IHD vs CAD
Syndromes - IHD
Atherosclerosis Risk Factors
Non-modifiable (Constitutional):
- Genetic abnormalities
- Family history
- Advancing age
- Male gender
Modifiable:
- Hyperlipidemia
- Hypertension
- Cigarette smoking
- Diabetes
- Inflammation (CRP levels)
- Hyperhomocysteinemia
- Elevated lipoprotein A levels
- Metabolic syndrome
Question for Ischemic Heart Diseas (IHD)
Try yourself:
Which of the following is a non-modifiable risk factor for atherosclerosis?Explanation
- Atherosclerosis is a condition characterized by the buildup of plaque in the arteries, leading to reduced blood flow.
- Non-modifiable risk factors are those that cannot be changed or controlled.
- Family history is a non-modifiable risk factor for atherosclerosis, as individuals with a family history of the condition are at a higher risk.
- Genetic abnormalities and advancing age are also non-modifiable risk factors.
- Hyperlipidemia, hypertension, cigarette smoking, diabetes, inflammation, hyperhomocysteinemia, elevated lipoprotein A levels, and metabolic syndrome are all modifiable risk factors that can be controlled or managed through lifestyle changes or medical interventions.
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Plaque Stable vs Unstable
Critical stenosis >70% occlusion
IHD - Pathogenesis
Sequential Myocardial Changes in MI
Question for Ischemic Heart Diseas (IHD)
Try yourself:
What is the main difference between stable and unstable plaques?Explanation
- Stable plaques are characterized by a fibrous cap and a lipid-rich core, and they have a gradual progression over time.
- These plaques have less than 70% occlusion and do not usually cause symptoms.
- Unstable plaques, on the other hand, have a thin fibrous cap and a large lipid core, making them prone to rupture.
- When a plaque ruptures, it can lead to the formation of a blood clot, which can completely occlude the blood vessel and result in an acute myocardial infarction (heart attack).
- Therefore, the main difference between stable and unstable plaques is the risk of rupture and subsequent complications.
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Lab Investigations in Ml
The laboratory assessment of myocardial infarction (MI) relies on measuring the blood levels of macromolecules that seep out of injured myocardial cells due to damaged cell membranes. These molecules encompass:
- Myoglobin
- Cardiac troponins T and I (TnT, TnI)
- Creatine kinase (CK), specifically the myocardial isoform, CK-MB
- Lactate dehydrogenase
IHD - Complication
- Rupture of the myocardium
- Impaired contractile function
- Development of arrhythmias
- Onset of pericarditis
- Formation of ventricular aneurysm
- Dilatation of cardiac chambers leading to progressive late-stage heart failure (chronic IHD)
- Infarct expansion associated with mural thrombus
- Dysfunction of papillary muscles
- Involvement of the right ventricle
Question for Ischemic Heart Diseas (IHD)
Try yourself:
Which macromolecule is commonly used for the laboratory assessment of myocardial infarction (MI)?Explanation
- The laboratory assessment of myocardial infarction (MI) involves measuring the blood levels of macromolecules that seep out of injured myocardial cells.
- The macromolecules commonly used for this assessment include myoglobin, creatine kinase (CK), lactate dehydrogenase, and cardiac troponins T and I (TnT, TnI).
- Among these options, cardiac troponins T and I (TnT, TnI) are the most specific and sensitive markers for myocardial infarction.
- Therefore, cardiac troponins T and I (TnT, TnI) are commonly utilized in the laboratory assessment of myocardial infarction (MI).
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In general, individuals experiencing anterior infarcts tend to have a more unfavorable clinical prognosis compared to those with posterior infarcts.
IHD - Repeats
- Discuss pathogenesis and pathology of ischemic heart disease (1999)
- Give the morphological changes and complications in myocardial infarction (2007).
- What are sequential myocardial changes in myocardial infarction?
Discuss the laboratory investigations in a case of myocardial infarction. (2016)