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Myocardial infar: etiopathogenesis similar to angina pectoris.

Risk factors: non

modifiable factors: age 40-60, sex & genetic predisposition. Modifiable factors:
smoking, hypertension, diabetes, obesity, type A of character, alcoholism. 3
pathogenetic factor: 1- stable factor atheroma. If atheroma < 50 % compensated by
dilation of other part (adenosine, prostacyclin). If narrowing 50-575%
hypercoagulation due to turbulrnt flow red thrombion vessels wall non effective
compensatory dilatation ishemick attack. 2 types of atheroma: crescent & circuit-like
(more dangerous & severe), 20 thrombosis: stress -. Activation of coagulatiuon system.
When calm anticoagulation activated additional factor not permanent. 3- spasm:
generalized or local. Gen (main trunk in spasm) spasms occurs in cases of disorders of
central sympathetic activity -. Variant angina that can lead to MI. Localized spasm: in
places of atheromas due to decreses vasodilator production. Difference from AP is that
disorder remains for more than 30 min leading to irreversible damage MI is non
reversible condition, can result in scaring or death. Mi connected with exertion in 50%
may be at rest . Mi as primary process is 50 % & 50 % after AP. Mian mech is
hypercoagulation. Thia may occur in cases of atheroma plugs then with thrombosis due
to action of cathecholamines in blood due to stress during night or day. Class: 1- atatus
anginosus: pain lasting > 30 min. it may last till necrosis cells are broken down &
pain stops after 1 day pain is so sharo that it may lead to schock & death. Pina
properties similar to that of Ap but sharpers with morw radiation. First patient keep
silent but then moves to relieve pain he has weakness, bradycardia, palpitations,
tachycardia 75% have this form. Gial variant (10%): dangerous like pain of ulcer. Pain
localized in epigastric region, associated with irritation of intestine dyspepsia
(belching, distention, flatulence, paralyss of bowel, meteorism) palpation in upper
abdomen is painful due to reaction of peritoneum ECG. 3- asthmatic variant 5 %:
dyspnea & asthma(cardia), dec output by 3 times increase hydrostatic pressure in
lung veins intestitial edema-. Asthma. Tachypnea, orthopnea. Seen in patient older
than 70 with cardisclerosis with disbalance between sym & parasympathetic with
dominance of para, those who have suffered from Mi in past scaring. $- arrhythmic
variant: arrytmias without pain, they are ventricular with electrical disturbances. 5brain or bakalekov variant: first brain ischemia like stroke with loss os consc,
hemiplagia. Another variant withour pain without loss of cons generalized symp:
weakness, headache, dizziness. The disorder being dynamic brain symp dispaers &
cardia sym appears. -> dynamic variant that disapera after 1 day. 6- silent variant: no
pain or symptoms showing heart disorder. Diagnosis by ECG 1- scar with pathologic Q
wave. 2- subacute stage. In adition to pain we see toxicoresorptive symp: high temp,
headache, bad appetite. Cardiogenic shock: 1- reflex: connected with pain synd, if it
stays for some hrs without aid --. Death. 2- true cardiogenic shock: if vol of tissue are
affected . 50 % pain not so sharp but low output since onset, metabolic acidosis,

venodilation, 90% death, 5 % may survive with complicated TTT ; artificial heart. 3arrythmical: tachy, arryth, low output scock, sharp bradycar at Av, 4- reactive
cardiogenic shock: special drugs are used, BP< 80/40, patient inactive, pale skin with
cyanotic discoloration like marble, stupor. TTT of MI hospitalization but if old at home
and if patient has tumor also at home & if old Mi > 3days at home. Drugs to stop pain:
nemolyptic analgesia, synthetic opioid: phentaryl combined with droperidol act over
hr sleep, pain stop, if wake up + still pain infarction is spreading another
injection., morphin , lidocaine, we can gice B-blockers prevent dev of other attack, drug
decrese stress as phenobarbitol.