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Coronary H eart D isease (CHD)

Coronary H eart D isease (CHD). L á szl ó Torn óci Inst. Pathophysiology Semmelweis University. Significance. CHD causes more deaths and disability than any other disease in the developed countries. CHD like stroke and occlusion of peripheral arteries is a consequence of atherosclerosis.

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Coronary H eart D isease (CHD)

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  1. Coronary Heart Disease (CHD) László Tornóci Inst. Pathophysiology Semmelweis University

  2. Significance CHD causes more deaths and disability than any other disease in the developed countries. CHD like stroke and occlusion of peripheral arteries is a consequence of atherosclerosis.

  3. Natural history • No symptoms • Angina pectoris • Acute myocardial infarction • Chronic heart failure • Sudden death Possible symptoms or results:

  4. Angina pectoris • Classic vs. Prinzmetal angina • Stable vs. unstable angina Severe, dull pain in the chest of limited duration. Usually provoked by physical activity, cold, or a large meal. Pain is relieved by nitrates in the classic type.

  5. Common Usually stress induced (effort angina) ECG: ST depression Responds to nitrates Caused by coronary occlusion Rare Usually occurs at rest (during sleep) ECG: ST elevation No response to nitrates Caused by coronary spasm Comparison of angina types Classic angina Prinzmetal angina

  6. Good prognosis Caused by quiescent plaque Reproducable pain Poor prognosis Caused by ruptured plaque Pain unusually bad, occurs more frequently or unexpectedly Stable vs. unstable angina

  7. Acute Myocardial Infarction (AMI) • Symptoms • Natural history, prognosis • ECG signs • Complications • STEMI vs. NSTEMI infarctions

  8. Vulnerable plaque NEJM: 342:101 (2000)

  9. Plaque rupture NEJM: 342:101 (2000)

  10. Acute Coronary Syndrome (ACS) • First angina-like pain ever • Angina in CHD patients, if: • Pain is not relieved by nitrates and/or • Pain is unusually severe ACS may be: AMI unstable angina ACS is suspected:

  11. ACS types

  12. Pathophysiology Stable angina NSTEMI UA, STEMI

  13. Diagnosis of AMI • Clinical signs • ECG signs (ST elevation, depression, pathological Q) • Plasma conc. of cardiac troponin T or I

  14. Prevention of CHD • Quit smoking • Avoid sedentary lifestyle • Care of hypertension • Care of DM • Care of hyperlipidemias

  15. Prevention of AMI in CHD patients All things mentioned in the previous slide • Use of drugs (aspirin) • Check progression of CHD • Hospitalize unstable angina cases • Surgery, angioplasty, stent if necessary

  16. Therapy of AMI • Minimize damage (PTCA, thrombolysis) • Control arrhythmias, circulation • Look for complications • Fight cardiac shock if it develops • Assessment of prognosis, rehabilitation • Secondary prevention

  17. PTCA Percutaneous Transluminal Coronary Angioplasty Currently the best way to minimize the damage caused by AMI Timing is very important, however

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