1. Coronary Heart Disease

2. Coronary Circulation Left Coronary Artery –Anterior descending –Circumflex Right Coronary Artery –Posterior descending Veins –Small, middle and great cardiac veins –Coronary sinus

5. Control of Coronary Blood Flow Metabolic Endothelial Collateral

7. Chronic Ischemic Heart Disease Most commonly due to atherosclerosis Vasospasm and thrombosis may contribute Perfusion pressure may be insufficient Angina pectoris

10. Myocardial Infarction Abrupt onset Pain severe and crushing Pain located as for angina, but not relieved by nitroglycerine GI complaints common Fatigue and weakness common

11. Myocardial Infarction Tachycardia, anxiety, restlessness, and feelings of impending doom Skin often pale, cool and moist 30 - 50% die within first few hours from ventricular fibrillation

12. Pathology Area of infarction is determined by coronary artery affected Myocardial Infarction

13. Right coronary artery Left coronary artery Blockage high up infarcts a large part of the muscle Blockage more distal infarcts a smaller spot

14. Pathology Transmural or subendocardial Anaerobic respiration Ischemic area ceases to function within a few minutes Necrosis after 20 to 40 minutes Microvascular injury occurs in 1 hour following necrosis Myocardial Infarction

15. Pathology Early reperfusion may reduce level of injury Three zones of tissue damage Myocardial Infarction

17. Pathology Necrotic area replaced with scar tissue After 4 - 7 days centre of infarcted area is soft and yellow Rupture often happens now Replacement is complete in 7 weeks Lacks contractility and conduction Myocardial Infarction

18. Classification ECG changes ST elevation usually indicates acute myocardial injury Significant Q waves usually signify MI Myocardial Infarction

20. Classification Serum markers signal MI Myocardial Infarction

22. Medical Management Thrombolytic therapy Angioplasty Myocardial Infarction

24. Medical Management Revascularization interventions Myocardial Infarction

26. Congestive Heart Failure Pumping ability of the heart becomes impaired Causes: –MI –Hypertension –Cardiomyopathies –Excessive work demands

27. Congestive Heart Failure High or low output Systolic or diastolic

28. Stroke volume (not anatomically correct) End diastole

29. Congestive Heart Failure Right or left sided

30. Right

31. Left