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
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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.
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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.
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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
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Blood supply of the hear
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Coronary angiography
Normal Left anterior coronary artery
LCA
LAD
LADBlockage
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Cardiac enzyme investigati
Cardiac enzyme can help you to pro
Time Course for Serum marker
in acute MI
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ECG
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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
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Tissue
plasminogenactivator (tPA
Plasminogen
Plasmin
Fibrin
Fibrin DegradationProducts
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Cyclooxygenase1
Aspirin
Arachidonic acid
Prostaglandin G2
Thromboxanesynthase
Thromboxane A2
decreased platele
activation andaggregation
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Medical use
Pulmonary embolism
Myocardial infarction
Stroke
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He was given diuretics and salt-restricted diet.
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Diuretics
Loop diuretics are diuretics that act at the
ascending loop of Henle in the kidney
Furosemide
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The progression of heart failu
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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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G G
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SEQUENCES OF PATHOLOGIC CHANG
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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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He was given diuretics and salt-restricted diet.
Di ti
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Diuretics
Loop diuretics
Furosemide
Whi h f th f ll i h i
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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
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Which of the following mechanismsis 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
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Which of the following mechanismsis the most likely inhibition of
aspirin ?
A. ADP pathway
B. cAMP activation
C. Plasmin metabolism
D. Thromboxane A2 synthesis
E. glycoprotein Iib/IIIa receptor
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Coronary Circulation
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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
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y
Supply
Chapter 18, Cardiovascular SystemFig
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