Mr Mohamed passing a hard time

Mr Mohamed passing a hard time

1. acute plaque changes

   • haemorrhage
   • thrombus formation over plaque
     • Pathogenesis of thrombos
       • virchow's triad
         • abnormal blood flow
           • turbulent flow
             • aneurysms
           • stasis
             • long flights
             • bed ridden patients
         • hypercoagulable state
           • primary
             • factor V leiden
             • prothrombin mutations
           • DIC
           • oral contraceptives
         • endothelial dysfunction
           • hypertension
           • atherosclerosis
           • smoking
           • increased homocysteine

2. Ischemic Heart Disease

   • types
     • angina
       • stable angina
         • pain during exertion
           • relieved by GTN or rest
         • ST segment depression
         • more than 70% stenosis of coronary artery
       • unstable angina
         • pain during rest and exertion
           • not relieved by nitroglycerine
         • ST segment depression
           • subendocardial ischemia
         • due to non occlusive thrombus formation on plaque
       • prinzmetal angina
         • spasm of coronary artery
         • ST segment elevation
       • treatment
         • atenolol
           • B-blocker
         • Isosorbide dinitrate
           • nitrates
         • Aspirin
         • Glyceryl trinitrate (GTN)
           • vasodilators.
     • myocardial infarction
       • types
         • STEMI
           • 100% stenosis
             • transmural infarction
         • NSTEMI
           • incomplete occlusion
             • subendocardial infarction
       • Causes
         • atherosclerotic vascular disease
         • vasospasm
         • vasculitis
         • thromboembolism
       • signs and symptoms
         • dyspnea
         • chest pain
         • diaphoresis
         • cardiac referred pain
           • common sites
             • neck, jaws, shoulders, arms, and stomach
           • areas of the body surface which send sensory impulses to the same levels of the spinal cord that receive cardiac sensation
         • cold sweats
       • Investigations
         • ECG
         • blood tests
         • Lipid profile.
         • Cardiac biomarkers
       • Complications
         • <4 h
           • cardiogenic shock
           • CHF
         • 4-24 h
           • arrhythmias
         • months
           • dessler's syndrome
           • ventricular aneurysm
           • mural thrombus
         • 1-3 D
           • fibrinous pericarditis
         • 4-7 D
           • rupture of ventricular free wall
           • rupture of papillary muscle
         • shocks
           • cardiogenic shock
             • low blood perfusion to tissues resulting in cellular injury and inadequate tissue function
             • signs
               • Anxiety
               • Distended jugular veins
               • Cool, clammy and mottled skin
           • types
       • epidemilogy
         • one of four deaths are attributed to heart attacks
       • risk factors
         • Age
         • Diabetes
         • Smoking
       • Family history
         • First concern are first and second degree relatives.
       • Hypertension
       • physical examination
         • Jugular Venous Pressure (JVP)
           • causes of high JVP
             • Heart failure.
             • Constrictive pericarditis
   • Management of IHD
     • acute setting of MI
       • STEMI
         • Aspirin
         • Morphine
         • oxygen supplementation
         • Reperfusion
           • angioplasty
             • done after doing angiography
             • opens blocked arteries and restores normal blood flow
           • thrombolytics
             • re-establish perfusion following occlusion of an artery by thrombus
             • MOA
               • activate plasminogen
             • Contraindications
               • cerebral vascular lesion
               • Suspected aortic dissection
             • side effects
               • bleeding
             • drugs
               • streptokinase
                 • obtained fromStreptococci
               • alteplase
                 • Obtained by recombinant DNA technology
       • NSTEMI
         • antithrombotics
         • ACE inhibitors
         • nitrates
         • B-blockers
     • antianginal drugs
       • nitrates
       • B blockers
       • CCBs
         • for Variant angina
     • Lifestyle modification
       • diet
       • smoking cessation
       • physical activity
       • alcohol intake reduction
       • weight management

3. retrosternal pain

   • Gastrointestinal problems
   • respiratory problems
   • cardiac problems

4. causes of non compliance

   • complicated regimens
   • adverse events of medications
   • Literacy
   • poor doctor-patient relationship

5. support groups

   • Members with the same issues can come together for sharing coping strategies,

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