ischemic cardioppathy

Question 1

Definition

CAD

Answer 1

imbalance between the amount of oxygen supplied

and the needs

Question 2

causes of CAD

Answer 2

–ATS is the main cause- BUT not the only one!!!
–Coronarian spasm
–Inflammation (colagenosis)
–Injury (radiation, chemotherapy)

Question 3

Risk factors of CAD

Answer 3

–Age is the strongest risk factor for CAD
–Hypertension
–Tobacco use
–diabetes
–Physical inactivity
–Unhealthy diet
–hypercholesterolemia/dyslipidemia
–Overweight and obesity

Question 4

CLASSIFICATION OF CAD (WHO):

Answer 4

• Without pain: arrhythmias, sudden cardiac death
• With pain: stable angina, unstable, AMI
• Chronic: stable angina (effort)
• Acute coronary syndromes: unstable angina, AMI

Question 5

Canadian Cardiovascular Classification System of Angina Pectoris (Class- Activities Triggering Chest Pain)

Answer 5

1. Strenuous, rapid, or prolonged exertion- Not usual physical activities (eg, walking, climbing stairs)
2. Strenuous, rapid, or prolonged exertion- Not usual physical activities (eg, walking, climbing stairs)
3. Walking, even 1 or 2 blocks at usual pace and on level ground, Climbing stairs
4. Any physical activity- Sometimes occurring at rest

Question 6

Stabe Angina

Answer 6

• De novo
  lIn the last month
• ​Crescendo angina- “aggravated” exertional (a progressive lower intensity of the effort) decubitus angina
• Post myocardial infarction- 1to 60 days after
• Prinzmetal angina (variant) – first lecture !

Question 7

1.ACUTE MYOCARDIAL INFARCTION- ST elevation acute coronary syndrome (STEMI)
Definion

Answer 7

Detection of rise of cardiac markers (troponines) together with myocardial ischemia with at least one of:

• Symptoms of ischemia (angina)
• ECG changes- ST segment, new left bundle branch block
• Developing of pathological Q wave on ECG
• Imaging evidence of new loss of myocardium or new regional wall motility

Question 8

STEMI

Manifestaiton

Answer 8

• Angor: at rest, severe, prolonged (>30 min-1 h), with anxiety
  !!! In postero-inferior AMI: pain in epigastrium, nausea, vomiting (mimicking gastric pathology)
• Dyspnea – sign of acute LVF
• Palpitations - arrhythmias

Question 9

Genera physica examination

STEMI

Answer 9

• Anxiety
• Agitation, no specific position to relieve the pain
  –Orthopnea- LF
• Sweating, pallor, cold skin

Question 10

AScultation

STEMI

Answer 10

crackles, rronchi, wheezes- acute pulm.edema

Question 11

Cardiac exam

STMI

Answer 11

• Diminshed intensity of the apex impulse
• Possible pericardial rub (pericarditis – complication of AMI)
• Diminished cardiac sounds, ventricular gallop (S3)
  –Tachycardia
  –Bradycardia- postero-inferior AMI
• Murmur of acute mitral regurgitation (rupture of mitral valve or chordae tendineae)[*]

Question 12

Complementary examinations:

Answer 12

–ECG
–Enzymes- markers
–Echocardiography: hypokinesia-a-kinesia, complications
–Coronarography
–Other (MRI)

Question 13

ECG in STEMI

Answer 13

• T: increased hyper-acute amplitude, symmetrical T wave (earliest change) – few hs
• ST elevation (convexity upwards or straightened )
• pathological Q waves= necrosis- few hs, days
• ST at baseline, neg.T, Q persistent- after days, weeks
• Q- persistent
  Persistent ST elevation: aneurysm

ST elevation+ mirror image in the opposite leads!

• the differential dg. (pericarditis)

Answer 14

• Symptoms, signs: similar with STEMI
• ECG:
  ST depression, inverted negative T waves, absence of the Q wave
  possible arrhythmias, tachycardia, bradycardia
• enzymes: - troponines, CK

!!! Differential diagnosis with unstable angina

• Echocardiography: a/hypo-kinesia
• Coronarography: stenosis

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