1. Coronary Artery Disease (CAD) Asymptomatic Myocardial Ischemia (Angina) Injury Myocardial Infarction (MI) Acute Coronary Syndrome (ACS)

2. Ischemia IschemiaInjuryInfarction 3. Angina Pectoris TypesPatho Stable Supply Problems Pain c exertion, relieved atherosclerosis, by rest &/or NTGvasospasm Unstable Demand Problems new or increasing stress, cold, exercise CP, often at rest coronary blood flow or PrinzmetalsO2 NOT variant, vasospastic, ofte sufficient to meet tissue n at rest or during sleepdemands 4. MI Triad Diagnosis1. Presenting S & S2. EKG changes/ abnormalities T wave changes ST elevation may not be immediately present3. Serum cardiac enzymes 5. CVMI S & S +/- Pain varies in intensity & location, crushing chest pain into L arm Tachycardia Dysrhythmias Pulm Dyspnea GI Epigastric pain, N & V Neuro Fatigue & weakness, esp. limbs Anxiety, denial, restlessness, feelings of doomSkin Pale, cool, moist/diaphoretic 6. MI Diagnosis - Labs Elevated ESR WBCs Creatine Kinase (CK) CK-MB LDH LDH2 becomes > LDH1 Troponin I 7. Myocardial Ischemia Patho Insufficient O2 Cells switch to anaerobic metabolism Lactic acid formed Cellular function impaired * silent ischemia (without pain) Inverted t wave 8. Myocardial Injury Progressive form of myocardial ischemia ST Elevation (STE) STEMI (myocardial infarction) 9. Myocardial Infarction (MI) Death of part of myocardium 20 minutes myocardial cells begin todie Q wave 10. MI Pathophysiology O2 supply inadequate K+, Ca++ & Mg++ leaks vascular occlusion out O2 reserves last for ~ 8 Na+ leaks inseconds Cell Contraction stops Cells switch to anaerobic Lysosomes releasemetabolismenzymes Lactic acid accumulates Cell membrane disrupted contents released 11. MI Repair 24 hours leukocytes invade damaged tissue & release proteolytic enzymes blood sugar goes up as catecholamines released from cells 7 to 14 days insulin goes up 10 to 14 days weak collagen matrix deposited 6 weeks scar formation complete 12. MI Complication- Dysrhythmias Etiology Heart block (AV block) ischemia Atria & ventricles contractindependently hypoxia Premature ventricular lactic acidosis contraction (PVC) electrolyte ectopic pacemaker initiatesimbalancesventricular contraction Which one most Fibrillation-quiveringlikely? Atrial (chronic) Ventricular must tx immediately