coronary heart disease...causes more deaths, disability, and financial cost than any other illness, due to atherosclerosis in the coronary arteries specifically

(remember, ischemia means O2 can't get to a tissue, and it become oxygen deprived)

What are the symptoms of acute, subacute, and chronic ischemia?

Acute:  chest pain or no pain at all

Subacute;  anginal pain, anxiety, dyspnea

Chronic:  low cardiac output, dyspnea (shortness of breath in general), orthopnea (shortness of breath when laying down), edema

STEMI:  usually means transmural ischemia, meaning that it involves the full thickness of the cardiac wall.

NSTEMI:  Ischemia is usually subendocardial rather than transmural. These are the more common of the two (55-60 percent of AMI's)

Remember that an AMI can be seen on a EKG as have elevated ST segments, which is the Ventricular Depolarization period

NSTEMI:  Rest, oxygen, sedation and analgesia, control arrhythmias, anticoagulation, heparin and anti platelet agetns needed (stop the growing of the clot, DOES NOT BREAK IT DOWN)

STEMI: Reperfusion, percutaneous coronary intervention (cathoder has to get to the clot and remove it via clot busting drugs, etc.), thrombolytic therapy, aspirin, oxygen nasal cannula, reduce myocardial oxygen demand, control arrrhythmias

Important concept....PCI is preferred over thrombolysis when  avaliable, biggest factor for preventing/surviving AMI's....is EARLY treatment...

Many factors to consider, age, health, size of vessel, prior infarctions, nature of treatment...if you survive the infarct, prognosis is relatively good after, death after 90 days is about 1-22% depending on the factors.

Used to be about 50% chance of survival after surviving the infarct in 1960.

Stable:  recurring episodes of chest pain, brought on by exertion or stress, relieved by rest.  Caused by coronary artherosclerosis, with anemia, fever, hyperthyroidism

Unstable: occurring with minimal activity or at rest

Variant (Pinzmental's) Atypical:  extreme fatigue with minimal exertion

Treat the acute episodes via vasodilation, reduce the frequency via, hypertension control, lipid managment, life style modification, coronary revascularization, or drugs that are beta blockers, nitrates, or calcium channel blockers

Prognosis is okay.  MOst eventually in 3-5 years progress to acute coronary syndrome or congestive heart failure

Cardiac function insufficient to meet the metabolic and blood flow requirements the body needs to function at 1-- percent capacity, the ventricular ejection fraction (EF = SV-EDV-ESV/EDV) is reduced!

Usually the left ventricle is the first to go....increases pulmonary pressure etc...

CHF is a rising incidence in the world!!!!

dyspnea, orthopnea (inability to sleep supine without dyspnea), edema, enlarged heart, reduced EF, evidence of pulmonary edema

Prognosis is still pretty grim, overall, 5 year survival at 50% is usually best outcome

Reduce cardiac workload, limit activity, reduce weight, control hypertension, reduce blood volume, restrict sodium, give diuretics such as Lasix

Reduce cardiac remodeling with aldosterone antagonists, treat hyperlipidemia with statins may help, use agents proven to imprrove the survival such as beta blockers, ACE inhibitors

What is the most common type of shunt?

ASD:  foramen ovale didn't close up after birth, clot from the LE could be the cause of a stroke versus a pulmonary embolism

VSD:  hole between the two ventricles, leading to the hypertrophy of the right ventricle (much worse condition than that of a ASD because non oxygenated blood gets into the arterial system, causing ischemia)

Transposistion of Great Vessels:  blood goes back out without ever being oxygenated, incompatible with life! In fetal baby, can cause blue baby from lack of oxygen

Ductus Arteriosus:  DA fails to shut close after birth, loose efficiency on the left side of the heart, can lead to growth problems in the lower extremeties, when kids try to walk or run, reduced even more, surgery can take care of it really early in life, not a life threatening abnormality (least mortality)

Coarctation of the Aorta:  pressure to the arms and head will be increased due to narrowing (pinched) of the aorta, can be recognized by taking blood pressure at the arms, and at the femoral artery, BP will be lower at the Femoral region

Tetrology of Fallot:  rcombination condition...Right ventricular hypertrophy, VSD, pulmonic stenosis, overriding aorta

Thrombosis:  formation of a thrombus (blood clot) in an intact vessel

Embolism:  thrombus that dislodges and travels to a distant site where it occludes an arterial vessel

PE:  venous thrombus that embolizes to a pulmonary (thrombus is caught in the capillaries of the lungs)

Virchow's Triad:  venous stasis, hypercoagulability, vascular injury

Surgcial procedues, abdominal or pelvic, or any joint replacement procedures

Usually the embolism comes from the LE

Most common:  dyspnea, and pain with inspiration

least common:  hemoptysis, wheezing, leg pain

Somtimes: sudden collapse, "cardiac arrest"