Angina and Myocardial infraction (1) darshu.pptx

Introduction of Angina Pectoris and Myocardial infraction , type of it, along with their etiopathogenesis, Clinical Manifestation and Management

1. Angina and Myocardial infraction Presented by- Darshana S. Varma

2. Ischemic Diseases (IHD) Angina and Myocardial infraction are ischemic diseases. Ischemic is condition in which there is an inadequate supply of blood and oxygen to poor of myocardium Ischemic heart disease Angina Acute coronary syndrome Stable , Extertional (classical) Unstable Microvascular Acute myocardial infraction 1) Non-ST segment elevation MI Variant/ prinzmetal / vasospastic (NSTEMI ) 2) ST segment elevation MI (STEMI)

3. Risk Factor:- Smooking Dyslipidemia Hypertension Diabetes Obesity History of coronary artery diseases

4. Angina It is condition marked by severe pain in the chest, often also spreading to the shoulders, arms, and neck, owing to an inadequate blood supply to the heart. Angina index = heart rate systolic BP   Sr no Types Description 1 Stable Attack predictably provoked by exercise , emotion, eating or coitus which create greater demand for oxygen rich blood to reach heart rate. Pain usually go away at rest 2 Microvascular More common in female due to microvascular dysfunction and no coronary blockage there 3 Variant Attack are unpredictable and almost always occur at rest/ during sleep

5. Pathophysiology Angina pectoris ( chest pain) Narrowing of coronary arteries Insufficient blood flow Myocardial Oxygen demands exceeds supply Anaerobic metabolism with lactic acid accumulation Myocardial nerve fibres irritated Pain message transmitted to cardiac nerve and upper posterior nerve roots

6. Etiopathogenesis Atherosclerosis Extrem cold Anemia Psychological stress Excessive vasoconstriction Thrombin Narrowing outflow valve of heart Extreme Physical exercise Thickening of heart muscle Genetic Heavy meal

7. Clinical Manifestation Chest pain Pain at jaw and neck Dizziness Fatigue Inability to exercise Slightly headache or sweating Rapid breathing / shortness of breath Anxiety Chest pressure / fast heart rate

8. Management Diagnosis:- Typical clinical features Determination of biochemical markers of ischaemia in blood . Eg -Raised of troponin 1, myoglobin creatinine kinase CBC Lipid profile ECG Chest X-ray Coronary CT Echocardiography MRI

9. Non-Pharmacology Stable angina:- Daily exercise – e.g. cobra yoga Stop smooking Avoid alcohol Dietary modification: -low cholesterol intake , low fat diet . Avoid any activity cause chest pain Unstable angina :- Complete bed rest

10. Pharmacological Organic nitrates β -Blocker K + channel Antiplatelet Opioids e.g.- Glyceryl trinitrate Atenolol opener agent eg - IV eg - Nicorandil eg - Aspirin Morphine Oxygen ACEI therapy eg – Enalapril Statins eg - Atorvastatin Calcium Channel blocker (CCB) Thrombolytic eg -Amlodipine eg - Streptokinase Anticoagulant eg - low molecular Heparin

11. Surgical :- Coronary Artery Bypass Graft (CABG) Angioplasty

12. Coronary Artery Bypass Graft (CABG):- CABG surgery restores normal blood flow to heart by creating a bypass around the blocked arteries This is done by using a healthy blood vessel called graft A graft is usually a piece of blood vessels located in the chest, leg or arm The graft is connected below and above the blocked arteries in the heart. This creates a pathway to carry oxygen rich blood to the heart. CABG is recommended in patients Significant left main coronary artery stenosis Three vessel diseases One or two vessel disease with extensive myocardial risk and not suitable for PCI

13. Angioplasty:- It is also known as Percutaneous coronary intervention (PCI) It is carried out without fibrinolysis A stent is a metal or plastic tube inserted into lumen of the blocked coronary artery to keep the passageway open, and stenting in the placement of stent The following types of stent are available 1) Bare metal stents (BMS):- These are mesh like tube made up of thin metal wire . They are without a coating or covering of drugs 2) Drug eluting stents (DES) :- These are coated with medicine , which is released into artery over time to prevent the artery from narrowing again 3) Biodegradable or bioabsorbable stents :- These stents are dissolved after a few months They are useful when the need is temporary

14. PCI is considered in patient with:- Contraindicated to IV fibrinolytic therapy High risk features with cardiogenic shock High bleeding risk ( peptic ulcer, thrombocytopenia, severe coagulopathy) Intolerance for oral antiplatelets long term use

15. Acute coronary syndrome Acute coronary syndrome is sudden reduced flow to heart producing symptom. It is life threatening . Sr no Types Description 1 Unstable Angina More sever than stable angina. Occur at rest lasting and prolonged >20min 2 Acute myocardial infraction Refer to death of myocytes (necrosis) of portion of myocardium due to sudden occlusion of branch of coronary artery. It also known as heart attack. Non-ST-segment elevation myocardial infraction (NSTEMI) It more severe than unstable angina . Obstruction of coronary artery is incomplete but myocardial necrosis up to some extent is there b ST-segment elevation myocardial infraction (STEMI) It is most serious type of heart attack . Obstruction of artery is complete and full thickness of ventricular wall an larger area of myocardium is necrosed

16. Myocardial Infraction:- It is a diseased condition which caused by reduced blood flow in a coronary artery due to atherosclerosis (deposition of fatty material inner wall of arteries) and occlusion(blockage) of an artery by an embolus or thrombus(blood clot formed).

17. Pathophysiology : - Severe arterial occlusion Severe Vasospasm Atheroma Reduced Blood Flow Myocardial infraction Deficient Pumping Congestive Shock Cardiac failure Death

18. Etiopathogenosis:- Decreased cardiac output Damming blood in pulmonary Arrhythmias Ventricular remodeling Rupture of papillary muscle Acute heart failure Thrombus formation Platelet aggregation Hemorrhage

19. Clinical Manifestation:- Sensation of tightness Pressure or squeezing Pain radiate at left arm , lower jaw, neck, right arm , back Vomiting Nausea Weakness Abdominal pain Dizziness Headache Dyspnea

20. Management :- As same as angina