Patho Diagram MI

  67 Predisposing Factors Age: >45 years (61 y/o)Gender: MALE Family history of CHD Precipitating Factors Preexisting conditions:Diabetes mellitusHypertensionLifestyle:High-fat diet Smoking Sedentary lifestyleLow HDL cholesterolEtiology:AtherosclerosisThrombosis/embolismCoronary stenosis/spasmPlatelet aggregationIncreased levels of LDL cholesterolMacrophages release free radicals thatoxidize LDLExposure of subendothelial tissue to bloodcomponents endothelial cell loss   Platelet adhesion aggregation and fibrindepositionFormation of atherosclerotic plaque in thecoronary arteryBlood volume circulated into the myocardialtissue will be decreased, causing ischemia Signs Symptoms: Chest pain that usuallyhappens during workbut relieved by rest Dx test: Coronary angiographyECGX-rayPlaque continues to formComplete occlusion of thecoronary arteryO2 deprivation of myocardialtissues results in shifting fromaerobic to anaerobic metabolismAccumulation of lactic acid anddecrease in cellular pHIf ischemia is longer than 45 minutes,irreversible myocardial cell damage necrosis occursAcidosis causes the myocardium to becomevulnerable to lysosomal effects within thecell, and leads to conduction disordersIf treatedIf NOT treatedGoodprognosis Treatment:Lifestyle: Rest lifestylemodification Pharmacologic: NitroglycerinAntiplateletsAntilipedemicsBeta blockers Surgical: CABGPTCA  68 ACUTE MYOCARDIAL INFARCTION Signs Symptoms: Atypical chest painunrelieved by rest nitroglycerinNausea dizzinessShortness of breath/difficultyof breathingUnexplained anxiety,weakness or fatiguePalpitations, diaphoresis or paleness Dx test: Coronary angiographyECGRadionuclide imagingCardiac enzyme tests(Troponin I, CK-MB, LDH,Myoglobin, AST) As myocardial cells necrose, intracellular enzymes will be releasedIf treatedFair prognosis Pharmacologicmanagement: Thrombolytic therapy within3 hours of onset to restorevessel patency minimizenecrosisNitroglycerin to relieve chestpainMorphine to relieve painAspirin for platelet inhibitionIV heparin to promotepatency in affected arteryLidocaine, epinephrine tocombat dysrhythmias Medical-surgicalmanagement: PTCACABGStent insertion Infarcted area maycompromise ventricular contractile functionLEFT-SIDED HEARTFAILUREDecreased cardiac outputBlood that should be pumpedinto the systemic circulationback up into the left atriumand into the lungsShifting of intravascular fluidinto the interstitium of thelung pulmonary edemaoccurs Signs Symptoms: Dyspnea, orthopneaFatigueCrackles, non-productivecoughhemoptysis If treatedIf NOT treated AB  69 If NOT treated A Pharmacologicmanagement: O2 administrationLoop diureticsIntravenous nitrates   (glycerol nitrate)DigoxinACE inhibitorsBeta-blockersMorphine Lifestyle modification B Fair prognosisBacteria will colonize in thefluidAlveoli will be inflamedLung consolidationAlveolar collapseLow O2 saturation decreased tissue perfusionPoor prognosisDEATH Signs symptoms: Fever Crackles; non-productivecough Dx tests: Sputum AFB Pharmacologicalmanagement: AntipyreticsMucolyticsO2 administrationAntibacterial therapy