Heart is a muscular organ. Pathology of heart indicates any disorder of heart, a properly functioning heart is important to sustain a live because it pumps blood out to whole body providing oxygen and nutrients. Here I've discussed on two common cardiovascular pathological condition.

1. Systemic Pathology: Heart (Part 1)
(for BSc Critical Care as per curriculum of WBUHS)
Prepared by
Abiyad Ahmed
BS Critical Care, WBUHS
ACLS Provider, FIMHRC

2. What’s Inside
• Unstable Angina
• Myocardial Infarction

3. Preface: Conductive System

4. Preface: Coronary Arteries

5. Unstable Angina: Preface
• A form of Ischemic heart disease
• Acute Coronary Syndrome (STEMI & NSTEMI)
• UA is part of ACS
• UA or Non STEMI signifies prejudiced circulation in one or more coronary arteries
and carries a risk of serious cardiac arrhythmias, cardiac failure and sudden death.
• Approx. 80% of patient with UA or NSTEMI have a previous history of UA before
the acute event.
• Unstable angina is defined as angina pectoris ischemic discomfort with presence of
– Occurs at rest and lasts more than 10 minutes
– Severe
– Crescendo Pattern

6. Atherosclerosis
↓
Total occlusion of coronary artery
↓
Myocardial ischemia
↓
Angina
Unstable Angina: Etiopathogenesis

7. • Class – I: New onset, naturally severe or frequent
• Class – II: In rest, Past history but not during previous 48 hours
• Class – III: Anginal attack at rest within prior 48 hours
Unstable Angina: Clinical degree severity

8. • Chest Pain
• SoB
• Sweating
• Tightening of chest
Unstable Angina: Clinical manifestation

9. • UA Post Angioplasty
• UA after Bypass surgery
• Prinzemetal’s angina
Unstable Angina: Syndromes

10. • HTN
• Smoking
• Diabetes
• Obesity
• Previous h/o arrhythmia, ACS etc.
• Hereditary factor
Unstable Angina: Risk factors

11.  ECG
 STEMI
 NSTEMI
 Cardiac biomarkers
 Troponin – I
 Troponin – T
 CPK-MB
 Routine blood examinations
 CRP
 Serology
 Serum Na+, K+, Ur, Cr, Lipid Profile
 Radiological examination
 Chest Xray
 Echocardiography
 Surgical intervention
 Coronary angiography
Unstable Angina: Clinical assessment

12. • Anticoagulant
– Heparin
– LMWH
• Antiplatelets
– Aspirin 300mg
• Nitrates
– Nitroglycerin
• Beta-blockers
– Metoprolol
– Propranlol
• Calcium channel blockers
Unstable Angina: Pharmacological Management

13. • Coronary artery bypass grafting (CABG)
• Percutaneous coronary intervention (PCI)
Unstable Angina: Surgical intervention

14. • Monitor vitals
• IV access
• Documentation ECG
• Patient health education
Unstable Angina: Nursing Assessment

15. • Fever
• Tachycardia
• Tachyarrhythmia
• Bradyarrhythmia
• Hypoglycemia
• Hypovolemia
• Acute Exacerbation of COPD
• Acute mental stress
Unstable Angina: Precipitating factors

16. MI is a clinical syndrome that results from occlusion of a coronary artery, with
resultant death of cardiac myocytes in the region supplied by that artery.
Acute MI signifies the state or condition of necrosis of the myocardium.
Atherosclerosis and an occult thrombus formed into coronary vessels.
Prompt diagnosis and early treatment in ICU can reduce rate of mortality.
It takes- hours for the entire thickness of the heart to become necrosed.
Acute Myocardial Infarction: Introduction

17. • Type – I : Plaque erosion
• Type – II : Ischemia due to either increased O2 demand or decreased supply
• Type – III : Sudden cardiac death involving cardiac arrest
• Type – IV : MI associated with PCI
• Type – V : MI associated with CABG
Acute Myocardial Infarction: Types

18. • Clinical features
– Chest Pain
– Hypertension
– Sweating
– Presence of syncope episode
• Diagnostics
– 12 lead ECG
– Echocardiography
– Cardiac enzymes
– Routine blood tests
Acute Myocardial Infarction: Diagosis

19. • STEMI
– ST-segment morphologically convex or obliquely flat
– LBBB patterns
– Q wave generally occurs after 8-12 hours
• NSTEMI
– Symmetrically downward ST depression
– Inverted or biphasic T wave
– W-P-W syndrome
Acute Myocardial Infarction: ECG Changes

20. Acute Myocardial Infarction: ECG Changes

21. • Troponins
– Trop I
– Trop T
• CPK-MB
Acute Myocardial Infarction: Cardiac Enzymes
Causes of Trop I & Trop T elevation
o ACS
o AMI
o Shock (Cardiogenic, Obstructive,
Distributive)
o Sepsis
o Renal failure
o Polytrauma
o Burns
o Pulmonary embolism
o Extreme physical exercise

22. • Bed rest
• IV access
• 12 lead ECG
• Vitals monitoring
Management of ST elevated MI

23. • Pain relief
• Nitrates
• Beta blockers
• Interventional therapy
– Fibrinolysis
Supportive Pharmacological Management in STEMI

24. • Fibrinolytic agents administered early in the course of AMI
• Benefits occur the ability to lyse clots within the coronary artery and thereby re-establish -perfusion of
blood to the affected area of the myocardium.
• Indication
– Suspected or Established AMI
– Chest pain more than 30 mins
– ECG: ST elevation more than 1-2 mm in Lead I, aVL, II, III, aVF
• Contraindication
– Bleeding disorders
– CVA in the recent pasr
– Uncontrolled severe hypertension
– Pregnant/Postpartum/Menstruating women
• Risk
– Bleeding
– Reperfusion arrhythmia
• Drugs
– Streptokinase (cont. IV infusion of 1.5 million units over 1 hour)
Acute Myocardial Infarction: Fibrinolytic therapy

25. • Percutaneous Coronary Intervention
• Surgical Reperfusion
– Coronary artery bypass grafting
Surgical Management of STEMI

26. • Cardiogenic shock
• Left ventricular failure
• Congestive heart failure
• Arrhythmia
• Pericarditis
• Rupture of interventricular septum
• Pulmonary embolism
Acute Myocardial Infarction: Complication

27. Thank You!