-few months later pericarditis
3 Pathogenesis
3.1 >75% coronary artery stenosis
3.2 Changes in plaque morphology
3.2.1 Fissuring
3.2.2 Hemorrhage
3.2.3 Plaque ruptures
3.3 Coronary artery thrombosis
3.4 Coronary artery vasospasm
3.5 Occlusion of lumen- emboli, vasculitis, dissection
4 Angina pectoris
4.1 Stable angina
4.1.1 Clinical features
4.1.1.1 Episodic chest pain
4.1.1.2 Associated with exertion
4.1.1.3 Relieved by rest
4.1.2 Pathogenesis
4.1.2.1 Fixed atherosclerotic narrowing
4.1.2.2 Inadequate myocardial oxygen supply
4.1.3 Treatment
4.1.3.1 Reduce demand - rest
4.1.3.2 Vasodilator
4.2 Unstable angina
4.2.1 Clinical features
4.2.1.1 Increased attack frequency
4.2.1.2 Increased attack intensity
4.2.1.3 Precipitated by less exertion
4.2.2 Pathogenesis
4.2.2.1 Acute plaque change
4.3 Prinzmetal angina
4.3.1 Clinical features
4.3.1.1 Pain at rest
4.3.2 Pathogenesis
4.3.2.1 Coronary artery spasm
5 Sudden death
5.1 Arrhythmia
5.2 Ruptured infarct (Cardiac tamponade)
6 Chronic ischemic heart disease
6.1 Clinical features
6.1.1 Progressive congestive heart failure
6.1.2 Arrhythmias
6.2 Morphology
6.2.1 Moderate to severe coronary artery disease
6.2.2 Heart enlarged
6.2.3 Multiple areas of myocardial fibrosis
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