IHD Ischaemic Heart Disease

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     1  IHD-Ischaemic Heart Disease: Dr. Venkatesh M. Shashidhar Senior Lecturer in Pathology Fiji School of Medicine.
     2  Road Map: Introduction Ischemic Heart Disease Pathogenesis Gross Pictures Microscopic Pictures Complications Conclusions Atherosclerosis
     3  Anatomy
     4  Coronary Arteries Left Coronary A. L.A.Descending Left Circumflex Right Coronary A. LCx LAD
     5  Ischaemic Heart Disease Common Health problem. High Mortality & Morbidity. Etiology – common Atherosclerosis Two major types Angina & MI. Risk factors – Hypertension Hypercholesterolemia Diabetes Smoking, Life style, Diet, Genetic.
     6  Patterns of CHD: Angina Pectoris: Acute Myocardial Infarction: Sudden cardiac death:
     7  Pathogenesis: Obstruction to blood flow. Atheroma, Thrombosis Embolism Diminished coronary perfusion. Ischemia – Angina Infarction – Necrosis Inflammation Granulation tissue Fibrous scarring.
     8  Myocardial Infarction-MI “Death of heart tissue due to lack of blood supply” Atherosclerosis is the common cause. Coagulative necrosis – intact cell shape. Severe chest pain, breathlessness & sweating Complications –cardiogenic shock, Death or Cardiac failure.
     9  Gross - Morphology - Micro 1-18h – none 24h – Pale, edema 3-4D – Hemorrhage 1-3W – Thin, yellow 3-6W – Tough white None Edema, inflammation Necrosis, granulation Granulation tissue Dense Fibrosis Myocardial Infarction-MI
     10  Myocardial Infarction - Gross
     11  Coronary Atherosclerosis
     12  Coronary Atherosclerosis with Thrombosis
     13  Myocardial Infarction – 1 wks.
     14  Myocardial Infarction - CS
     15  2wk - Myocardial Infarction - 3d
     16  Normal Myocardium:
     17  MI 18-24 hr loss of nucleus, contaction bands, coagulative necrosis.
     18  MI 3-4 day – Hemorrhage, inflammation.
     19  MI 1-2w – Granulation tissue
     20  MI 2-4 W - Resorption, fibrosis
     21  MI >4-6 W - Collagen Scar
     22  Complications: Cardiogenic shock, death Arrhythmias and conduction defects, Congestive heart failure (pul edema) Mural thrombosis, - embolization Myocardial wall rupture, tamponade Ventricular aneurysm
     23  MI - Rupture
     24  Laboratory Diagnosis LDH - 1-5 (1 - 2 flip) CK- Isoenzymes (Fractions) MM - Muscles MB - Cardiac muscle. BB - Brain Troponins
     25  Management: Aimed to prevent complications. Rest & sedation* Supportive mesures Thrombolytic agents - Streptokinase
     26  Congenital Heart Diseases
     27  Congenital Heart Diseases: Left-to-Right shunts. Atrial Septal Defect (ASD) Ventricular Septal Defect (VSD) Patent Ductus Arteriosus (PDA) Right-to-Left shunts Transposition of Great Arteries Obstructions Coarctation of Aorta Others.
     28  Atrial Septal Defect (ASD)
     29  Patent Ductus Arteriosus (PDA) The ductus arteriosus, serves to shunt blood from pulmonary artery to aorta during intrauterine life. Persistence of ductus, which normally closes soon after birth, results in left-to-right shunt.
     30  Coarctation of Aorta - Infant
     31  Aneurysms & Varicose Veins
     32  Aneurysms: Abnormal dilatation of blood vessel. Fusiform, Saccular & dissecting. Atherosclerosis, Syphilitic & congenital. Berry aneurysms – Base of brain. Complications: Thrombosis Embolism Rupture
     33  Berry Aneurysm:
     34  Complications of Aneurysms: Thrombosis Embolism Rupture
     35  Varicose Veins: Abnormal diffuse dilatation of veins. Lower limbs- common Congenital or acquired Pathogenesis: Damage to valves Stagnation Increased pressure ? dilatation. Chronic ulcers.
     36  Varicose Veins:
     37  Thank You... Dr. Venkatesh M. Shashidhar Senior Lecturer in Pathology Fiji School of Medicine.