Pictorial Presentation Mike Clark MD Figure 187a Right ventricle Right coronary artery Right atrium Right marginal artery Posterior interventricular artery Anterior interventricular ID: 775362
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Slide1
Coronary Artery Disease 2
Pictorial Presentation
Mike Clark, M.D.
Slide2Figure 18.7a
Right
ventricle
Right
coronary
artery
Right
atrium
Right
marginal
artery
Posterior
interventricular
artery
Anterior
interventricular
artery
Circumflex
artery
Left
coronary
artery
Aorta
Anastomosis
(junction of
vessels)
Left
ventricle
Superiorvena cava
(a) The major coronary arteries
Left atrium
Pulmonary
trunk
Slide3Coronary Artery supply
Different areas of the heart are supplied by different coronary arteries.
Slide4Coronary Artery supply
Slide5An occlusion in this artery would give
ischemia to areas of the heart served
by this blood vessel.
Slide6Areas of the body where
Ischemic heart disease can
Be felt.
Slide7Standard EKG Waves & Segments
Slide8Slide9The EKG Looks at Heart Areas
Slide10Slide11The patient would have a normal S-T segment, but has he/she
Increases speed and grade on the treadmill the S-T segment begins to sag.
Slide12This is the cath lab where heart
catherization
occurs; the doctors are
performing coronary angiography.
Slide13During heart
catherization
to examine the coronary arteries, a catheter is generally
introduced in the thigh in the femoral artery and is threaded up the aorta until
its tip is placed in the opening of the coronary arteries.
Slide14Note the narrowing in
the coronary artery.
How much the artery is
closed is stated as a
percentage in terms of
occlusion
. How much it
is open is stated in terms
of percent of
patentcy.
For example, if an artery
is 45% occluded, then it
is 55% patent.
Slide15This is a stent placed in the wall of a coronary artery to open it up and attempt to
keep it open.
Slide16An atherectomy is a procedure to remove plaque.
Slide17Slide18Slide19The crushing chest pain (angina pectoris) of a heart attack (myocardial infarction).
Slide20Blood Clot in Coronary Artery
Slide21Infarction
Slide22Slide23The steeply elevated ST segments mean
the patient is currently suffering a
myocardial infarction (heart attack).
Slide24The EKG Looks at Heart Areas
Slide25Drawing blood in the emergency room to obtain blood to evaluate the
cardiac isoenzymes and troponin.
Slide26Cardiac markers
are biomarkers measured to evaluate heart function. They are often discussed in the context of myocardial infarction, but other conditions can lead to an elevation in cardiac marker level.
Most of the early markers identified were enzymes, and as a result, the term "cardiac enzymes" is sometimes used. However, not all of the markers currently used are enzymes. For example, in formal usage, troponin would not be listed as a cardiac enzyme.
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Slide27Troponin
The most sensitive and specific test for myocardial damage. Because it has increased specificity compared with CK-MB, troponin is a superior marker for myocardial injury
Peaks in 12 hours
Troponin is released during MI from the cytosolic pool of the myocytes. Its subsequent release is prolonged with degradation of actin and myosin filaments. Differential diagnosis of troponin elevation includes acute infarction, severe pulmonary embolism causing acute right heart overload, heart failure, myocarditis.
Troponins
can also calculate infarct size but the peak must be measured in the 3rd day. released in 2–4 hours and persists for up to 7 days.
Slide28Q-wave of MI