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1. MYOCARDINAL INFRACTION
* Myocardial Ischaemia sudden death
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- severe
- return to normal life
- increase risk of second infarct
*Thrombus Blocks the lumen of coronary artery
*Atherosclerosis narrowed the lumen
the blood flow is insufficient to suplly the
oxygen
2. ANGINA PECTORIS
3. SUDDEN DEATH
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However the cause of the suddenthly of the death still remains
unexplained.
Might be - minor painless ischaemia interrupt the
electrical conduction
- release of stored regulatory hormones
(catecholamine)
- disturbanceof regulatory ios (hypoxic disionism)
Note :
The pain of ;
Angina pectoris : - directly
- quatitativately releated to exertion
- induced by emotion
ATHEROSCELEROSIS
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THE DEVELOPMENT OF ATHEROMA
4 Stages (WHO)
1. Fatty Spot :
- in tunica intima of the vessel
- thickenings of the intima
- slightly raised a long flattened yellow streak
- the elevation of the intima due to the formation of connective
tissues cells, distended, contains cholesterol within the fat
droplets.
2. Fibrous Plaque :
- between tunica intima and tunica media
- circumscribed, firm, grey/pearly white
- diameters, 1- several mm, irregular
- the plaques become larger, project into the lumen (medium size
of artery)
3. Soft Plaque
- contains large amounts of fatty material, softened
4. Break Down
- plaque surface, break down
- atheromatous ulcer ragged irregular edges
- fibrous tissue at the base of the ulcer scarring
- vessel narrowed and distort slowing down the flow of blood
- deposit of calcium haemorrhages occure in the base
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THE PREDISPOSITION OF THE THICKENING OF INTIMA;
Epidemiology of HD
- man in well to do classes
- men + 45 yr, women unknown (>50 yr)
- the greater percentage of death, 35 40 yr
- the lower incidence is from the poor immigrants and under /
develop countries (include ASEAN)
AETIOLOGY
Familial ; - inherited
- environmental experience of hypertension, diabetes,
gout and axanthomatosis.
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PREVENTION
1. DIET
Fats ; hyperlipidemia, hyper
CARBOHYDRATES
Carbohydrate fat
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PROTEIN
2. SEDENTARY LIFE
3. SMOKING
maybe due to :
- vasoconstrictor action
- undesirable effect on the level of plasma lipids
- blood coagulation
- the survival of platelet
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4. STRESS AND STRAIN
5. POLUTION
COMMUNITY PROPHYLAXIS
REDUCE
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INCREASE