The most beautiful things in life The most beautiful things in life cannot be seen or even cannot be seen or even

touched, touched, They must be felt with the They must be felt with the

heart.heart.--Helen KellerHelen Keller

HeartachesHeartaches

Gerald P. ValenzuelaGerald P. Valenzuela

CardiovascularCardiovascular

pertaining to heart and blood vesselspertaining to heart and blood vessels

HeartHeart Blood vesselsBlood vessels BloodBlood

HeartHeart

PericardiumPericardium Pericardial fluidPericardial fluid WallsWalls

– EpicardiumEpicardium– MyocardiumMyocardium– Endocardium Endocardium

Heart ChambersHeart Chambers

2 Atria2 Atria Interarterial Interarterial

septumseptum 2 ventricles2 ventricles Interventricular Interventricular

septumseptum

Heart ValvesHeart Valves

Tricuspid valve TVTricuspid valve TV Pulmonary Pulmonary

semilunar valvesemilunar valve Mitral valve or Mitral valve or

bicuspid valvebicuspid valve Aortic or semilunar Aortic or semilunar

valvevalve

The Blood Supply of the The Blood Supply of the HeartHeart

The Circulatory System

Be still my beating Be still my beating heart………heart………

My HeartbeatMy Heartbeat

The conduction The conduction systemsystem

Electrical impulsesElectrical impulses Sinoatrial Node SASinoatrial Node SA Atrioventricular Atrioventricular

Node AV nodeNode AV node Bundle of HisBundle of His Purkinje fibersPurkinje fibers

Heart SoundsHeart Sounds

SS11 lubb sound – caused lubb sound – caused by the tricuspid and by the tricuspid and mitral valve closing mitral valve closing between the atria and between the atria and ventriclesventricles

SS2 2 dupp sound – dupp sound – shorter and higher shorter and higher pitch, caused by pitch, caused by closing of semilunar closing of semilunar valves as blood is valves as blood is pumped out of the pumped out of the heartheart

Pulse and Blood PressurePulse and Blood Pressure

PulsePulse Blood PressureBlood Pressure Systolic pressureSystolic pressure Diastolic PressureDiastolic Pressure Hg - mercuryHg - mercury

The BloodThe Blood

Plasma – nutrients, hormones and Plasma – nutrients, hormones and waste products, clotting proteinswaste products, clotting proteins

Serum – plasma minus clotting Serum – plasma minus clotting proteinsproteins

Fibrinogen and prothrombin are Fibrinogen and prothrombin are clotting proteins clotting proteins

The BloodThe Blood

Erythrocytes – mature RBCsErythrocytes – mature RBCs Reticulocyte – youngReticulocyte – young Hemoglobin – iron containing Hemoglobin – iron containing

pigment which binds oxygenpigment which binds oxygen Lifespan 120 days Lifespan 120 days

The BloodThe Blood

Leukocytes – immunity & protectionLeukocytes – immunity & protection NeutrophilsNeutrophils BasophilsBasophils EosinophilsEosinophils LymphocytesLymphocytes Monocytes Monocytes

The BloodThe Blood

Thrombocytes – plateletsThrombocytes – platelets Not cells, but fragments of Not cells, but fragments of

megakaryocytesmegakaryocytes For clotting bloodFor clotting blood

Blood TypesBlood Types

Blood TypeBlood Type Can Donate Can Donate toto

Can Receive Can Receive FromFrom

AA A or AB onlyA or AB only A or O onlyA or O only

BB B or AB onlyB or AB only B or O onlyB or O only

AB AB (universal (universal recipient)recipient)

AB onlyAB only A, B, AB, OA, B, AB, O

O (universal O (universal donor)donor)

A, B, AB, OA, B, AB, O O onlyO only

The Rh factorThe Rh factor

Rhesus monkeysRhesus monkeys Rh (+) presence of antigenRh (+) presence of antigen Rh (-)Rh (-) Mother is Rh- and Father is Rh+Mother is Rh- and Father is Rh+ Baby inherits Rh+Baby inherits Rh+ Mother develops Ab against Rh antigenMother develops Ab against Rh antigen 22ndnd pregnancy will result to pregnancy will result to

erythroblastosis fetaliserythroblastosis fetalis Tx: Rh immune globulin or RhogamTx: Rh immune globulin or Rhogam

Medical Specialties related to Medical Specialties related to Cardiovascular SystemCardiovascular System

CardiologistCardiologist HematologistHematologist

Pathology of the Pathology of the Cardiovascular SystemCardiovascular System

Coronary Artery DiseaseCoronary Artery Disease, , CADCAD, is , is atherosclerosisatherosclerosis of the coronary arteries of the coronary arteries that may cause that may cause angina pectorisangina pectoris, , myocardial infarctionmyocardial infarction and sudden death. and sudden death.

End-stage coronary artery diseaseEnd-stage coronary artery disease is is the final phase of CAD characterized by the final phase of CAD characterized by unrelenting angina pain and a severely unrelenting angina pain and a severely limited lifestyle in which medication is the limited lifestyle in which medication is the only remaining treatment option.only remaining treatment option.

CADCAD

AtheroAtherosclerosissclerosis is is hardening and hardening and narrowing of the narrowing of the arteries due to a arteries due to a buildup of buildup of cholesterol plaques cholesterol plaques oror fatty substance fatty substance..

CADCAD

An An atheratheromaoma which is which is characteristic of characteristic of atherosclerosis, is a atherosclerosis, is a plaque within the plaque within the arterial wall.arterial wall.

This type of plaque This type of plaque ((PLACKPLACK) is similar to ) is similar to the buildup of rust the buildup of rust inside a pipe and it inside a pipe and it may protrude outward may protrude outward into the opening of the into the opening of the vessel or move inward vessel or move inward into the wall of the into the wall of the vessel.vessel.

CADCAD

IschemiaIschemia is a deficiency in blood is a deficiency in blood supply due to either the constriction supply due to either the constriction or the obstruction of a blood vessel.or the obstruction of a blood vessel.

Ischemic heart diseaseIschemic heart disease, , IHDIHD, is a , is a group of cardiac disabilities resulting group of cardiac disabilities resulting from an insufficient supply of from an insufficient supply of oxygenated blood to the heart that is oxygenated blood to the heart that is usually associated with CAD.usually associated with CAD.

CADCAD

Angina pectorisAngina pectoris is severe episodes is severe episodes of spasmodic of spasmodic choking or choking or suffocating chest suffocating chest pain. incomplete pain. incomplete blockage of, the blockage of, the supply of oxygen supply of oxygen to the myocardium.to the myocardium.

CADCAD

A A myocardial infarctionmyocardial infarction a.k.a. a.k.a. heart attackheart attack or or MIMI, is the , is the occlusionocclusion of of a coronary artery a coronary artery resulting in an infarct resulting in an infarct of the affected of the affected myocardium. Damage myocardium. Damage to the myocardium to the myocardium impairs the heart’s impairs the heart’s ability to pump blood ability to pump blood through the body.through the body.

An An infarctinfarct is a localized is a localized area of necrosis caused area of necrosis caused by interruption of the by interruption of the blood supply.blood supply.

Congestive Heart FailureCongestive Heart Failure

CHFCHF, is a , is a syndromesyndrome in which the in which the heart is unable to pump enough heart is unable to pump enough bloodblood to meet the body’s needs for to meet the body’s needs for oxygen and nutrients. In response to oxygen and nutrients. In response to the reduced blood flow, the kidneys the reduced blood flow, the kidneys retain more fluid within the body and retain more fluid within the body and this fluid accumulates in the legs, this fluid accumulates in the legs, ankles and lungs. The term ankles and lungs. The term congestivecongestive refers to this refers to this fluid buildupfluid buildup..

CardCarditisitis

EndocardEndocarditisitis

Bacterial endocarditisBacterial endocarditis - inflammation of the - inflammation of the lining or valves of the heart caused by lining or valves of the heart caused by bacteria.bacteria.

MyocardMyocarditisitis – Rheumatic heart fever, rheumatic heart diseaseRheumatic heart fever, rheumatic heart disease

PericardPericarditisitis

Heart ValvesHeart Valves ValvulValvulitisitis

Mitral valve prolapseMitral valve prolapse is an abnormal protrusion is an abnormal protrusion of the mitral value that results in the incomplete of the mitral value that results in the incomplete closure of the valve.closure of the valve.

Mitral stenosisMitral stenosis - narrowing - narrowing

Tricuspid stenosisTricuspid stenosis

A valve that does not function properly may allow A valve that does not function properly may allow blood to flow back into the heart chamber. The blood to flow back into the heart chamber. The sound of this abnormal flow is called a sound of this abnormal flow is called a heart heart murmurmurmur..

Ventricular Septal Defects Ventricular Septal Defects VSDVSD

Tetralogy of Fallot

•Pulmonary Stenosis

•Overriding of the aorta

•Ventricular septal defect

•Right ventricular hypertrophy

ArrythmiasArrythmias Cardiac arrhythmiaCardiac arrhythmia a.k.a. a.k.a. dysrhythmiadysrhythmia

BradyBradycardia -cardia - abnormally abnormally slowslow heartbeat. heartbeat.

FlutterFlutter - a cardiac arrhythmia in which the atrial - a cardiac arrhythmia in which the atrial contractions are rapid but regular.contractions are rapid but regular.

PalpitationPalpitation is a pounding or racing heart with or without is a pounding or racing heart with or without irregularity in rhythm. This is associated with certain heart irregularity in rhythm. This is associated with certain heart disorders or it may be a response accompanying a panic disorders or it may be a response accompanying a panic attack.attack.

TachycardiaTachycardia is an abnormally fast heartbeat. This term is is an abnormally fast heartbeat. This term is usually applied to rates over 100 beats per minute.usually applied to rates over 100 beats per minute.

Paroxysmal tachycardiaParoxysmal tachycardia is a fast heartbeat of sudden is a fast heartbeat of sudden onset..onset..

FibrillationFibrillation rapid, random and rapid, random and ineffective contractionsineffective contractions

of the heart.of the heart.

Atrial fibrillationAtrial fibrillation, , A fibA fib, the atria beat , the atria beat faster than the ventricles. This produces faster than the ventricles. This produces an irregular quivering action of the atria an irregular quivering action of the atria and a very rapid ventricular heartbeat.and a very rapid ventricular heartbeat.

Ventricular fibrillationVentricular fibrillation, , V fibV fib, is the , is the result of irregular contractions of the result of irregular contractions of the ventricles and is fatal unless reversed by ventricles and is fatal unless reversed by electric defibrillation.electric defibrillation.

Blood VesselsBlood Vessels AngiAngitistis a.k.a. a.k.a. vasculitisvasculitis is the inflammation of a is the inflammation of a

blood or lymph blood or lymph vesselvessel..

AngioAngionecrosisnecrosis

AngioAngiospasmspasm

AngioAngiostenosisstenosis

HemangiHemangiomaoma

HypoHypoperfusionperfusion is a deficiency of blood passing is a deficiency of blood passing through an organ or body part.through an organ or body part.

ArteriesArteries AneurysmAneurysm - a localized weak spot or balloon-like - a localized weak spot or balloon-like

enlargement of the wall of an artery. enlargement of the wall of an artery. ArterArteritisitis

PolyPolyarterarteritisitis

ArterioArteriosclerosissclerosis

Raynaud’s phenomenonRaynaud’s phenomenon consists of consists of intermittent attacks of intermittent attacks of pallorpallor, , cyanosiscyanosis and and rednessredness of the of the fingers and toesfingers and toes. These symptoms . These symptoms are due to arterial and arteriolar contraction and are due to arterial and arteriolar contraction and are usually caused by are usually caused by coldcold or or emotionemotion..

VeinsVeins

PhlebPhlebitisitis

Varicose veinsVaricose veins - abnormally swollen - abnormally swollen veins usually occurring in the legs. A veins usually occurring in the legs. A varicosityvaricosity is one area of swelling. is one area of swelling.

Thromboses and EmbolismsThromboses and Embolisms ThrombosisThrombosis - an abnormal condition in which a - an abnormal condition in which a

thrombus develops within a blood vessel.thrombus develops within a blood vessel.

ThrombusThrombus - blood clot - blood clot

Thrombotic occlusionThrombotic occlusion Coronary thrombosisCoronary thrombosis EmbolusEmbolus - a foreign object, such as a blood clot, - a foreign object, such as a blood clot,

quantity of air gas or a bit of tissue or tumor that quantity of air gas or a bit of tissue or tumor that is circulating in the blood.is circulating in the blood.

EmbolismEmbolism is the blockage of a vessel by an is the blockage of a vessel by an embolus. embolus.

Blood DisordersBlood Disorders DysDyscrasiacrasia – bad – bad mixturemixture, any abnormal or , any abnormal or

pathologic condition of the blood.pathologic condition of the blood.

HemochromatosisHemochromatosis a.k.a. a.k.a. iron overload iron overload diseasedisease. This is a genetic disorder in which . This is a genetic disorder in which the intestines absorb the intestines absorb too much irontoo much iron. The . The excess iron enters the bloodstream and excess iron enters the bloodstream and accumulates in organs where it causes accumulates in organs where it causes damage.damage.

SepticemiaSepticemia, a.k.a. , a.k.a. blood poisoningblood poisoning, is the , is the presence of pathogenic microorganisms or presence of pathogenic microorganisms or their toxins in the blood.their toxins in the blood.

CholesterolCholesterol

These are These are lipidslipids that that travel in the blood in travel in the blood in packages called packages called lipoproteinslipoproteins. The . The presence of cholesterol presence of cholesterol at certain levels is at certain levels is normal and essential normal and essential for good health. A for good health. A pathologic condition is pathologic condition is present when these present when these fats are present in fats are present in excessive amountsexcessive amounts. .

CholesterolCholesterol Low-density lipoproteinLow-density lipoprotein LDLLDL or or bad cholesterolbad cholesterol

because excess quantities contribute to plaque buildup in because excess quantities contribute to plaque buildup in the arteries.the arteries.

High-density lipoproteinHigh-density lipoprotein HDLHDL or or good cholesterolgood cholesterol

because it carries unneeded cholesterol back to the liver for because it carries unneeded cholesterol back to the liver for processing and does not contribute to plaque buildup.processing and does not contribute to plaque buildup.

TriglyceridesTriglycerides are combinations of fatty acids attached to are combinations of fatty acids attached to glycerol that are also found normally in the blood in limited glycerol that are also found normally in the blood in limited quantities.quantities.

HomocysteineHomocysteine is an amino acid normally found in the is an amino acid normally found in the blood and used by the body to build and maintain tissues. blood and used by the body to build and maintain tissues. However, when present in elevated levels, it can damage However, when present in elevated levels, it can damage arterial walls and increase the risk of coronary artery arterial walls and increase the risk of coronary artery disease. Such increases may be caused by a diet severely disease. Such increases may be caused by a diet severely lacking in several B vitamins.lacking in several B vitamins.

HyperlipidemiaHyperlipidemia or or hyperlipemiahyperlipemia

Blood CellsBlood Cells ErythrocytErythrocytosisosis is an abnormal increase in is an abnormal increase in

the number of circulating red blood cells.the number of circulating red blood cells.

ThrombocytoThrombocytopeniapenia a.k.a. thrombopenia, is a.k.a. thrombopenia, is an abnormal decrease in the number of an abnormal decrease in the number of platelets.platelets.

LeukoLeukopeniapenia is an abnormal decrease in the is an abnormal decrease in the number of white blood cell. number of white blood cell.

LeukLeukemiaemia is a malignancy characterized by a is a malignancy characterized by a progressive increase of abnormal leukocytes progressive increase of abnormal leukocytes

AnemiasAnemias

AnAnemiaemia is a disorder characterized is a disorder characterized by lower than normal levels of red by lower than normal levels of red blood cells in the blood.blood cells in the blood.

AplasticAplastic anemia anemia is marked by an is marked by an absence of all formed blood elements. absence of all formed blood elements. This is caused by the failure of blood This is caused by the failure of blood cell production in the bone marrow.cell production in the bone marrow.

AnemiasAnemias

HemoHemolyticlytic anemia anemia - red blood cells are - red blood cells are destroyed faster than the bone marrow destroyed faster than the bone marrow can replace them.can replace them.

Iron-deficiency Iron-deficiency anemiaanemia develops if not develops if not enough iron is available to bone marrow to enough iron is available to bone marrow to make hemoglobin. It may be caused by make hemoglobin. It may be caused by inadequate iron intake, malabsorption of inadequate iron intake, malabsorption of iron, pregnancy and lactation, or chronic iron, pregnancy and lactation, or chronic blood loss.blood loss.

AnemiasAnemias

MegaloblasticMegaloblastic anemia anemia the bone marrow the bone marrow produces megaloblasts. These are large produces megaloblasts. These are large abnormal red blood cells with a reduced abnormal red blood cells with a reduced capacity to carry oxygen. This type of capacity to carry oxygen. This type of anemia is almost always caused by a anemia is almost always caused by a vitamin deficiency.vitamin deficiency.

PerniciousPernicious anemia anemia an autoimmune an autoimmune disorder results in the inability of the body disorder results in the inability of the body to absorb vitamin B12 normally.to absorb vitamin B12 normally.

AnemiasAnemias Sickle cellSickle cell anemia anemia is a genetic disorder is a genetic disorder

that causes abnormal hemoglobin that that causes abnormal hemoglobin that result in the red blood cells assuming an result in the red blood cells assuming an abnormal sickle shape. This abnormal abnormal sickle shape. This abnormal shape interferes with normal blood flow shape interferes with normal blood flow resulting in damage to most of the body resulting in damage to most of the body systems.systems.

ThalassemiaThalassemia a.k.a. a.k.a. Cooley’sCooley’s anemia anemia, is a , is a group of genetic disorders characterized by group of genetic disorders characterized by short-lived red blood cells that lack the short-lived red blood cells that lack the normal ability to produce hemoglobin.normal ability to produce hemoglobin.

HypertensionHypertension Essential hypertensionEssential hypertension, a.k.a. , a.k.a. primary primary

hypertensionhypertension or or idiopathic hypertensionidiopathic hypertension, is , is consistently elevated blood pressure of unknown consistently elevated blood pressure of unknown origin.origin.

Secondary hypertensionSecondary hypertension is caused by a different is caused by a different medical problem such as a kidney disorder or a medical problem such as a kidney disorder or a tumor on the adrenal glands. When the other tumor on the adrenal glands. When the other problem is cured, the secondary hypertension should problem is cured, the secondary hypertension should be resolved.be resolved.

Malignant hypertensionMalignant hypertension is characterized by the is characterized by the sudden onset of severely elevated blood pressure. It sudden onset of severely elevated blood pressure. It can be life-threatening and commonly damages can be life-threatening and commonly damages small vessels in the brain, retina, heart and kidneys.small vessels in the brain, retina, heart and kidneys.

Physical ExaminationPhysical Examination A2 louder than P2 A2 louder than P2 aortic click aortic click aortic regurgitation aortic regurgitation apical systolic murmur apical systolic murmur arrhythmias arrhythmias asystole asystole trial fibrillation (often dictated Ay-trial fibrillation (often dictated Ay-

Fib or AF) Fib or AF) atrial flutter atrial flutter bradycardia bradycardia cardiomegaly cardiomegaly click click diastolic murmur diastolic murmur first heart sound (S1) first heart sound (S1) first and second heart sounds first and second heart sounds

normal; normal; no third or fourth heart sound no third or fourth heart sound fourth heart sound fourth heart sound ejection murmur ejection murmur ejection systolic murmur ejection systolic murmur gallop gallop

grade 1/6, 2/6, 3/6, 4/6, 5/6* grade 1/6, 2/6, 3/6, 4/6, 5/6* grade I, grade II, grade III, grade IV, grade I, grade II, grade III, grade IV,

grade V, grade VI*) grade V, grade VI*) heart sound heart sound heave heave holosystolic murmur holosystolic murmur intercostal space intercostal space irregularly irregular irregularly irregular knock knock MAT (multifocal atrial tachycardia)MAT (multifocal atrial tachycardia) midclavicular line midclavicular line mitral valve prolapse mitral valve prolapse mitral regurgitation mitral regurgitation multifocal atrial tachycardia (MAT) multifocal atrial tachycardia (MAT)

murmur murmur Graham Steell murmur – Graham Steell murmur –

pulmonary insufficiencypulmonary insufficiency Austin Flint murmur – aortic Austin Flint murmur – aortic

insufficiency insufficiency murmur radiating to the axilla or murmur radiating to the axilla or

neck neck normal sinus rhythm (NSR) normal sinus rhythm (NSR) P2 louder than A2P2 louder than A2

Physical Examination Physical Examination parasternal border parasternal border pericardial knock pericardial knock physiologic split of S2 physiologic split of S2 PMI - point of maximum impulse PMI - point of maximum impulse

point of maximum impulse (PMI) point of maximum impulse (PMI)

in fifth intercostal space in fifth intercostal space premature ventricular premature ventricular

contractions (PVC) contractions (PVC) prosthetic click/sound prosthetic click/sound PVC - premature ventricular PVC - premature ventricular

contractions contractions regular sinus rhythm (RSR) regular sinus rhythm (RSR) rapid ventricular response rapid ventricular response rub rub S1, S2, S3, S4 S1, S2, S3, S4 S1 equals S2S1 equals S2 S1 and S2 normal, no S3 or S4 S1 and S2 normal, no S3 or S4

S3 gallop S3 gallop second heart sound (S2) second heart sound (S2) supraventricular tachycardia supraventricular tachycardia

(SVT) (SVT) systolic ejection murmur systolic ejection murmur tachycardia tachycardia third heart sound (S3) third heart sound (S3) thrill thrill tricuspid regurgitation tricuspid regurgitation ventricular fibrillation (often ventricular fibrillation (often

dictated Vee-Fib) dictated Vee-Fib) ventricular tachycardia (often ventricular tachycardia (often

dictated Vee-Takdictated Vee-Tak Corrigan, water-hammer pulseCorrigan, water-hammer pulse Pistol shot pulsePistol shot pulse Quincke pulse, capillary Quincke pulse, capillary

pulsationspulsations– Aortic insufficiencyAortic insufficiency

Pulsus paradoxusPulsus paradoxus

Diagnostic Procedures of the Diagnostic Procedures of the Cardiovascular SystemCardiovascular System

AngiographyAngiography is a radiographic study of blood is a radiographic study of blood vessels after the injection of a contrast medium.vessels after the injection of a contrast medium.

AngiocardiographyAngiocardiography

Cardiac catheterizationCardiac catheterization - catheter is passed - catheter is passed into a vein or artery and is guided into the into a vein or artery and is guided into the heart. heart.

PhlebographyPhlebography

ElectrocardiogaphyElectrocardiogaphy ElectrocardiogramElectrocardiogram

ECG or EKGECG or EKG

Holter monitorHolter monitor - - ECG ECG monitor 24-hour period.monitor 24-hour period.

Stress testsStress tests are ECGs are ECGs after an exerciseafter an exercise

Thalium stress testThalium stress test assess blood flow assess blood flow during stressduring stress

Ultrasonic Diagnostic Ultrasonic Diagnostic ProceduresProcedures

EchoEchocardiographcardiographyy ECHOECHO, , ultrasound of the ultrasound of the heart to measure heart to measure structures and structures and motionmotion

TransTransesophagiesophagial al echocardiographechocardiographyy TEETEE

Laboratory ProceduresLaboratory ProceduresCreatine phosphokinase (CK)Creatine phosphokinase (CK) - Levels - Levels

rise 4 to 8 hours after an acute MI, rise 4 to 8 hours after an acute MI, peaking at 16 to 30 hours and returning peaking at 16 to 30 hours and returning to baseline within 4 daysto baseline within 4 days25-200 U/L 25-200 U/L 32-150 U/L 32-150 U/L

    CK-MB CK isoenzymeCK-MB CK isoenzyme  - It begins to   - It begins to

increase 6 to 10 hours after an acute increase 6 to 10 hours after an acute MI, peaks in 24 hours, and remains MI, peaks in 24 hours, and remains elevated for up to 72 hours.elevated for up to 72 hours.< 12 IU/L if total CK is <400 IU/L < 12 IU/L if total CK is <400 IU/L <3.5% of total CK if total CK is >400 <3.5% of total CK if total CK is >400 IU/L IU/L

MyoglobinMyoglobin - early and sensitive diagnosis - early and sensitive diagnosis of myocardial infarction in the of myocardial infarction in the emergency department This small emergency department This small heme protein becomes abnormal within heme protein becomes abnormal within 1 to 2 hours of necrosis, peaks in 4-8 1 to 2 hours of necrosis, peaks in 4-8 hours, and drops to normal in about 12 hours, and drops to normal in about 12 hours.hours.< 1 < 1

Troponin ComplexTroponin Complex - Peaks in 10-24 hours, - Peaks in 10-24 hours, begins to fall off after 1-2 weeks.begins to fall off after 1-2 weeks.< 0.4 < 0.4

   

(LDH) Lactate dehydrogenase(LDH) Lactate dehydrogenase - Total  - Total LDH will begin to rise 2 to 5 days after LDH will begin to rise 2 to 5 days after an MI; the elevation can last 10 days.an MI; the elevation can last 10 days.140-280 U/L 140-280 U/L

   

LDH-1 and LDH-2 LDH isoenzymesLDH-1 and LDH-2 LDH isoenzymes - - Compare LDH 1 and LDH 2 levels. Compare LDH 1 and LDH 2 levels. Normally, the LDH-1 value will be less Normally, the LDH-1 value will be less than the LDH-2. In the acute MI, than the LDH-2. In the acute MI, however, the LDH 2 remains constant, however, the LDH 2 remains constant, while LDH 1 rises. When the LDH 1 is while LDH 1 rises. When the LDH 1 is higher than LDH 2, the LDH is said to higher than LDH 2, the LDH is said to be flipped, which is highly suggestive be flipped, which is highly suggestive of an MI. A flipped pattern appears 12-of an MI. A flipped pattern appears 12-24 hours post MI and persists for 48 24 hours post MI and persists for 48 hours.hours.LDH-1 18%-33% LDH-1 18%-33% LDH-2 28%-40% LDH-2 28%-40%

    SGOT SGOT - will begin to rise in 8-12 hours and - will begin to rise in 8-12 hours and

peak in 18-30 hourspeak in 18-30 hours10-42 U/L 10-42 U/L

       

Table of Cardiac markers

Serum Markers of Myocardial Injury  

Detected

Peak Falls

Myoglobin 1-3 1-8 12-18

CK/CK-MB 3-8 12-16 24-48

MB Isoforms 1-6 4-8 12-48

Troponin Complex

3-6 10-24cTnI: 5-9 days cTnT: 7-14 days

Typical Marker Values during AMI

  

Hematologic ValuesHematologic ValuesR.B.C. (Red Blood Cell Count)R.B.C. (Red Blood Cell Count)

Normal Adult Female Range: 3.9 - 5.2 Normal Adult Female Range: 3.9 - 5.2 mill/mclmill/mclOptimal Adult Female Reading: 4.55Optimal Adult Female Reading: 4.55Normal Adult Male Range: 4.2 - 5.6 Normal Adult Male Range: 4.2 - 5.6 mill/mclmill/mclOptimal Adult Male Reading: 4.9Optimal Adult Male Reading: 4.9Lower ranges are found in Children, Lower ranges are found in Children, newborns and infants newborns and infants

  PLATELET COUNTPLATELET COUNT

Normal Adult Range: 130 - 400 thous/mclNormal Adult Range: 130 - 400 thous/mclOptimal Adult Reading: 265Optimal Adult Reading: 265Higher ranges are found in children, Higher ranges are found in children, newborns and infants newborns and infants

W.B.C. (White Blood Cell Count)W.B.C. (White Blood Cell Count)Normal Adult Range: 3.8 - 10.8 thous/mclNormal Adult Range: 3.8 - 10.8 thous/mclOptimal Adult Reading: 7.3Optimal Adult Reading: 7.3Higher ranges are found in children, Higher ranges are found in children, newborns and infantsnewborns and infants

NEUTROPHILS and NEUTROPHIL NEUTROPHILS and NEUTROPHIL COUNT -COUNT - this is the main defender of the this is the main defender of the body against infection and antigens. High body against infection and antigens. High levels may indicate an active infection.levels may indicate an active infection.Normal Adult Range: 48 - 73 %Normal Adult Range: 48 - 73 %Optimal Adult Reading: 60.5Optimal Adult Reading: 60.5Normal Children’s Range: 30 - 60 %Normal Children’s Range: 30 - 60 %Optimal Children’s Reading: 45 Optimal Children’s Reading: 45

   

LYMPHOCYTES and LYMPHOCYTE LYMPHOCYTES and LYMPHOCYTE COUNTCOUNT - Elevated levels may indicate - Elevated levels may indicate an active viral infections such as an active viral infections such as measles, rubella, chickenpox, or measles, rubella, chickenpox, or infectious mononucleosis.infectious mononucleosis.Normal Adult Range: 18 - 48 %Normal Adult Range: 18 - 48 %Optimal Adult Reading: 33Optimal Adult Reading: 33Normal Children’s Range: 25 - 50 %Normal Children’s Range: 25 - 50 %Optimal Children’s Reading: 37.5 Optimal Children’s Reading: 37.5

    MONOCYTES and MONOCYTE COUNT MONOCYTES and MONOCYTE COUNT - -

Elevated levels are seen in tissue Elevated levels are seen in tissue breakdown or chronic infections, breakdown or chronic infections, carcinomas, leukemia (monocytic) carcinomas, leukemia (monocytic) or ...lymphomas.or ...lymphomas.Normal Adult Range: 0 - 9 %Normal Adult Range: 0 - 9 %Optimal Adult Reading: 4.5 Optimal Adult Reading: 4.5

    EOSINOPHILS and EOSINOPHIL EOSINOPHILS and EOSINOPHIL

COUNT COUNT - Elevated levels may indicate - Elevated levels may indicate an allergic reactions or parasites.an allergic reactions or parasites.Normal Adult Range: 0 - 5 %Normal Adult Range: 0 - 5 %Optimal Adult Reading: 2.5 Optimal Adult Reading: 2.5

    BASOPHILS and BASOPHIL COUNT BASOPHILS and BASOPHIL COUNT - -

Basophilic activity is not fully Basophilic activity is not fully understood but it is known to carry understood but it is known to carry histamine, heparin and serotonin. High histamine, heparin and serotonin. High levels are found in allergic reactions.levels are found in allergic reactions.Normal Adult Range: 0 - 2 %Normal Adult Range: 0 - 2 %Optimal Adult Reading: 1 Optimal Adult Reading: 1

Hematologic ValuesHematologic ValuesHEMATOCRIT (HCT)HEMATOCRIT (HCT)

Normal Adult Female Range: 37 - Normal Adult Female Range: 37 - 47%47%Optimal Adult Female Reading: 42%Optimal Adult Female Reading: 42%Normal Adult Male Range 40 - 54%Normal Adult Male Range 40 - 54%Optimal Adult Male Reading: 47Optimal Adult Male Reading: 47Normal Newborn Range: 50 - 62%Normal Newborn Range: 50 - 62%Optimal Newborn Reading: 56 Optimal Newborn Reading: 56

    HEMOGLOBIN (HGB)HEMOGLOBIN (HGB)

Normal Adult Female Range: 12 - 16 Normal Adult Female Range: 12 - 16 g/dlg/dlOptimal Adult Female Reading: 14 Optimal Adult Female Reading: 14 g/dlg/dlNormal Adult Male Range: 14 - 18 Normal Adult Male Range: 14 - 18 g/dlg/dlOptimal Adult Male Reading: 16 g/dlOptimal Adult Male Reading: 16 g/dlNormal Newborn Range: 14 - 20 g/dlNormal Newborn Range: 14 - 20 g/dlOptimal Newborn Reading: 17 g/dl Optimal Newborn Reading: 17 g/dl

   

MCH (Mean Corpuscular MCH (Mean Corpuscular Hemoglobin)Hemoglobin)Normal Adult Range: 27 - 33 pgNormal Adult Range: 27 - 33 pgOptimal Adult Reading: 30 Optimal Adult Reading: 30

    MCV (Mean Corpuscular Volume)MCV (Mean Corpuscular Volume)

Normal Adult Range: 80 - 100 flNormal Adult Range: 80 - 100 flOptimal Adult Reading: 90Optimal Adult Reading: 90Higher ranges are found in Higher ranges are found in newborns and infants newborns and infants

    MCHC (Mean Corpuscular MCHC (Mean Corpuscular

Hemoglobin Concentration)Hemoglobin Concentration)Normal Adult Range: 32 - 36 %Normal Adult Range: 32 - 36 %Optimal Adult Reading: 34Optimal Adult Reading: 34Higher ranges are found in Higher ranges are found in newborns and infants newborns and infants

Lipid ValuesLipid ValuesCHOLESTEROLCHOLESTEROL - High density lipoproteins - High density lipoproteins

(HDL) is desired as opposed to the low (HDL) is desired as opposed to the low density lipoproteins (LDL), two types of density lipoproteins (LDL), two types of cholesterol. Elevated cholesterol has cholesterol. Elevated cholesterol has been seen in artherosclerosis, been seen in artherosclerosis, diabetes, hypothyroidism and diabetes, hypothyroidism and pregnancy. Low levels are seen in pregnancy. Low levels are seen in depression, malnutrition, liver depression, malnutrition, liver insufficiency, malignancies, anemia insufficiency, malignancies, anemia and infection.and infection.Normal Adult Range: 120 - 240 mg/dlNormal Adult Range: 120 - 240 mg/dlOptimal Adult Reading: 180 Optimal Adult Reading: 180

    LDL (Low Density Lipoprotein)LDL (Low Density Lipoprotein) - -

studies correlate the association studies correlate the association between high levels of LDL and arterial between high levels of LDL and arterial artherosclerosisartherosclerosisNormal Adult Range: 62 - 130 mg/dlNormal Adult Range: 62 - 130 mg/dlOptimal Adult Reading: 81 mg/dl Optimal Adult Reading: 81 mg/dl

    HDL (High Density Lipoprotein)HDL (High Density Lipoprotein) - A - A

high level of HDL is an indication of a high level of HDL is an indication of a healthy metabolic system if there is no healthy metabolic system if there is no sign of liver disease or intoxication.sign of liver disease or intoxication.Normal Adult Range: 35 - 135 mg/dlNormal Adult Range: 35 - 135 mg/dlOptimal Adult Reading: +85 mg/dl Optimal Adult Reading: +85 mg/dl

   

TRIGLYCERIDESTRIGLYCERIDES - Increased levels may - Increased levels may be present in artherosclerosis, be present in artherosclerosis, hypothyroidism, liver disease, hypothyroidism, liver disease, pancreatitis, myocardial infarction, pancreatitis, myocardial infarction, metabolic disorders, toxemia, and metabolic disorders, toxemia, and nephrotic syndrome. Decreased levels nephrotic syndrome. Decreased levels may be present in chronic obstructive may be present in chronic obstructive pulmonary disease, brain infarction, pulmonary disease, brain infarction, hyperthyroidism, malnutrition, and hyperthyroidism, malnutrition, and malabsorption.malabsorption.Normal Adult Range: 0 - 200 mg/dlNormal Adult Range: 0 - 200 mg/dlOptimal Adult Reading: 100 Optimal Adult Reading: 100

    CHOLESTEROL/LDL RATIOCHOLESTEROL/LDL RATIO

Normal Adult Range: 1 - 6Normal Adult Range: 1 - 6Optimal Adult Reading: 3.5 Optimal Adult Reading: 3.5

Treatment Procedures of the Treatment Procedures of the Cardiovascular systemCardiovascular system

Antihypertensive MedicationsAntihypertensive Medications AntihypertensiveAntihypertensive - administered to lower blood pressure. - administered to lower blood pressure.

The following are medications used for this purpose.The following are medications used for this purpose.

ACE inhibitorsACE inhibitors, which are used to treat hypertension and , which are used to treat hypertension and CHF, interfere with the action of the kidney hormone rennin CHF, interfere with the action of the kidney hormone rennin that causes the heart muscles to squeeze.that causes the heart muscles to squeeze.

Beta-blockersBeta-blockers slow the heartbeat. slow the heartbeat.

Calcium channel blockersCalcium channel blockers reduce the contraction of the reduce the contraction of the muscles that squeeze blood vessels tight. These muscles that squeeze blood vessels tight. These medications are used to treat hypertension, angina, and medications are used to treat hypertension, angina, and arrhythmia.arrhythmia.

DiureticsDiuretics which increase urine secretion to rid the body of which increase urine secretion to rid the body of excess sodium and water, are administered to treat excess sodium and water, are administered to treat hypertension and CHF.hypertension and CHF.

Additional MedicationsAdditional Medications StatinsStatins a type of cholesterol-lowering drug, are used to reduce LDL a type of cholesterol-lowering drug, are used to reduce LDL

cholesterol or other lipids in the blood.cholesterol or other lipids in the blood.

DigoxinDigoxin a.k.a. digitalis slows and strengthens the heart muscle a.k.a. digitalis slows and strengthens the heart muscle contractions and is used in the treatment of atrial fibrillation and CHF.contractions and is used in the treatment of atrial fibrillation and CHF.

NitroglycerinNitroglycerin a vasodilator, is used to relieve the pain of angina. It may a vasodilator, is used to relieve the pain of angina. It may be administered sublingually, through the skin or orally as a spray.be administered sublingually, through the skin or orally as a spray.

AnticoagulantAnticoagulant or or thrombolyticthrombolytic agent, slows blood clotting and prevents agent, slows blood clotting and prevents new clots from forming.new clots from forming.

AntiarrhythmicAntiarrhythmic

Tissue plasminogen activatorTissue plasminogen activator TPA, is a clot-dissolving enzyme used for TPA, is a clot-dissolving enzyme used for the immediate treatment of heart attack victims.the immediate treatment of heart attack victims.

VasoconstrictorVasoconstrictor constricts the blood vessels. constricts the blood vessels.

VasodilatorVasodilator dilates the blood vessels. dilates the blood vessels.

Cardiac glycosidesCardiac glycosides

digitoxin (Crystodigin)digitoxin (Crystodigin) digoxin (Lanoxin, Lanoxicaps)digoxin (Lanoxin, Lanoxicaps)

ACE (angiotensin-converting ACE (angiotensin-converting enzyme) inhibitorsenzyme) inhibitors

captopril (Capoten)captopril (Capoten) enalapril (Vasotec)enalapril (Vasotec) fosinopril (Monopril)fosinopril (Monopril) lisinopril (Prinivil, Zestril)lisinopril (Prinivil, Zestril) quinapril (Accupril)quinapril (Accupril) ramipril (Altace)ramipril (Altace)

Drug used to treat anginaDrug used to treat angina

NitratesNitrates Nitrates given orally:Nitrates given orally:

– isosorbide dinirate (Isordil, isosorbide dinirate (Isordil, Sorbitrate)Sorbitrate)

– isosorbide mononitrate (Imdur)isosorbide mononitrate (Imdur) Nitro-Bid (sustained-release Nitro-Bid (sustained-release

capsule)capsule) Nitordisc (transdermal patch)Nitordisc (transdermal patch) Nitro-Dur (transdermal patch)Nitro-Dur (transdermal patch) Nitrogard (transmucosal Nitrogard (transmucosal

tablet)tablet) Nitrol (topical ointment)Nitrol (topical ointment) Nitrolingual (sublingual spray)Nitrolingual (sublingual spray) Transdermal-Nitro Transdermal-Nitro

(transdermal patch)(transdermal patch) Tridil (I.V.)Tridil (I.V.)Alpha/beta adrenergic blockersAlpha/beta adrenergic blockers carvedilol (Coreg)carvedilol (Coreg)

Beta blockersBeta blockers atenolol (Tenormin)atenolol (Tenormin) bisoprolol (Zebeta)bisoprolol (Zebeta) carterolol (Brevibloc)carterolol (Brevibloc) metoprolol (Lopressor, Toprol)metoprolol (Lopressor, Toprol) nadolol (Corgard)nadolol (Corgard) propranolol (Inderal)propranolol (Inderal)Calcium channel blockersCalcium channel blockers amlodipine (Norvasc)amlodipine (Norvasc) bepridil (Vascor)bepridil (Vascor) diltiazem (Cardizem)diltiazem (Cardizem) mibefradil (Cardene)mibefradil (Cardene) nifedipine (Adalat, Procardia)nifedipine (Adalat, Procardia) verapamil (Calan, Covera-HS, verapamil (Calan, Covera-HS,

Isoptin, Verelan)Isoptin, Verelan)

Drugs used to treat Drugs used to treat myocardial infarctionmyocardial infarction

captopril (Capoten)captopril (Capoten) lisinopril (Prinivil, Zestril)lisinopril (Prinivil, Zestril) quinapril (Accupril)quinapril (Accupril) aspirinaspirin atenolol (Tenormin)atenolol (Tenormin) metoprolol (Lopressor, Toprol)metoprolol (Lopressor, Toprol) propranolol (Inderal)propranolol (Inderal) timolol (Blocadren)timolol (Blocadren)

Drugs used to treat Drugs used to treat arrhythmiasarrhythmias

Drugs for atrial and ventricular Drugs for atrial and ventricular arrhythmiasarrhythmias

flecainide (Tambocor)flecainide (Tambocor) quinidine (cardioquin, quinidine (cardioquin,

Quinaglute, Quinidex)Quinaglute, Quinidex)Drugs for atrial arrhythmiasDrugs for atrial arrhythmias ibutilide fumarate (Corvert)ibutilide fumarate (Corvert)Drugs for ventricular arrhythmiaDrugs for ventricular arrhythmia adenosine (Adenocard)adenosine (Adenocard) amiodarone (Cordarone)amiodarone (Cordarone) bretylium (Bretylol)bretylium (Bretylol) disopyramide (Norpace)disopyramide (Norpace) lidocaine (Xylocaine)lidocaine (Xylocaine) mexiletine (Mexitil)mexiletine (Mexitil) moricizine (Ethmozine)moricizine (Ethmozine) procainamide (Procan SR, procainamide (Procan SR,

Pronestyl)Pronestyl) propafenone (Tonocard)propafenone (Tonocard)

Beta blockers Beta blockers (for ventricular (for ventricular arrhythmias)arrhythmias)

acebutolol (Sectral)acebutolol (Sectral) atenolol (Tenormin)atenolol (Tenormin) bisoprolol (Zebeta)bisoprolol (Zebeta) esmolol (Brevibloc)esmolol (Brevibloc) metoprolol (Lopressor)metoprolol (Lopressor) nadolol (Congard)nadolol (Congard) pindolol (Visken)pindolol (Visken) propranolol (Inderal)propranolol (Inderal) sotalol (Betapace)sotalol (Betapace) timolol (Blocadren)timolol (Blocadren)Calcium channel blockersCalcium channel blockers diltiazem (Cardizem)diltiazem (Cardizem) verapamil (Calan, Covera-HS, verapamil (Calan, Covera-HS,

Isoptin, Verelan)Isoptin, Verelan)

Antihypertensive drugsAntihypertensive drugsCalcium channel blockersCalcium channel blockers amlodipine (Norvasc)amlodipine (Norvasc) diltiazem (Cardizem)diltiazem (Cardizem) nifedipine (Adalat, Procardia)nifedipine (Adalat, Procardia) verapamil (Calan, Covera-HS, verapamil (Calan, Covera-HS,

Isoptin, Verelan)Isoptin, Verelan)ACE inhibitorsACE inhibitors benazepril (Lotensin)benazepril (Lotensin) captopril (Capoten)captopril (Capoten) enalapril (Vasotec)enalapril (Vasotec) fosinopril (Monopril)fosinopril (Monopril) lisinopril (Prinivil, Zestril)lisinopril (Prinivil, Zestril) moexipril (Univasc)moexipril (Univasc) quinapril (Accupril)quinapril (Accupril) ramipril (Altace)ramipril (Altace) trandolapril (Mavik)trandolapril (Mavik)Angiotensin II antagonistsAngiotensin II antagonists irbesartan (Avapro)irbesartan (Avapro) losartan (Cozaar)losartan (Cozaar) valsartan (Diovan) valsartan (Diovan)

Antiadrenergic drugsAntiadrenergic drugsDrugs that block α and β Drugs that block α and β

receptorsreceptors carvedilol (Coreg)carvedilol (Coreg)Drugs that block α receptors in Drugs that block α receptors in

the brainthe brain clonidine (Catapres)clonidine (Catapres) guanabenz (Wytensin)guanabenz (Wytensin) guanfacine (Tenex)guanfacine (Tenex) methyldopa (Aldomet)methyldopa (Aldomet)Drugs that block α receptors in Drugs that block α receptors in

the blood vesselsthe blood vessels guanadrel (Hylorel)guanadrel (Hylorel) guanethidine (Ismelin)guanethidine (Ismelin) reserpinereserpineAlpha adrenergic blockersAlpha adrenergic blockers doxazosin mesylate (Cardura)doxazosin mesylate (Cardura) prazosin (Minipress)prazosin (Minipress) terazosin (Hytrin)terazosin (Hytrin)Vasodilators Vasodilators hydralazine (Apresoline)hydralazine (Apresoline) minoxidil (Loniten)minoxidil (Loniten)

Antihypertensive drugsAntihypertensive drugsCombination drugsCombination drugs (An antihypertensive agent with a (An antihypertensive agent with a

diuretic)diuretic) Aldoril (methyldopa, hydrochlorothiazide)Aldoril (methyldopa, hydrochlorothiazide) Apresazide (hydralazine, hydrochlorothiazide)Apresazide (hydralazine, hydrochlorothiazide) Combipres (clonidine, chlorthalidone)Combipres (clonidine, chlorthalidone) Diupres (reserpine, chlorothiazide)Diupres (reserpine, chlorothiazide) Enduronyl (deserpidine, methylclothiazide)Enduronyl (deserpidine, methylclothiazide) Hydropes (reserpine, hydrochlorothiazide)Hydropes (reserpine, hydrochlorothiazide) Inderide (propanolol, hydrochlorothiazide)Inderide (propanolol, hydrochlorothiazide) Renese-R (reserpine, polythiazide)Renese-R (reserpine, polythiazide) Salutensin (reserpine, hydroflumethiazide)Salutensin (reserpine, hydroflumethiazide) Tenoretic (atenolol, chlorthalidone)Tenoretic (atenolol, chlorthalidone) Zestoretic (lisinopril, hydrochlorothiazide)Zestoretic (lisinopril, hydrochlorothiazide)Drugs used to treat hypertensive crisisDrugs used to treat hypertensive crisis peripheral vasodilatorsperipheral vasodilators beta blockersbeta blockers calcium channel blockerscalcium channel blockers

Drugs used to treat Drugs used to treat peripheral vascular diseaseperipheral vascular disease cyclandelate (Cyclan)cyclandelate (Cyclan) isoxsuprine (Vasodilan)isoxsuprine (Vasodilan)

Drugs for intermittent claudicationDrugs for intermittent claudication pentoxifylline (Trental)pentoxifylline (Trental)

Drugs used to treat Drugs used to treat hyperlipidemiahyperlipidemia

Bile acid sequestrantsBile acid sequestrants atorvastatin (Lipitor)atorvastatin (Lipitor) cerivastatin (Baycol)cerivastatin (Baycol) cholestyramine (Questran)cholestyramine (Questran) clofibrate (Atromid-S)clofibrate (Atromid-S) colestipol (Colestid)colestipol (Colestid) fluvastatin (Lescol)fluvastatin (Lescol) gemfibrozil (Lopid)gemfibrozil (Lopid) lovastatin (mevacor)lovastatin (mevacor) pravastatin (Pravachol)pravastatin (Pravachol) simvastatin (Zocor)simvastatin (Zocor)Nonprescription dietary supplements used to teat Nonprescription dietary supplements used to teat

hypercholesterolemia and hyper triglyceridemiahypercholesterolemia and hyper triglyceridemia niacin (nicotinic acid, Nicolar)niacin (nicotinic acid, Nicolar) omega-3 fatty acids (Promega)omega-3 fatty acids (Promega)

Resuscitation DrugsResuscitation DrugsDrugs for emergency resuscitationDrugs for emergency resuscitation epinephrine (Adrenalin)epinephrine (Adrenalin) Licodaine (Xyclocaine)Licodaine (Xyclocaine) AtropineAtropine Sodium bicarbonateSodium bicarbonate Calcium chlorideCalcium chlorideDrugs used after successful resuscitationDrugs used after successful resuscitation dobutamine (Dobutrex)dobutamine (Dobutrex) dopamine (Intropin)dopamine (Intropin) isoproterenol (Isuprel)isoproterenol (Isuprel) norepinephrine (Levophed)norepinephrine (Levophed)Drugs used to treat anaphylactic shockDrugs used to treat anaphylactic shock epinephrine (Adrenalin)epinephrine (Adrenalin)

Anticoagulant drugsAnticoagulant drugs

anisindione (Miradon)anisindione (Miradon) ardeparin (Normiflo)ardeparin (Normiflo) dalteparin (Fragmin)dalteparin (Fragmin) danaparoid (Orgaran)danaparoid (Orgaran) dicumaroldicumarol enoxaparin (Lovenox)enoxaparin (Lovenox) heparinheparin warfarin (Coumadin)warfarin (Coumadin)Platelet aggregation inhibitorsPlatelet aggregation inhibitors abciximab (ReoPro)abciximab (ReoPro) aspirinaspirin dipyridamole (Persantine)dipyridamole (Persantine) ticlopidine (Ticlid)ticlopidine (Ticlid)

Thrombolytic drugsThrombolytic drugs

Tissue plasminogen activators (tPA)Tissue plasminogen activators (tPA) alteplase (Activase)alteplase (Activase) reteplase (Retavase)reteplase (Retavase)

Thrombolytic enzymesThrombolytic enzymes anistreplase (Eminase)anistreplase (Eminase) streptokinase (Kabikinase, Streptase)streptokinase (Kabikinase, Streptase) urokinase (Abbokinase)urokinase (Abbokinase)

Clearing Clearing Blocked ArteriesBlocked Arteries

Percutaneous Percutaneous transluminal transluminal coronary coronary angioplastyangioplasty PTCAPTCA or or balloon balloon angioplastyangioplasty. .

Clearing Blocked ArteriesClearing Blocked Arteries

Stent placementStent placement to prevent restenosis to prevent restenosis

Clearing Blocked ArteriesClearing Blocked Arteries An An atheratherectomyectomy is is

the surgical removal the surgical removal of plaque from the of plaque from the interior lining of an interior lining of an artery. After the artery. After the catheter and balloon catheter and balloon are in place, the are in place, the balloon is inflated balloon is inflated and a cutting tool is and a cutting tool is used to shave off used to shave off pieces of the plaque pieces of the plaque buildup.buildup.

Clearing Blocked ArteriesClearing Blocked Arteries

EndEndarterarterectomyectomy

Carotid endarterectomyCarotid endarterectomy The The artery may be reinforced with a piece artery may be reinforced with a piece of vein taken from the leg. This of vein taken from the leg. This procedure is performed to reduce the procedure is performed to reduce the risk of stroke by ensuring the blood risk of stroke by ensuring the blood flow to the brain.flow to the brain.

Coronary Artery Bypass Coronary Artery Bypass GraftGraft

CABGCABG is also known as is also known as bypass surgerybypass surgery. In this . In this surgery which requires opening the chest, a piece surgery which requires opening the chest, a piece of vein from the leg is implanted on the heart to of vein from the leg is implanted on the heart to bypass a blockage in the coronary artery and to bypass a blockage in the coronary artery and to improve the flow of blood to the heart.improve the flow of blood to the heart.

Minimally invasive direct coronary artery Minimally invasive direct coronary artery bypassbypass (MIDCAB) (MIDCAB), a.k.a keyhole or buttonhole , a.k.a keyhole or buttonhole bypass is an alternative technique for some bypass is an alternative technique for some bypass cases. This procedure is performed with bypass cases. This procedure is performed with the aid of a the aid of a fiberopticfiberoptic cameracamera through small through small openings between the ribs.openings between the ribs.

HeartHeart

Defibrillation a.k.a. cardioversionDefibrillation a.k.a. cardioversion

Valvoplasty or valvuloplastyValvoplasty or valvuloplasty

PacemakerPacemaker for bradycardia and for bradycardia and atrial fibrillationatrial fibrillation

Cardiopulmonary resuscitationCardiopulmonary resuscitation, , CPRCPR,,

DefibrillationDefibrillation

Blood Vessels, Blood and Blood Vessels, Blood and BleedingBleeding

AneurysmAneurysmectomyectomy

AneurysmoAneurysmorrhaphyrrhaphy

ArteriArteriectomyectomy

HemoHemostasisstasis

Blood Vessels, Blood and Blood Vessels, Blood and BleedingBleeding

TransfusionTransfusion

PlasmapheresisPlasmapheresis - a procedure in - a procedure in which the which the plasma is removedplasma is removed from from donated blood and the remaining donated blood and the remaining components, mostly components, mostly RBCs, are returned RBCs, are returned to the donorto the donor. This is performed to . This is performed to reduce or eliminate harmful substances reduce or eliminate harmful substances present in the plasma.present in the plasma.

I must be learning I must be learning something because it something because it

hurts.hurts.-Tom Tompkins-Tom Tompkins