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Siminka's Notes 6

Siminka's Notes 6 - Atherosclerosis of Coronary Heart...

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Atherosclerosis of Coronary Heart Disease If heart bursts, blood goes into the pericardial sac, heart cannot work with fluid in pericardial sac, so heart will be muffled and can even slow or stop the contraction of the heart. Edema – accumulation of fluid. Complications – Acute effects Myocardial Rupture- softened necrotic myocardium may rupture as a result of increased pressure of the blood within the ventricle. Rupture of the left ventricle fills the pericardial sac, can lead to cardiac tamponade – compression of the heart by blood in the pericardial cavity. (hematopericardium)- blood in the pericardium (Arrhythmia ) – loss or abnormality of rhythm; denoting especially an irregularity of the heartbeat. Pic- (book) pg. 156 Hematopericardium(blood in pericardium) due to rupture of an infarct Cardiac tamponade – compression of the heart due to critically increased volume of fluid in the pericardium Cardiac Aneurysm – massive myocardial infarcts of the left ventricle, which are replaced by fibrous scars, bulge under the pressure of blood in the left ventricle, forming a ventricular aneurysm. The heart is dilated and contracts irregularly because the fibrous scar forming the wall of the aneurysm does not contain contractile elements. Pic – notes- Radiograph, can see blood leaked out into lungs. Pic – notes- CAT scan, can see the anerurysm (Arch aneurysm) Pic – notes – Aneurysm in the abdomen of the aorta An aneurysm is okay, it is just when blood gets between the layers of aorta, leads to dissecting aneurysm. Mural Thrombus – The endothelium is damaged and disrupted. Blood within the ventricle coagulates in contact with the necrotic endothelium, and forms a thrombus on the wall(Mural thrombus ). The thrombi can impede the blood flow and weaken the contraction of the ventricular myocardium, which may contribute to heart failure. Fragments of the thrombus may detach and give rise to emboli, which can cause infarcts in distant organs. Emboli – a plug, composed of a detached thrombus occluding a vessel. Pic – Ultrasound image of mural thrombi on the left ventricle of the heart Pic – Effect of an embolus that has moved and has caused little clots in the leg. (Arterial Embolus) Mural thrombi attacks the endothelium, do not want thrombi to break off and move. Chronic Problems after having Coronary Heart Disease
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Congestive Heart Failure – (Refers to Passive Congestion)- most of the symptoms are a consequence of hypoxia(decrease below normal levels of oxygen in blood or tissue) of the myocardium, will result in pump failure. Active congestion = vessels congestive with blood. Hyperimia, due to slap on the hand, it turns red. Blood vessels have hyperemia of bloods vessels are injected. Passive congestion = the heart cannot move the blood.
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