Your Coronary Event Part 1...Signals of a Heart Attack • Most people do not realize that they have...
Transcript of Your Coronary Event Part 1...Signals of a Heart Attack • Most people do not realize that they have...
YourCoronaryEventPart1
• Theheartisamuscularorganaboutthesizeofafist.Itliesinthecenterofthechest,slightlytotheleftandisprotectedbythebreastbone(sternum).Theheartpumpsblood,oxygen,andnutrientstoallpartsofthebody,includingtotheheartmuscleitself.Theheartmuscle’soxygenneedsincreasewithexercise.
ChambersofHeartTheheartisdividedintofourchambers.Twoupperchambers(atria)receivebloodfromtheveins.Twolowerchambers(ventricles)pumpbloodoutoftheheart.Fourvalvesintheheartatasone-waydoorstodirectbloodflow.Awall(septum)dividestheheartintoarightandleftside.
BloodFlowThroughtheHeartUnoxygenatedbloodreturnsfromtheorgansofthebodyandenterstherightsideoftheheartthroughtherightatrium.RightatriumàTricuspidvalveàRightventricleàPulmonaryvalveàPulmonaryarteryàLungs(whereoxygenispickedupandcarbondioxide,awasteproduct)isbreathedoutàOxygenatedbloodisbroughtbythePulmonaryveinàLeftatriumthroughtheMitralvalveàLeftventricleàthroughtheAorticvalveàAorta(thebodiesmainbloodvessel)tothebody.
CoronaryArteryAnatomyFortheheartmuscletowork,itneedsoxygenandnutrients,whicharedeliveredthroughthecoronary(heart)arteries.Therearetwomaincoronaryarteriesthatencircletheheartandtakebloodintoheartmuscle.1.RightCoronaryArtery(RCA)deliversbloodtorightsideandbackofheart.2.LeftMainCoronaryArtery(LCA)splitsintotheCircumflexArtery(CFX)andtheLeftAnteriorDescending(LAD)arterywhichsupplybloodtotheleftsideandmiddleofheart.
CAD=CoronaryArteryDisease/NarrowingofBloodFlow
CADiscausedbythebuild-upoffattysubstancessuchascholesterol,thatcollectalongtheliningofthecoronaryarteries,inaprocessknownasathersclerosis.Thisisreferredtoasa“plaque,”“lesion,”“blockage,”or“stenosis.”Arteriescanbeblockedbyatherosclerosis,bloodclot,both,ornarrowingbyaspasm.Anyoftheseeventuallyblocktheflowofblood.CADresultsinaninadequatesupplyofoxygentoheartmuscle.
HeartAttackBecausethecoronaryarteriessupplyoxygenrichbloodtotheheart,untreatedblockagecanbeveryseriousandcanleadtoaheartattack,knownasamyocardialinfarction.Thiscandamageheartmuscle.
Amyocardialinfarction(MI)isthemedicaltermforaheartattack.“Myocardia”referstoheartmuscle.“Infarction”causespermanentdamagetoaportionoftheheartandresultsfromalackofoxygenandbloodtoanareaoftheheart.Heartattacksareoneofthemostcommonillnessesthataffectwomenandmenofallagegroups.HeartattacksaretheleadingcauseofdeathintheUnitedStates.
Anginavs.HeartAttack/MI
• Anginaisatemporarypainortightnessthatmaystartinthechestandwillsometimesspreadtootherpartsofyourupperbody.Itmaystartsuddenlyandlastonlyafewminutesorlonger.Anginawillberelievedeitherbyrestingortakinganitroglycerine.
• HeartAttack/MI–Whenbloodflowtotheheartmuscleisslowedorstoppedfor15to30minutesorlonger,thereisdamagetotheheartmuscle.Aheartattackwillnotberelievedbyrestorsublingualnitroglycerine,usually.
SignalsofaHeartAttack• Mostpeopledonotrealizethattheyhaveheartdisease.
Everyonewillexperiencedifferentsymptomswitheachheartattack.Thefirstsignthatsomethingmaybewrongcouldbeanepisodeofangina,orevenaheartattack.
• Signals:• Afullnessorpaininthecenterofthechestbehind
breastbone.Thesesymptomsmayextendtoyourjaw,neck,arms,orshoulderblades.
• Asensationinthechestthatmaybefeltaschoking,numbness,squeezingorpressure,crushingorheaviness.
• Symptomsalsoincludeheartburn,nausea,vomiting,excessivesweating,fatigue,shortnessofbreathorpalpitations.
LocationsofInfarctsInferiorInfarct–inferiorwall
issuppliedbyrightcoronaryartery
PosteriorInfarct-dependsonwhichcoronaryarterysuppliestheposteriorwall:
RCA–80%ofpopulationCircumflex–20%of
populationAnteriorInfarct–Occlusionof
leftanteriordescendingarteryLateralInfarct–Occlusionof
leftcircumflexartery
Theheartbeginstohealduringthefirstseveralweeksafteraheartattack.Ithealsintwomainways:1)byformingscartissueand2)byexpandingthesmallerbloodvesselswithin2-3hours,tosupplysurroundingtissues.Thesearecalled“collateralbloodvessels.”In2-3weeksthosearterieswillbelargeenoughtobringmorebloodtothesurroundingtissues.
ZonesofInfarcts
• Ischemic–damagedbutsalvageable.
• Injury–severeoxygendeprivation,tissuesalvageable,mechanicaldysfunction(notgoodcontractilityandelasticfunctionisdecreased).
• Necrotic–damageisirreversible.Treatmentisaimedatrestoringcirculationtoischemicandinjuryzonetolimitsizeofinfarction.
DiagnosingaHeartAttack• EKG–recordselectricalactivityandwavesofheart.Thewavescorrespondtocontractionandrelaxationpatternofdifferentpartsofheart.Eachwavepatternislabeledwithaletter. STwaveelevationisastrong
indicatorofaheartattackalongwith symptoms.Thissuggestsablocked heartarteryandfullthicknessheart muscledamage.
NonSTelevationorSTdepression heartattacksgenerallyshowlessinjurytoheartmuscle.
EKGPictures
• BloodTests 1.Troponin–proteinsreleasedintobloodstreambytheheartmusclecellsthatbecomedamaged.Showsupinblood3-6hoursafterheartdamage.Peaksat20hours.Ifelevatedinblood,isagoodindicatorthatpersonhashadaheartattack.Thistestismorespecifictoheartmuscle. 2.CPK(creatinephosphokinase)–enzymesfoundinheart,brain,andskeletalmuscle.Ifelevatedinbloodstream,meanstherehasbeeninjurytoeithertheheart,brain,ormuscletissue.Thistestisnotspecifictoonlyheartmuscle.Levelsincrease3-6hoursafteraheartattackandpeakat12-24hoursafter.
**IfbothtroponinandCPKsareelevated,itisagoodindicatorthat
aheartattackhasoccurred.
UnderstandingCardiacTesting
• ChestX-ray• 12LeadEKG• Echocardiogram• ExerciseToleranceTest• CardioliteStressTest
ChestX-ray
• Thechestx-rayvisualizestheshapeoftheheart,itschambersandvessels.Itcanalsodetectifthereisfluidaccumulatinginthelungsandtheplacementofapacemakerorinternaldefibrillator.
12LeadEKG
• AnEKGrecordstheelectricalimpulsesmovingthroughtheheartmuscle.Thistestcantellthedoctorifyourheartbeatisregularorirregular,tooslowortoofast,orifyouarehavingaheartattack.
Echocardiogram
• Theechocardiogramisanultrasoundusingsoundwavestolookatyourheart’ssizeandhowthechambersandvalvesareworking.Itrevealshowwelltheheartispumping.Itmeasuresanejectionfraction(EF)whichisapercentageofbloodthatispumpedoutoftheheartwitheachbeat.NormalEFis55-70%
ExerciseToleranceTest
• Theexercisetolerancetestusesexerciseormedicationstoincreasetheworkoftheheart.Forcardiacrehab,itisusedasaguidetowriteyourexerciseprescriptionandsetsyourtargetheartraterange.Duringthistest,yourEKGpatternismonitoredforanychanges.Changesmayindicatealackofbloodandoxygentotheheart.Thismayindicatetheneedforanangiogram.
CardioliteTreadmillorStressTest
• Acardiolitetreadmillisoftenorderedratherthanaregulartreadmill.Thisisdeterminedbyyourdoctor.
• Whileexercising,aradioactivedyeisinjectedintothebloodstreamandyourEKGiscontinuouslymonitored.Thedyemovesthroughtheheartchambersandmuscle.Anuclearcamerarecordstheheartimagesandthedoctorisabletoseewhichareasoftheheartarereceivingtoolittlebloodandoxygen.Itcanalsodetermineifanyareasofthehearthavebeendamagedfromaheartattack.
• Sources/Picturestakenfrom:• • www.drsvenkatesan.wordpress.com• www.emedicinehealth.com• www.heart-diseaseandprevention.com• www.heartstroketayside.org.uk• www.heartsurgeons.com• www.mayoclinic.com• www.medscape.com• www.news4u.com• www.nsh.nsw.gov.au• www.thrombosisadvisor.com• www.uptodate.com• www.wikipedia.com