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Definition:
irreversible destruction of heart muscle (myocardial necrosis) caused by insufficient oxygen supply, usually by thrombotic occlusion of the supply section of the coronary vessels.
Cause:
# 95% CHD
# breaking an ulcerated atherosclerotic plaque and thrombus formation of a vessel closure
process of atherosclerosis

	What happened?	What occurs?
1.	fats are deposited on arterial inner wall plaques arise from
second	fat deposits are covered by a connective tissue layer harden	fat deposits are
third thicken form	new muscle cells within the sediments, the vessel walls
4th	caused cracks in hardened deposits	particles dissolve and form a blood clot
5th	Blood clots seal the already narrowed artery, or plaques on break and bleeding occurs	blood supply in the following modified tissue is closed

Drug treatment

• acute phase: analgesics / opioids
• continuous therapy:
  
• CSE inhibitor / lipid lowering agents [CSE = cholesterol synthesis inhibitors]
• antiplatelet anticoagulants

HEART ATTACK DRUG

drug	effect	acute phase	term therapy
morphine analgesia		5-20 mg diluted with NaCl	-
diazepam	sedation	5-10 mg, sc / iv	-
nitrates	dilation of the vessels	Spray Perfusor	tablets
beta-receptor blockers	preventing tachycardia	oral; iv	tablets
heparin (high dose)	preventing thrombus formation, anticoagulation	5000 IU iv bolus; Perfusor 1000 IU / h	-
heparin (low dose)	- "-	1-2 times daily sc	- iv
ASS	platelet aggregation inhibitors	Aspisol;	oral tablet 1 time daily
OR (based on long-term treatment)
warfarin / Falithrom	Vitamin K - antagonist	-	tablet
ADP receptor antagonist	platelet aggregation inhibitors	oral	tablet, about 1 year
thrombolytics	resolution of the thrombus	iv; syringe pump for 1 h	-
ACE inhibitors	-	-	tablets
lipid lowering	lowering cholesterol	-	tablets

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coronary heart disease

ì Synonyms: CHD = coronary artery disease ischemic coronary artery disease

ì Definition: manifestation of atherosclerosis in the coronary arteries.

ì process:

1. 
   
   Atherosclerosis in the coronary arteries


2. 
   
   development of stenosis


3. 
   
   reduced blood flow to the heart muscle


4. 
   
   mismatch between 0 ₂ -demand and O ₂ offer

ì Etiology: [ á increased =]

risk factors of first order 2 risk factors = heart attack risk increased 4-fold 3 risk factors = risk of heart attack 10-fold increase	risk factors of second order
hypertension smoking diabetes mellitus dyslipidemia genetic predisposition age male gender metabolic syndrome	sedentary stress lipoprotein A á fibrinogen á homocysteine á

ì pathophysiology (4 degrees of severity of coronary stenosis)

Grade 1 25 - 49%

; Grade 2 50 - 74% Grade 3 75

- 99% (critical stenosis)

, Grade 4 100% (total occlusion)

Ü only 75% the first symptoms

two forms of CHD

latent coronary heart disease ~ KHK manifest

(asymptomatic (Symptomatische DL)

DL; Stumme ;

Ischämie)

                                                 

diseases manifest CHD

diseases	share of onset (in%)	Description
angina pectoris	55	chest pain due to reversible Myocardischmie
heart attack	25	Ischemic Myocardnekrose
heart failure	-	Ischemic heart muscle damage
arrhythmias	-	ventricular arrhythmias and ventricular fibrillation
Sudden cardiac death	20

ì coronary vessels (coronary arteries)

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Extras:

# are end arteries

#, there are no anastomoses with the einzellne arteries

# dies at closing tissue from

effect of the risk factor nicotine

adrenal medulla:

• 
  
  release of adrenaline and noradrenaline


• 
  
  ð peripheral increase in heart rate


• 
  
  ð increase in O 2 -consumption of the heart

coronary vessels & Vessels:

• 
  
  narrowing of these vessels


• 
  
  ð increased vascular resistance


• 
  
  ð reduced O ₂ offer

vessel walls:

• 
  
  promote platelet aggregation


• 
  
  increase in fibrinogen levels


• 
  
  damage the intima of the arteries


• 
  
  ð increase the clotting ability Blood


• 
  
  ð encouraging early deposits


• 
  
  ð promote atherosclerosis

effect of the risk factor of alcohol

positive	negative reduced
increase in HDL-cholesterol platelet aggregation reduction of fibrinogen in serum blood pressure reduction with low regular alcohol consumption	increase in triglycerides in serum blood pressure with increased regular alcohol consumption (from 30 g / d = 0.3 liters of wine or 0.8 liters of beer)

main complaints / symptoms in diseases of the heart

symptom	statement	differential diagnosis
chest pain	linksthorakal or retrosternal	angina pectoris, pulmonary embolism, heart attack, tuberculosis
dyspnea	breathlessness	pneumonia, lung CA, heart attack, Tbc
palpitations	unpleasant perception of one's own heartbeat	heart attack, hyperthyroidism
cyanosis	bluish discoloration of lips, mucous membranes, skin	hypothermia, pulmonary embolism
distended neck veins	by damming the blood before the right heart	bronchial CA, pericarditis, valve stenosis
nocturia	increased urination at night	right heart failure, urinary incontinence
cough	-	flu, colds, pneumonia
syncope	sudden, brief loss of consciousness, by reducing supply to the brain with O 2	cardiac arrhythmias, arteriosclerosis
reduced exercise capacity	-	-