Sd Ischemie Miocardica

Question 1

Cauze non ateroscleroeice de ischemie miocardica

Answer 1

• anomalii congenitale
  -spasm coronarian
  -inflamatia - vasculite
• amonlii
• tromboza orimara
• disectia coronaroana
• dezechil aport neces oxigen
• proliferare intensa intravascukara
• afectare microcirculatie coronariana
• sd X , Y la femei respectiv barbati

Question 2

Factori de risc pt ateroscleroza

Answer 2

1. Varsta - mai ales 50-60 ani
2. Sexul - mai mica la femei sub 50 ani, dar dupa menopauza se egaleaza
3. Ereditatea
4. Obezitatea
5. Sedentarismul - creste risculcv, efortul cresteHDL,m scade TGL, creste sensibilitatea la insulina, creste diametrul coronarelor
6. Fumatul - creste Col total, scade HDL , creste FBR, activeaza plachetele si creste TA si AV, inducand spasul corinarian
7. HTA - det hipertrofie de VS si apoi dezechil oxigen
   TA sistolica >180 mm hg scade debitul coronarian
8. Dislipodemia - mentinere LDl < 100 mg/dl si HDL <40 mg/dl e factor de risc
9. DZ
10. Factori psihosociali

Question 3

Factori noi de risc coronarian

Answer 3

1. Hiperhomocisteinemia x generic, deficit de folati, metab alterat al folatilor, HIPOtiroidie si IR
2. Lipoproteina a favorizeaza aterogeneza si trombogeneza
3. Factori proinfl - FBR, IL 6
4. Factori protrombotici - hiperFRB, factor V Lieiden, defiict prot C,S,AT Ii, sd antifosfolipidic , hiperagregabilitate plachetara, mutatia protrombinei

Question 4

Placa erodata

Answer 4

• bogata in cel musculare netede si PG
• disfunctia cel endoteliale
• fara defect de substanta la niv placii
• tromboza supraadaugata

Question 5

Placa vulnerabila

Answer 5

• cu risc crescut de tromboza si progresi erapida a stenozei

Question 6

Placa rupta

Answer 6

• defect major de substanta la niv capisonului fibros cu delimineata miezul lipidic central de fluxul sg, expunand miezul trombogen

Question 7

Placa trombozata

Answer 7

• placa cu tromb supraiacent
• trombul e ocluziv sau mon ocluziv , proeminent in lumenul vasului

Question 8

Afectare ischemica miocardica primle emanifestari

Answer 8

• angina stabila
• sd coronarian acut
• ischemia silentioasa

Question 9

Angina stabila factori de risc

Answer 9

-xantelasme
- xantoame
- HTA
- obezitate

Question 10

Examen aparat cardiac la angina stabila

Answer 10

• tahocardie
• aritmii
• galop protodiastolic
• suflu de insuf mitrala prin disfunctie ischemica de pilieri

Question 11

Angina stabila paraclinic

Answer 11

• profil lipidic si glicemie + TTOG
• creatinina serica
• markeri de ischemie - CK, CKMB, troponina T, I,
• markeri de inflamatie - prot C reactiva, FBR, homocisteina, NT-proBNP

Question 12

De citit alta ingestigatii paraclinice

Answer 12

Pg 143

Question 13

Diagnostic diferential angina pectorala cu patologii de cauza cardiovasculara

Answer 13

• periacardita acuta/miopericardita
  Sd Dressler - pericardita post IMA
• CMH, CMD
  -valvulopatii
• HTPulm
• disectie de ao
• TEP x trombembolism pulm
• sd X coronarian

Question 14

Dg dif boli digestive

Answer 14

• esofagiene
• gastro- duodenale
• colica biliara
• oancreatita acuta

Question 15

Dg dif cu boli resp

Answer 15

• af pleurale
• af mediastinale
• tumori intratoracica

Question 16

Dd dig cu boli are peretelui toracic

Answer 16

Sd Tietze - costocodrita
- herpes zoster
Z- nevralgia toracica

Question 17

Sd coronariene acute care sunt

Answer 17

• angina instabila
• nonSTEMI
• STEMI