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Diagnosis of coronary artery diseases, particularly the Atrioventricular valves- located between the atria and
myocardial injury caused by ischemia ventricles
Developed to analyze the myocardial function on a more Semilunar valves- located between ventricles, aorta &
comprehensive level where the more insight physiological pulmonary artery
and pathological information can be extracted
Provides a more significant meaning and higher efficacy 2 Separate Circulations
than what the conventional EKG can provide Pulmonary circulation- allows the exchange of oxygen
Valuates the function of the myocardium directly, it can and carbon dioxide in the lungs
detect any early subtle changes in myocardial function or Systemic circulation- provides the exchange of nutrients
injuries caused by the obstruction of small coronary and wastes between the blood and the cells throughout the
arteries which cannot be detected by catheterization or body
angiography
Cardiac Cycle
Heart Describes the circulation of blood through the heart and
It pumps blood throughout both the pulmonary and body as the heart muscles alternates
systemic circulation Diastole- period of relaxation
Weighs 250-350 g and about the size of human fist Systole- period of contraction
Located in the mediastenum between the lungs and
enclosed in a double-walled pericardial sac with serious? Symptoms of heart disease
Membrane between the walls to provide lubricating fluis Dyspnea Chest pain
that facilitates heart movements Palpitations Syncope
The heart is made up of the two atria which receive blood Fatigue Edema
and two ventricles which are the actual pumps of the
heart. The left ventricle pumps blood into the aorta Fatigue
sending oxygenated blood to the rest of the body Feelings of weakness and fatigue can be considered as
symptoms arising out of inadequate blood flow to the
Layers of the heart heart muscles mostly during any physical activity
Myocardium- cardiac muscle that pumps the blood This is caused when the heart pumps inefficiently as it
throughout the body (middle layer of the heart) does in heart failure
Endocardium- inner later and forms the heart valves that
separate four chambers of the heart Chest pain
a. Upper chambers- right and left atria The inadequate supply of blood cause chest pain, when
b. Lower chambers – left and right ventricles stiffness or grasping sensation in the chest (angina) is
Interventricular septum- separate left and right sides of the experienced due to inadequate supply of blood
heart This is caused when the muscles in the heart do not get
enough blood (a condition referred to as ischemia), and
Blood vessels enough oxygen, to be carried to tissues by the blood
Arteries- transport blood away from the heart into the
lungs or body tissues and arterioles (small branches or Light headedness and fainting
arteries) This is caused when there is inadequate flow of blood, due
Capillaries- very small vessels that allow the exchange of to irregularities in the heart rate or rhythm, the heart
the fluids ( O2, Co2, electrolyte, glucose) cannot pump adequately resulting in light-headedness,
Veins- has thinner walls and less smooth muscle than faintness, or fainting (syncope)
arteries (superior & inferior vena & coronary sinus)
Pulmonary veins- supply blood to the left atrium Swelling & Numbness
Aorta- removes blood from the left ventricle Swelling is caused due to the accumulation of fluid
(edema) in tissues.
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It occurs when blood collect in the leg veins, increasing Paroxysmal nocturnal dyspnea-is an accumulation of the
pressure in the leg veins and forcing fluids out of the veins fluid in the lungs at night
into tissues Cyanosis- bluish discoloration of the skin caused by an
This collecting of pooling of blood may be an indication increased amount of non-oxygenated hemoglobin in the
of heart failure or venous disorder, such as deep vein blood
thrombosis. Similarly numbness may be caused along Heart Disease
with swelling of the blood supply to the affected area is Congenital heart disease- involves valvular defects that
inadequate interfere with the normal flow of blood, septal defects that
allow mixing of oxygenated blood from the pulmonary
Changes in skin color circulation with unoxygenated blood from the systemic
The changes in the color of the skin occur when there is circulation shunts
inadequate supply of blood, due to anemia, or o the veins
do not drain adequately. Influences
These changes may make skin appear pale, bluish or Alcohol abuse
purplish Maternal rubella infection
Infection with German measles
Palpitation Drug treatment with radiation
Irregular heartbeats is the prime symptom of palpitations
Symptoms like shortness of breath, chest pain, fatigue, or Congestive heart failure
fainting which are more likely to result from an abnormal Results from the inability of the heart to pump blood
heart rhythm or a severe disorder then you may be effectively
suffering from palpitation Characterized by symptoms of accumulation of fluid in
The disease can be properly diagnosed by the doctor with the lungs throughout the body & occurs if the heart
the help of electrocardiography (ECG) muscle itself is weak or heart is stresses beyond the ability
to react
Shortness of breath Left side of the hearts fails and result in accumulation of
A very common symptom of heart disease is shortness of fluids in the lungs (pulmonary edema)
breath which is also called dyspnea Right side of the heart fails result in accumulation of fluid
This symptom is regarded as a common symptom of heart in systemic circulation (generalized edema)
failure
The disease occurs due to the condition called pulmonary Atrial septal defects
congestion or pulmonary edema which is due to when Due to malformation of ducts and abnormality causes left-
fluid seeps into the air spaces of the lungs right shunting of blood between atria
Shortness of breath occurs mostly in people suffering Pulmonary hypertension and atrial arrhythmias are
from coronary artey disease and usually occurs during common if the patient is older than age 30
physical activity
Coronary heart disease
Limitation of Physical activity Caused by lack of nutrient and oxygen supply to the heart
Physical activities are very much needed, if you want to muscle and results in myocardial ischemia (due to
keeps yourself away from the heart diseases obstruction in one of the arteries)
A very frequent and common symptom of heart disease is
a person’s limitation on physical activity or in performing Cardiomyopathy
any kind of chores Abnormality of the heart muscle and dilates out of
Can be graded on that basis as mild, moderate and severe proportion resulting in an enlarged heart
Other symptoms: Arrhythmias
Orthopnea- breathlessness when a patient lies flat, occurs Malfunction in cardiac conduction
when blood is redistributed in the supine position which
increases the pressure of abdominal contents against the
diaphragm
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Atherosclerosis
Thickening & hardening of the artery walls caused by ANTISTREPTOLYSIN-O TEST
deposits cholesterol lipid-calsium plaque in the lining of Protein produced by streptococcal bacteria
arteries In response to infection, the body produces streptolysin
antibody
Hypertensive heart disease Antibodies for streptolysin, called antistreptolysin-O
A systolic pressure of greater than 160 mmHg and antibodies
diastolic pressure greater than 95 mmHg High levels indicate the presence of an infection like
Most common cardiovascular disease affecting 505 Endocarditis or rheumatic fever
middle age people
Normal: 120 systolic, 80 diastolic BLOOD FAT PROFILE
Prehypertension:120-139 systolic, 80-89 diastolic Cholesterol
Stage 1 hypertension: 140-159, 90-99 diastolic HDL (good cholesterol)
Stage 2 hypertension-: 160 systolic, 100 diastolic LDL (bad cholesterol)
Triglycerides
Rheumatoid heart disease
Due to infection of Group A Sterptococci Cholesterol
Desirable: Less than 200 mg/dL (5.18 mmol/L)
Acute Coronary Syndrome (ACS) Borderline high: 200- 239 mg/dL (5.18 to 6.18 mmol/L)
It encompasses several clinical situations having High: 240 mg/dL (6.22 mmol/L) or higher
myocardial ischemia in common; stable angina, unstable
angina, acute MI & sudden cardiac death (SCD) HDL Cholesterol
Low risk: Less than 40 mg/dL 91.0 mmol/L) for men and
Types less than 50 mg/dL (1.3 mmol/L) for women
Non-invasive Tests Average risk: 40-50 mg/dL (1.0-1.3 mmol/L) for men and
Invasive/Interventional Tests between 50-59 md/dL (1.3-1.5 mmol/L) for women
Less than average risk: 60 mg/dL (1.55 mmolo/L) or
Non-invasive Test higher for both men and women
Blood tests
Carotid & Extremity Vascular Testing LDL Cholesterol
CAT Scans Optimal: Less than 100 mg/dL (2.59 mmol/L)
Echocardiography Near/above optimal: 100-129 mg/dL (2.59-3.34 mmol/L)
Electrocardiograms (EKG) Borderline high: 130- 159 mg/dL (3.337-4.12 mmol/L)
Holter and Event (Loop) Monitoring High: 160-189 mg/dL (4.15 4.90 mmol/L)
Exercise Stress Test
MRIs Triglycerides
Desirable: Less tahn 150 mg/dL (1.70 mmol/L)
BLOOD TESTS Borderline high: 150-199 mg/dL (1.702.2 mmol/L)
Antistreptolysin-O test High: 200-499 mg/dL (2.3-5.6 mmol/L)
Arterial blood gases Very high: Greater than 500 mg/dL (5.6 mmol/L)
Blood fat profile
Blood calcium test BNP BLOOD TEST
BNP blood test Measures the level of hormone called B-type natriuretic
C-reactive protein test peptide
INR/prothrombin time tests BNP rises in heart failure
Serum myoglobin test
Total serum protein
Waste products test
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C-REACTIVE PROTEIN TEST Following AMI, levels rise within 4-8 hours, peak at 12-
An inflammatory marker 24 hours and normalize in 48-72 hours
Provides information about a patient’s risk of having a Lactate dehydrogenase
heart attack or stroke Catalyze the interconversion of lactic and pyruvic acids
High levels of CRP in the blood mean there is tetramic which contains 4 subunits (H and M forms)
inflammation somewhere in the body Elevations in LDH levels occur 12-24 hours following MI
CARBON DIOXIDE CONTENT and peak in 48 to 72 hours. Remains elevated in 10-14
Used as an investigative and diagnostic tool for patients days
with breathing problems Normally LDH 1 is lower than LDH 2
COMPLETE BLOOD COUNT
Information about the types of blood cells present Troponin
Condition and number (percentage) in relation to other Composed of 3 proteins- troponin C, cardiac troponin I,
cells and cardiac troponin T
ELECTROLYTE PANEL Troponin I especially has a high affinity for myocardial
Measure the amount of potassium, sodium, chloride and injury
carbon dioxide levels in the blood Rises within 3 hours and persists for up to 7 days
ERYTHROCYTES SEDIMENTATION RATE Normal values are low, with troponin I being lower than
Measures the rate at which red blood cells separate from 0.6 ng/mL and troponin T normally ranging from 0 to 0.2
plasma ng/mL
High levels may occur during a heart attack, rheumatic Any rise can indicate myocardial cell damage
fever, giant cell arteritis, severe anemia, cancer relapse or
other conditions 1. Creatine Kinase- enzymes that is involved in the transfer
Low levels may be associated with heart failure, sickle of energy in muscle metabolism
cell anemia or other conditions - Has 3 isoenzymes: CK-MM, CK-MB, CK-BB in
electrophoresis. The fastest migrating is BB (CK1), MB
CARDIAC ENZYME TESTS (CK2), then MM (CK3)
Creatine kinase-MB - CK-MB – diagnosis of acute myocardial infarction since
Lactate dehydrogenase its high specificity for cardiac injury
Troponin
Myoglobin
Creatine kinase-MB An oxygen-bnding protein found in cardiac and skeletal
An elevation in value indicates myocardial damage muscle
An elevation occurs within 4 to 6 hours and peaks 18 to Level rises within 1 hour after cell death, peaks in 4 to 6
24 hours following an acute ischemic attack hours
Normal value is 0% to 5% of total; total CK is 26 to 174 Returns to normal within 24 to 36 hours
units/L
It catalyze the transfer of a phosphate group between 2. AST- first marker used for the laboratory diagnosis of
creatine phosphates and adenosine diphosphate acute myocardial infarction. It lacks specificity
Involved in the storage of high energy creatine pO4 in the 3. Lactate dehydrogenase (LD) - cytoplasmic enzyme found
muscles in almost all cells of the body and not specific also for MI
Composed of pair of monomers, M and B This begins to rise at 6 hours- 12 hours from the onset of
CK-MM, CK-BB, CK-MB shest pain, peaks 1-3 days and normalize within 8 days
CK-MM- major isoenzymes (94-100%) LD1 and LD2 are subfractions that are specific for the
heart
CK-BB- brain type, rare in adult due to high molecular
size
Abnormal CK Types
CK-MB- hybrid type, myocardium is the only tissue that
Macro-CK – is a CK-Ig complex. On electrophoresis it
releases in significant quantities (20%), sensitive indicator
migrates between MM and MB. It is found in completely
of AMI
healthy elderly women
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Mitochondrial CK – migrates very close to MM, usually Unbound free fatty acid (u- FFA)
slower than MM. it is seen in patients with advanced often Is elevated in reversible and irreversible cardiac ischemia
disseminated, malignancies and is associated in poor usually very early
prognosis.
Glycogen Phophorylase isoenzymes (B) G PBB
Troponin T (TnT) – an asymmetrical globular protein It is a glycolytic enzymes that play an essential role in the
Allows for both early and late diagnosis of acute regulation of CHO metablosim by mobilizing glycogen
myocardial infarction. Rise after few hours onset of pain Found in the hearts and brain but seen in wbc platelets,
and peak by 2 days. spleen
Clearly differentiate cardiac damage with muscle damage Increased after 3-4 hours after onset of pain
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