CVS Present

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Cardiovascular system

นศพ.

เกมกว ครษฐภาม รหัส520

นศพ. ศลา โรจนรัตนเกยรต รหัส 540

อาจารยท ปรกษาผศ. ดร. บษบา พ พ ธพร

ดร.

วัชราภรณ เทวกล ณ.

อยธยา



History A 65-year-old man presented to the emergency room wit

recent (6-hour) history of severe chest pain radiating to

arm. He was suspected to have had a "heart attack." Co

angiography revealed a complete occlusion of the left an

descending branch about 2 cm from its origin. He was g

therapeutic dose of recombinant human tissue plasmino

activator (t-PA). This treatment restored coronary arter

flow, and his chest pain improved. Simultaneously, he w

started on one tablet of aspirin per day.



Seven days later, he noted swelling of both le

and feet and was found to have pitting edem

the legs; his liver was somewhat enlarged; an

neck veins (jugular) appeared full. He was g

diuretics and salt-restricted diet.

A few days later, he developed dypsnea,

orthopnea, cough with pink frothy sputum. Hbecame very breathless and died suddenly.



Section I

◦ severe chest pain radiating to his larm.

◦ complete occlusion of the left antedescending branch

◦ tissue plasminogen activator (t-PA

◦

one tablet of aspirin Section II

◦ swelling of both legs and feet

◦

liver was somewhat enlarged◦ neck veins (jugular) appeared full



Blood supply of the hear



Coronary angiography

Normal Left anterior coronary artery

LCA

LAD

LADBlockage



Cardiac enzyme investigati

Cardiac enzyme can help you to pro

Time Course for Serum marker

in acute MI



ECG



He was given a therapeutic dose ofrecombinant human tissue plasminog

activator (t-PA). This treatment restorecoronary artery blood flow, and his cpain improved. Simultaneously, he wstarted on one tablet of aspirin per da



Tissue

plasminogenactivator (tPA

Plasminogen

Plasmin

Fibrin

Fibrin DegradationProducts



Cyclooxygenase1

Aspirin

Arachidonic acid

Prostaglandin G2

Thromboxanesynthase

Thromboxane A2

decreased platele

activation andaggregation



Medical use

Pulmonary embolism

Myocardial infarction

Stroke



He was given diuretics and salt-restricted diet.



Diuretics

Loop diuretics are diuretics that act at the

ascending loop of Henle in the kidney

Furosemide

http://en.wikipedia.org/wiki/Furosemide




The progression of heart failu



Question

At the time of admission, What is thehistopathologic finding in this patient

A. Fibrosis and collagen deposition

B. Plasma cells and caseous necrosisC. Abundant neutrophils and monocytes

D. Monocyte infiltration and

neovascularizationE. Coagulation necrosis with few

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SEQUENCES OF PATHOLOGIC CHANG



At the time of admission, What is thehistopathologic finding in this patient

A. Fibrosis and collagen deposition

B. Plasma cells and caseous necrosisC. Abundant neutrophils and monocytes

D. Monocyte infiltration and

neovascularizationE. Coagulation necrosis with few



He was given diuretics and salt-restricted diet.

Di ti



Diuretics

Loop diuretics

Furosemide

Whi h f th f ll i h i





Which of the following mechanis

is the most likely inhibition of

aspirin ? A. ADP pathway

B. cAMP activation

C. Plasmin metabolism

D. Thromboxane A2 synthesis

E. glycoprotein IIb/IIIa receptor

Which of the following mechanisms



Which of the following mechanismsis the most likely inhibition of

aspirin ?

A. ADP pathway

B. cAMP activation



E. glycoprotein Iib/IIIa receptor

Which of the following mechanisms



Which of the following mechanismsis the most likely inhibition of

aspirin ?

A. ADP pathway

B. cAMP activation



E. glycoprotein Iib/IIIa receptor



Coronary Circulation



Coronary Circulation

Coronary circulation is the functio

blood supply to the heart muscle its

Collateral routes ensure blood

delivery to heart even if major vess

are occluded

Chapter 18, Cardiovascular System

Coronary Circulation: Arterial



y

Supply

Chapter 18, Cardiovascular SystemFig

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CVS Present

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