缺血性心脏病和动脉瘤课件.pptVIP

Ischemic heart disease and aortic aneurysms Cardiovascular lab #1 Ischemic heart disease general concepts Ischemic heart disease-- Designation of a group of disorders that all cause ischemia to the myocardium Ischemia results from an imbalance of supply and demand Decreased coronary blood flow ( ~90% of myocardial ischemic dz) Most commonly due to atherosclerosis with superimposed thrombus, vasospasm or both Uncommon causes of decreased supply are arteritis, emboli, cocaine-vasospasm and systemic hypotension Normal flow but not enough oxygen (increased demand or hypoxia) Tachycardia, and hypertrophy Cyanosis due to congenital heart disese (rt-lt shunts), smoking, carbon monoxide poisoning, lung disease... Myocardial ischemic syndromes Four basic ischemic syndromes-- Angina pectoris-- chest pain resulting from ischemia without frank infarction (reversible ischemia) Three clinical patterns of angina Stable--underlying path is usually stenosis of major coronary vessel (75% stenosis) Prinzemetal-- Vasospasm Unstabe-- plaque disruption with variable mural thrombi Myocardial infarction (MI)-- Death of cardiac muscle cells Transmural infarcts-- infarctions of full thickness of ventricular wall. Subendocardial infarcts-- infarction limited to the inner 1/3-1/2 of myocardium Chronic ischemic heart disease-- Elderly with multivessel disease insidiously develop CHF due to post-infarct decompensation, or slow myocyte degeneration Sudden cardiac death-- defined as unexpected cardiac death within 1 hour of sx’s onset Many underlying disease that all trigger a common final mechanism of death-- fatal arrhthymia Myocardial infarction Transmural infarcts-- Pathogenesis-- Underlying disease--90% due to coronary atherosclerosis and subsequent disruption of plaques Initial event-- acute plaque change or disruption (this includes erosion, ulceration, fissuring, rupture or hemorrhagic expansion)-- plaque change precipitated by vasospasm or hemodynamic stress Thrombosis follows