Prof. S.M.Andreychyn

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Myocardial infarction. Clinical forms, laboratory and ECG diagnosis. Early signs and complications. Principles of treatment of non complicated myocardial infarction. Prof. S.M.Andreychyn. 1. Sudden coronary death or heart arrest (HA) 1 .1. HA with following resuscitation .
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Myocardial infarction. Clinical forms, laboratory and ECG diagnosis. Early signs and complications. Principles of treatment of noncomplicatedmyocardial infarction Prof. S.M.Andreychyn
  • 1. diagnosis. Early signs and complications. Principles of treatment of Sudden coronary death or heart arrest (HA)
  • 1.1. HA with following resuscitation.
  • 1.2. HA with following mortal outcome.
  • 2. Angina pectoris (AP)
  • 2.1 Stable angina at exertion.
  • 2.1.1 Stable angina at exertion( functional class should be determined).
  • 2.1.2 Stable angina at exertionin angiographically intact vessels (coronary syndrome X).
  • Clinical forms of IHD
  • 2.2. diagnosis. Early signs and complications. Principles of treatment of Angiospastic angina (angina in rest, spontaneous, variant, Prinzmetals’ angina)
  • 2.3. Unstable angina.
  • 2.3.1. Primary angina.
  • 2.3.2. Progressive angina.
  • 3. MYOCARDIAL INFARCTION (МI)
  • 4. CARDIOSCLEROSIS (postinfarctional, focal and diffuse)
  • 5. MYOCARDIAL ASCHEMIA WITHOUT PAIN
  • 6. CARDIAC RRHYTHM DISORDERS (form)
  • 7. HEART FAILURE (stage, functional class)
  • Acute myocardial infarction with the presence of wave Q ( diagnosis. Early signs and complications. Principles of treatment of transmural).
  • Acute myocardial infarction without Q wave.
  • Acute subendocardial myocardial infarction.
  • Acute myocardial infarction (undefined).
  • Recurrent myocardial infarction.
  • Repeated myocardial infarction.
  • Acute coronary insufficiency.
  • Classification of IM
  • It is necrosis of area cardiac to the  diagnosis. Early signs and complications. Principles of treatment of muscle, that is predefined by an ischemia that arises up sharply as a result of disparity of coronal blood stream  to the requirements of myocardium in oxygen.
  • Myocardial infarction (MI)
  • 85 % - diagnosis. Early signs and complications. Principles of treatment of stenotic atherosclerosis of coronary arteries
  • 10 % - spasm of coronary arteries
  • 5 % - transitory thrombocytes aggregates
  • 100 % - combination of these factors
  • Morbidity in males is 4 times higher than in females
  • Causes of IHD
  • Smoking diagnosis. Early signs and complications. Principles of treatment of
  • Dyslipidemia
  • Arterial hypertension
  • Diabetes mellitus
  • Obesity
  • Dietary factors
  • Thrombogenic factors
  • Lack of physical activity
  • Alcohol abuse
  • Provocation factors The accumulation of cholesterol in the vascular wall - atherosclerotic plaque
  • Schematic of atherosclerotic plaqueMI: 1 - subendocardial 2 - transmural 3 - subepicardial 4 - intramural
  • 2
  • Time of occurrence: atherosclerotic plaque
  • -primary;
  • -second (after 1 month. following the first);
  • - recurrent (in the range of 72 hours. Before 28 days after the first).
  • Myocardial infarction can be:
  • Anginous atherosclerotic plaquevariant
  • Abdominal variant
  • Asthmatic variant
  • Arrythmiccariant
  • Cerebral variant
  • Asymptomatic variant
  • Clinical variants of MI
  • Pain atherosclerotic plaquepattern simillar to angina pectoris but pain intensity is much more severe that is why nitrates can’t release pain. Pain duration is longer.
  • Clinics – main symptom If patient feels pain, you must ask him about: atherosclerotic plaque
  • 1. The nature of pain.
  • 2. Localization.
  • 3. Duration.
  • 4. Irradiation.
  • 5. Contact with the physical, emotional stress, movements, breathing, eating, and other factors.
  • 6. Effect of different drugs on pain.
  • Pain atherosclerotic plaquesyndrom Pain atherosclerotic plaquesyndrom The second severity of symptoms is dyspnea. It may be accompanied by pain or be the only sign of MI. Next complains can be tachycardia, accompanied by pain or be the only sign of MI.different arrhythmias, high temperature, swelling.
  • Typical history and clinical presentation. accompanied by pain or be the only sign of MI.
  • Characteristic of ECG changes.
  • There are three zones on ECG:
  •    - Zone of ischemia - negative or high T wave;
  •    - Zone of damage - shift segment S-T;
  •    - Zone of necrosis – Q wave larger then ¼ R wave
  • Diagnosis of MI:
  • Shows the process of rapid ventricular accompanied by pain or be the only sign of MI.repolarisation.
  • Always positive in I - II, aVF, V2 - V6.
  • In the third, aVL, V1 can be positive or negative.
  • Duration 0.12 - 0.16 s, amplitude 2.5 - 6mm.
  • Wave T
  • It is accompanied by pain or be the only sign of MI.excitation interventricular septum.
  • Duration to 0.03 sec., height does not exceed ¼ wave R.
  • Sometimes can not register.
  • Registration Q wave even small amplitude in leads V1 - V3 pathology.
  • Wave Q І. accompanied by pain or be the only sign of MI.Superacute (before the development of necrosis) – clinical pattern of prolonged attack of anginous pain (duration 30 min – 2 hours). Stages of MI
  • ІІ. accompanied by pain or be the only sign of MI.Acute stage(development of myocardial necrosis) – 2 – 7 days
  • - pain disappears;
  • - manifestation of heart failure
  • Acute stage
  • І accompanied by pain or be the only sign of MI.II. Subacute period (initial organization of a scar, displacement of nectoric tissues with connective one) – 3 weeks.
  • Subacute period
  • I accompanied by pain or be the only sign of MI.V. Postinfarctional stage (final organization of a scar),lasts for 3-6 month).
  • Postinfarctional stage ST segment elevation accompanied by pain or be the only sign of MI. QS wave accompanied by pain or be the only sign of MI.
  • I accompanied by pain or be the only sign of MI.- the front wall of the left ventricle
  • II - intermediate (repeats I or III toward pathology)
  • III - postlateraldiaphragmatic or right ventricle
  • aVR - basal parts of the left ventricle
  • aVL - upper lateral departments of left ventricle
  • aVF - diaphragmatic departments or right ventricle
  • Display units infarction on ECG
  • V1 - front wall accompanied by pain or be the only sign of MI.
  • V2 - front wall
  • V3 – partition (septum)
  • V4 - top
  • V5 – lower lateral departments of the left ventricle
  • V6 – lower lateral departments of the left ventricle
  • Anterior MI - presence of Q or accompanied by pain or be the only sign of MI.QS waves in V1 - V4.
  • Lower (posterior diaphragmatic) - the presence of Q or QS waves in II, III and aVF leads.
  • Side - the presence of Q or QS waves in and aVL, V5 - V6.
  • Posterior - reciprocal ECG changes in V1 - V2 leads.
  • ECG signs of acute myocardial infarction with Q wave
  • Serum troponin I or T levels (or CK-MB if troponin is not available).
  • Full blood count.
  • Serum creatinine and electrolyte levels, particularly potassium concentration, as hypokalaemia is associated with an increased risk of arrhythmias, especially ventricular fibrillation (grade B recommendation).
  • Serum creatinekinase(CK) level.
  • ALT, AST, LDG levels
  • Leucocitosis
  • Serum lipid levels (fasting levels of total cholesterol, low-density-lipoprotein cholesterol, high-density-lipoprotein cholesterol and triglycerides) within 24 hours.
  • Blood glucose level.
  • Blood tests Scheme of available).coronarography
  • A - available).Aspirin and Antianginal therapy
  • B - Beta-blocker and Blood pressure
  • C - Cigarette smoking and Cholesterol
  • D - Diet and Diabetes
  • E - Education and Exercise
  • Treatment of MI Thank you! available).
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