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Etiology - necrosis or irreversible damage of the myofibril caused by a prolonged ischemia, occlusion of coronary
artery due to thrombosis.
Classification - Acc investigation of ECG: ST elevation, Non-ST elevation
1. Acc etiology :
- caused by atherosclerosis
- caused by other reasons such as trauma, embolism, atheritis
2. Acc Clinical Pic
- Typical
- Atypical : Asthmatic form, Abdominal form, Cerebral form, Arrythmic form, Painless/Silent form
3. Location: Anterior, Posterior, Lateral, apex, septum
4. Stages: Acutus, Acute, Subacute, Chronic
5. Morphological: Transmural, Subendocardial
6. Acc to square: Transmural, Q MI, Non Q MI
Pathogenesis Pathogenesis :
- coronary thrombosis/ stenotic coronary sclerosis spasm/ disruption of atherosclerotic plaque, vasospasm,
platelet aggregation leading to coronary
artery occlusion.
- no blood supply to the myocardium, necrosis of the myocardium.
- 1st period: Moderate ischemia-activity decreased, slow.
- 2nd period(After 30 minutes): Deep ischemia-no activity. Cells don‘t function.
- 3rd period: Damage of myofibrils-Necrotic mass. Irreversible pathological stage.
Morpho
changes
Stage MI dev
MI : Q type MI : Non Q-type Atypical variant
Pathogenesis
Clinical pict 1. Asthmatic Type :
- Pain is absent; attack of symptom like cardiac
asthma.
- tachypnoe, cold sweat, palpitation, fear of
death, weakness, orthopnoe, apnoea & rales.
- inspiratory dyspnea, tachycardia, dizziness,
peripheral cyanosis, intestitial edema
- 1st Group: Old people 65-70 years, with
cardioclerosis
- 2nd Group: Previous MI. Secondary infarction
2. Arrythmic Type :
- without pain. In some case, Accompanied by
pain at rest
- Presence of palpitation, dizziness, fast &
irregular pulse.
- Often in patient more than 40 years old.
- sudden attack, ventricular arrhythmia,
tachycardia, extrabeats, transient arrythmias.
- predispose to fibrillation
3. Central/Brain Dependant Type :
- like stroke; loss of consciousness, weakness,
dizziness, vomiting, vertigo, nausea, headache.
- Impaired movement extremities one side,
impaired feeling of skin, paresis of muscle.
- When infarction area is big, cause
hypoxaemia
4. Silent Infarction :
- No symptoms showing heart disorder
- Might have discomfort in chest, pain in the
teeth or tip of finger.
- necrosis isn‘t so large.
- sudden weakness, soft vertigo, diminish
activity
of heart
- normally for pt with nerve insensitivity eg;
DM
5. Abdominal variant:
- Abdominal(epigastric pain). GIT
dysfunctions (meteorism, diarrhea, nausea,
vomiting).
- Bradycardia. Paralysis of bowel.
- Irritation of phrenic/vagus nerve
- associated with irritation of intestine
dyspepsia
(belching, distention, flatulence)
- palpation in upper abdomen is painful.
Prognosis
Classification
Antianginal Antiarrhythmic Fibrinolytic Anticoagulant Symptomatic therapy
6. morphine
10. sustained ventricular Anticoagulant Therapy:
7. nitroglycerin
tachycardia - Lidocaine
Heparin, Warfarin
8. 11.
beta blockers -metoprolol ventricular fibrillation
9. Opioid(synthetic 11. - prompt defibrillation - Unfractioned heparin -
alkaloid)+Neuroleptic (200-360 J)
initial dose is i/v 10000, then
Neuroleptanalgesia 12. -recurrences treated with 5000 or 2500 unit acc to
Fentanyl or Droperidol
lidocaine infusion
weight of the pt.
c. atrial fibrillation -IV
digoxin or IV amiodarone, - low molecular weight
verapamil, cloradole heparin (LMWH).
d. sinus bradycardia - IV Fibrinolytic therapy:
atropine,
13. - tPA, streptokinase,
- Quinidine
tenecteplase, reteplase,
- Amiodarone/Sotalol
Treatment alteplase, urokinase,
12. - Ca-channel
prourokinase.
antagonist: Verapamil (for
supraventricular arrhythmia)
14. -converts plasminogen to
plasmin and lysis the
13. - Beta-blockers: thrombi.
reduce chance of ventricular
arrhythmia, reinfarction. 15. - side effects like allergy,
Supraventricular arrhythmia. hemorrhage, arrhythmias,
Propanol, Metaprolol
relapsing of the thrombosis.
14. - AV Block –
- Contraindications:
Active
Atropine, Euphiline or internal bleeding Aortic
Prednisolone
dissection
Previous
hemorrhagic shock
Intracranial neoplasm
Thromboembolism/
Aneurysms of the heart Rupture of myocardium Pulmonary edema Dressler’s syndrome
thromboendocarditis
symptom : dyspnea at rest.
- acute coronary failure, Tachypnea, tachycardia,
edema of the lung, wheezing, HT
cardiogenic shock, rupture Diagnosis :
Complications
of the aneurysm, 15. - Xray- diffuse haziness, and
arrhythmias, Kerley B lines of interstitial
thromboembolism of edema.
pulmonary, acute LV insuff, 16. - echocardiography – to diff
acute pericardiatis betw cardiogenic or
noncardiogenic cause.
17. - ballon flotation catheter –
measures diff betw high and
normal pressure causes of
pulmonary edema
AP MI