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