IHD Flashcards
Stable angina
Exertional chest pain Relieve by tng or rest Secondry to artheriosclerosis No necrosis ST depression
Prinzmetal (vasospastic) angina
Secondary to spasm coronary
Transient ST elevation
* HTN and HLP are not risk factors
Trigger: alcol o cocain
Tx: no smoking, CCB, nitrates
Unstable angina
Thrombosis > incomplete occlusion
Unlike NSTEMI no cardiac marker elevation
With or wothout st depression and/or t inversion
At rest chest pain
Sudden cardiac death
CAD
cardiomyopathy (dilated and hypertrophic)
Hereditary ion channelopathy (QT syndrome, Brugada)
Arrhythmia like VF
prevention : ICD
STEMI
Transmural
NSTEMI
Subendocardial
MI complications 0-24 hrs
Coagulative necrosis Edema Hemorrhage Wavy fibers Reperfusion injury Free radical generation Lead to : - ventricular arrhythmia -HF -cardiogenic shick
MI complications 1-3 days
Acute inflamation around necrosis
Extensive coagulative necrosis
Lead to :
-post infarction fibrinous pericarditis
MI complication 3-14 days
Macrophage Granulation tissue at margins Lead to -free wall rupture and tamponade -papillary rupture and MR -interventricular septal rupture -LV pseudo aneurysm
MI complication 2w to several months
Dressler syndrome HF Arhythmia Ventricular aneurysm (risk of mural thrombus) Contracted scar
STEMI Tx
Reperfusion therapy (percutaneous intervention prefered over fibrinolysis) \+ NSTEMI tx
NSTEMI
For pain (morphin tng) Statin Betablocker Ace inhibitor Anticoagulation (heparin) Anti platelets (aspirin ADP receptor inhibitor (clopidogrel)