Professional Documents
Culture Documents
Dr. R. Deduyo
It takes several years until the fourth decade which is the most common
ATHEROTHROMBOSIS decade and
Acute thrombosis occurring in the presence or pre-existing If this would ruptured-complicated lesion(ACS)
atherosclerosis produces acute ischemic strokes, acute ischemic
strokes(if it affects the cerebral artery), acute ischemic syndromes of
peripheral arteries(found on patients who are chronically hypertensive ATHEROSCLEROSIS to ATHEROTHROMBOSIS
only or diabetics only or combination of DM and hypertension) and
acute coronary syndrome( patients with severe and chronic chest
discomfort) (including unstable angina, myocardial infarction (NSTEMI
and STEMI) and sudden death
Disrupted plaque
- Thick ,rich lipid core
- Thin fibrous cap
- (+) thrombus- it can partially occlude or completely occlude the arterial
lumen.
You will able to palpate and elicit tenderness and there will be an
inflammation , and it is contionus and last for 1-2-3 hours and even weeks,
and pag tumagal na, deads na sya!!
Atherosclerosis starts even during the first decade of life and some of them
are offspring of diabetic and hypertensive parents.It has been studied that
in the blood vessel of newborn, they were able to find fatty streaks on the
arterial wall ( fatty streaks which are the early lesion of atherosclerosis), so
this can progress for the 1st,2nd ,3rd decade of life, and as you can see , there
is gradual growth of atherosclerotic plaque.
history:
severe localized chest or arm pain at rest or on minimal exertion
If the ST elevation is not seen, diagnosis is either unstable angina or Non ST > 20mins crescendo pattern
elevation Myocardial Infarction
Chronic stable angina-angina related to activity and even at rest or no
If it is (+) with ST elevation, diagnosis is St elevation MI. activity, pain scale of 5-10.Sometimes the patient do not have the
luxury of discomfort pero heart Failure kagad. Presentation is not
A biochemical cardiac marker will distinguish the two (-) for ST elevation.
discomfort but severe DOB with crackles all over, with Pulmonary
It is not the LDH, CKA,etc but the TROPONIN(troponin I and T), edema and Heart Failure(complications).Sometimes patient
presentation are dyspneic, eith mitral regurgitation, S3 gallop, crackles
Unstable angina Negative(-) for St elevation and NormalTroponin and which is persistent.
with ischemic discomfort Unstable angina- cardiac marker is normal
Non ST elevation Myocardial InfarctionPositive(+) for troponin T and I NSTEMITroponi (+)
(w/c is in nanogram/dL; morethan 50 indicates positivity) and with an hour
of chest dicomfort. Physical exam:
pulmonary edema new or worsening MR, S3, new or worsening
Q wave indicates necrosis of myocardium. rales
ECG:
transient ST segment changes (>0.05mv) new bundle branch
block, sustained ventricular tachycardia
Left Bundle Block can be considered STEMI--+ peaking of T wave
and 4-6 mm above the base line in ST segment changes.
o Pathological Diagnosis
- Prolonged ischemia PATHOLOGIC Q WAVE;
- Myocyte Death
- Coagulation Necrosis
- Myocytolysis
o Clinical Diagnosis
- History
Accelerating Angina and rest pain(>30mins)
Consistricting, crushing, compressing, heaviness,
choking
Retrosternal radiating to ulnar aspect of left arm
Atypical presentation
- Physcial exam
Soft S1, S3, S4, MR due to papillary muscle dysfunction,
pericardial friction rub o STEMI ECG findings
Hypotension, tachycardia, bradycardia - At least 2mm ST segment elevation in two or more precordial leads
- ST segement elevation of at least 1 mm in two or more leads
S4(not always present); S3-decr resistance in ventricular filling
period of diastole o Myocardial Ischemia, Injury and Infarction
- QRS Complexes in Infarction
- ECG- ST Segment Elevation, Q waves(signifies necrosis) Normal QRS progression
- Cardiac Markers- Troponins (cTnT, cTnI), CK-MB mass, Height of R wave is related to thickness of viable myocardium
Myoglobin
- The golden hour is the first 4 hrs or 4-6 hrs- for fibrinoltyic o Abnormal Q waves
therapy. - Duration: > 0.04sec
- Depth: > 25% of the height of R wave
C. Non-diagnostic ECG
o ST depression 0.5-1mm
o T wave inversion or flattening in leads with dominant R waves
o Intermediate/low risk unstable angina
Prevention:
Clopidogrel-less expensive,( FOR LIFE)
New antiplatelet: PRASUGREL AND BRELINTA
Statin therapy high dose(FOR LIFE)
ACE ARB(FOR LIFE)