Coronary Artery Disease 2 Pictorial Presentation Mike Clark, M.D.

(a) The major coronary arteries Aorta Pulmonary trunk Superior vena cava Left atrium Anastomosis (junction of vessels) Left coronary artery Right atrium Circumflex artery Right coronary artery Left ventricle Right ventricle Anterior interventricular artery Right marginal artery Posterior interventricular artery (a) The major coronary arteries Figure 18.7a

Coronary Artery supply Different areas of the heart are supplied by different coronary arteries.

Coronary Artery supply

An occlusion in this artery would give ischemia to areas of the heart served by this blood vessel.

Areas of the body where Ischemic heart disease can Be felt.

Standard EKG Waves & Segments

The EKG Looks at Heart Areas

The 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.

This is the cath lab where heart catherization occurs; the doctors are performing coronary angiography.

During 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.

Note 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.

This is a stent placed in the wall of a coronary artery to open it up and attempt to keep it open.

An atherectomy is a procedure to remove plaque.

The crushing chest pain (angina pectoris) of a heart attack (myocardial infarction).

Blood Clot in Coronary Artery

Infarction

The steeply elevated ST segments mean the patient is currently suffering a myocardial infarction (heart attack).

The EKG Looks at Heart Areas

Drawing blood in the emergency room to obtain blood to evaluate the cardiac isoenzymes and troponin.

Cardiac markers are biomarkers measured to evaluate heart function Cardiac 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.[

Troponin 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.

Q-wave of MI