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Coronary Heart
Disease, Myocardial
Infarction,
and Heart Failure
A Review of the
Basics
Defining Heart
Disease
Heart disease is a broad term used to
describe a range of diseases that affect your
heart, such as:
Coronary heart disease (CHD)
Atherosclerosis
Myocardial infarction (MI)
Heart failure (formerly called congestive
heart failure)
Risk Factors
for Heart Failure
Obesity
Hypertension
Overweight or obesity
Ischemic heart disease
Changes in cardiovascular structure, such
as diseases to the heart valves or muscle
Coronary Heart
Disease: An
Blood flow
to the vessels surrounding
Overview
Plaque
Development
Many factors speed up plaque development:
Elevated cholesterol and triglyceride levels
Hypertension
Infection that initiates the inflammatory response
Elevated iron levelscarry free radicals that
damage lining
Elevated homocysteine level
Cigarette smoking
Diabetes
Obesity
Oxidized (LDL) levels
The Atherosclerotic
Process
Buildup of smooth muscle cells,
macrophages, and lymphocytes
Smooth muscle cells form a matrix of
connective tissue
Lipid and cholesterol accumulates in the
matrix
The Atherosclerotic
Process (contd)
Lipid deposits and other materials
(including cellular waste, fibrin, and
calcium) build up and form a plaque
After injury, platelets adhere to the
arterial wall and release growth factors,
which promote lesion development
Coronary Heart
Disease
Steps to development
of CHD:
Development
Coronary Heart
Disease
Steps to development
of CHD (contd):
Development
(contd)
Progressive narrowing of lumen
Insufficient blood flow to myocardium (ischemia)
results
Chest pain or angina pectoris occurs
Treatment of
Coronary Heart
Antihyperlipidemic
agents
Disease
Medications that lower triglycerides
Antiplatelets (aspirin)
Antihypertensives
Antianginals (nitroglycerin)
Antimicrobials
Angina Pectoris:
An Overview
Chest pain caused by myocardial ischemia
from reduced blood flow and/or reduced
oxygen supply to the myocardium
Angina is a warning sign that a heart attack
(MI) may occur
Angina Pectoris:
An Overview (contd)
Aerobic metabolism switches to anaerobic
metabolism:
Angina Pectoris:
An Overview (contd)
Other causes of decreased oxygen supply to
the myocardium:
Congestive heart failure
Congenital heart defects
Pulmonary hypertension
Left ventricular hypertrophy
Cardiomyopathy
Severe hypertension
Narrowing of the aortic valve
Angina Pectoris:
An Overview (contd)
Other causes of decreased oxygen supply to
the myocardium (contd):
Leakage of the aortic valve
Ventricle wall thickening
Atheroma leading to arterial narrowing
Causes of Increased
Oxygen Demand
Causes of increased oxygen demand on the
myocardium:
Anemia
Exercise
Thyrotoxicosis
Substance abuse, particularly cocaine
Hyperthyroidism
Emotional stress
Unstable:
Angina decubitus:
(contd)
Treatment of Angina
Antianginals (nitroglycerin)
Antiplatelets (aspirin)
ACE inhibitors
Beta-blockers
Calcium channel blockers
Thrombolytic therapy (if thrombi are the
cause)
Oxygen administration
Percutaneous transluminal coronary
angioplasty or coronary artery bypass graft to
prevent MI
Myocardial
Infarction: An
Death of Overview
cells in the myocardium, usually
related to prolonged or severe ischemia
Necrosis, tissue damage, and sometimes
death results
Cause of MI include:
Sudden onset of ventricular fibrillation
Embolus (most common cause)
Thrombosis
Atherosclerotic occlusion
Prolonged vasospasm
Myocardial
Infarction
Cellular injury
occurs from lack of oxygen:
Progression
If prolonged, will lead to cell death
Myocardial
Infarction
DamagedProgression
cells lead to decreased
(contd)
contractility:
Myocardial
Infarction: Signs and
Pain, typically
in middle of chest, radiating
Symptoms
to jaws, arms (usually the left), abdomen,
and/or shoulders, and lasting 20 minutes:
Myocardial
Infarction: Signs and
Symptoms
(contd)
Tachycardia
Excessive perspiration
Painful breathing and/or difficulty breathing
Anxiety/panic
Nausea/vomiting
Fever
Stomach pain, often confused with
indigestion
Laboratory
Evaluation
Creatinine kinase
Trophin
Myoglobin
Myocardial
Infarction
If more than 50% of heart tissue is
Complications
damaged, severe disability or death will
result
Myocardial
Infarction
Pericarditis may develop up to 2 months
Complications
later:
(contd)
Fever
Pericardial effusion
Pleurisy
Pleural effusion
Joint pain
Rupture of heart muscle
Ventricular aneurysm
Blood clots
Hypotension
Treatment Following
Myocardial
Antianginals
(nitroglycerin)
Analgesics
Infarction
Electrolyte replacement
Calcium channel blockers
Beta-blockers
Antihypertensives
Anticoagulants
Treatment Following
Myocardial
Infarction
(contd)
Antiarrhythmics
Thrombolytics
Oxygen
Mild antianxiety agents
Heart Failure:
An Overview
Causes of Heart
Failure
Hypertension
MI
Cardiomyopathies
Congenital heart disease
Valve disorders
Side effect of medication or alcohol
Types of Heart
Failure
Systolic dysfunction:
Diastolic dysfunction:
Types of Heart
Failure (contd)
Left sided:
More common
Fluid backs into lungs
Signs and symptoms include:
Fatigue
Activity
intolerance
Dizziness
Syncope
Dyspnea
Coughing
Pulmonary
crackles
Tacycardia
urine output
Shortness of
breath when
lying down
Types of Heart
Failure (contd)
Right sided:
Types of Heart
Failure (contd)
Biventricular (signs and symptoms of both
left and right heart failure):
Signs and symptoms include:
All symptoms of right
and left heart failure
Dyspnea at rest
Hepatomegaly and
splenomegaly
Abdominal pressure
Ascites
Anorexia
Cardiac Cachexia
10% to 15% of patients with heart failure
develop cardiac cachexia
Loss of 6% of nonedematous body weight
over 6 months
Concurrent loss of cardiac muscle mass as
a result
Cardiac Cachexia
(contd)
Many other metabolic changes:
Treatment of
Coronary Heart
Diuretics Disease
Dopamine
Analgesics
Antihypertensives
ACE inhibitors
Direct vasodilators
Antidysrhythmics
Cardiac glycosides (digitalis)
Aldosterone agonists
Treatment of
Coronary Heart
Antibiotics,
if necessary(contd)
Disease
Iron supplementation, if necessary
Supplemental oxygen
Nitrates
Beta-blockers
Anticoagulants
References
Academy of Nutrition and Dietetics. Nutrition Care Manual
[by subscription]. Nutrition Care Manual Web site.
www.nutritioncaremanual.org. Accessed December 1, 2013.
References (contd)
Raymond JL, Couch SC. Medical nutrition therapy for
cardiovascular disease. In: Mahan, LK, Escott-Stump S,
Raymond JL. Krauses Food and the Nutrition Care Process. 13th
ed. St Louis, MO: Elsevier Saunders; 2012:742-781.
The Merck Manual for Health Care Professionals. Cardiovascular
disorders. Merck Manuals Web site.
http://www.merckmanuals.com/professional/cardiovascular_diso
rders.html
. Accessed December 1, 2013.
What is angina? National Heart, Lung, and Blood Institute Web
site.
http://www.nhlbi.nih.gov/health/health-topics/topics/angina/.
Accessed December 1, 2013.