Fisiopatologia - Cardiopatia Isquémica
-
Upload
usmp-fn-archivos -
Category
Documents
-
view
228 -
download
15
description
Transcript of Fisiopatologia - Cardiopatia Isquémica
![Page 1: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/1.jpg)
CARDIOPATIA ISQUEMICA
Dr. Luis Angel Coaguila C.
Medico Intensivista. UNFV
Maestría en Fisiología UNMSM
Coordinador de Residentado Medico
Especialidad Medicina Intensiva - UNPRG
![Page 2: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/2.jpg)
Jhon T. Hansen. Netter´s Atlas of Human Physiology.2002
![Page 3: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/3.jpg)
Jhon T. Hansen. Netter´s Atlas of Human Physiology.2002
![Page 4: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/4.jpg)
Jhon T. Hansen. Netter´s Atlas of Human Physiology.2002
![Page 5: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/5.jpg)
Jhon T. Hansen. Netter´s Atlas of Human Physiology.2002
![Page 6: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/6.jpg)
Jhon T. Hansen. Netter´s Atlas of Human Physiology.2002
![Page 7: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/7.jpg)
Filippo Crea. Coronary Microvascular Dysfunction. 2014
![Page 8: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/8.jpg)
![Page 9: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/9.jpg)
![Page 10: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/10.jpg)
Banda A y H: Filamento miosina. Banda I: Filamentos finos actina. Discos Z :Unidas a actinas adyacentes, continuidad entre sarcomeros.
Contracción : La banda H desaparece y comprime la banda I.
![Page 11: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/11.jpg)
Berny y Levy. Fisiología. Sexta Edición. 2009
![Page 12: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/12.jpg)
![Page 13: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/13.jpg)
POTENCIAL DE ACCION
![Page 14: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/14.jpg)
![Page 15: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/15.jpg)
![Page 16: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/16.jpg)
ELECTROFISIOLOGIA
Filippo Crea. Coronary Microvascular Dysfunction. 2014
![Page 17: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/17.jpg)
![Page 18: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/18.jpg)
Arthur C Guyton. Tratado de Fisiologia Medica. 12va Edición. 2011
![Page 19: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/19.jpg)
![Page 20: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/20.jpg)
![Page 21: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/21.jpg)
![Page 22: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/22.jpg)
![Page 23: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/23.jpg)
![Page 24: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/24.jpg)
![Page 25: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/25.jpg)
RESISTENCIA A LA INSULINA
American Diabetes Association.Todo sobre la resistencia a la insulina. 2005
![Page 26: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/26.jpg)
![Page 27: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/27.jpg)
![Page 28: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/28.jpg)
![Page 29: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/29.jpg)
![Page 30: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/30.jpg)
![Page 31: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/31.jpg)
![Page 32: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/32.jpg)
![Page 33: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/33.jpg)
![Page 34: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/34.jpg)
![Page 35: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/35.jpg)
STEMI
![Page 36: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/36.jpg)
![Page 37: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/37.jpg)
![Page 38: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/38.jpg)
![Page 39: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/39.jpg)
Thygesen K, AlpertJS, White HD, et al: Universal definition o f myocardial infarction. J Am Coll Cardiol 60:1581, 2012
![Page 40: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/40.jpg)
Akashi YJ, Goldstein DS, Barbaro G, Ueyama T: Takotsubo cardiomyopathy: A new form o f acute, reversible heart failure. Circulation 118:2754, 2008
![Page 41: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/41.jpg)
Reichlin T, Schindler C, DrexlerB, etal: One-hourruleout and rule-in o f acute myocardial infarction using high-sensitivity cardiac troponinT. Arch Intern Med 172:1211, 2012.
![Page 42: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/42.jpg)
![Page 43: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/43.jpg)
![Page 44: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/44.jpg)
![Page 45: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/45.jpg)
![Page 46: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/46.jpg)
Diagnostico
Según la OMS, el diagnóstico de IAM está basado en la presencia de al menos dos de los siguientes criterios:
(1) Dolor de origen cardíaco.(2) Alteraciones del ECG.(3) Aumento de los marcadores
cardíacos.
![Page 47: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/47.jpg)
CLASIFICACION DE KILLIP
CLASE FUNCIONAL
SIGNOS CLÍNICOS MORTALIDAD (%)
I Ausencia de signos de insuficiencia ventricular
izquierda .
6
II Tercer ruido, estertores, hipertensión venosa pulmonar
.
17
III Edema pulmonar franco. 38
IV Shock cardiogénico (tensión sistólica < 90 mmHg, signos
de vasoconstricción periférica .
81
Publicado en www.portalesmedicos.com
![Page 48: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/48.jpg)
Troponinas cardiacas
![Page 49: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/49.jpg)
Troponina I
VN desde 0.03 - 0.08 ng/mL
> 0.10 ng/mL = daño miocárdico menor y temporal
Digestión proteolítica por enzimas lisosómicas, sin ruptura de la membrana.
> 1.00 ng/mL = daño miocárdico mayor
Necrosis: ruptura de la membrana celular del cardiocito.
![Page 50: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/50.jpg)
Troponina T cardiaca
Cinética en el IAM:
Empieza a elevarse: 4 - 6h Valor máximo: 12 - 20h Se normaliza: 10 – 14d
Resultado cualitativo: (+) / (-)
Se eleva en pacientes dializados (por regeneración muscular) y en ACVs.
![Page 51: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/51.jpg)
Tres signos electrocardiográficos específicos:
Isquemia:
Aparición de ondas T negativas
Lesión:
Elevación segmento ST
Necrosis:
Onda Q profunda
ALTERACIONES ELECTROCARDIOGRAFICAS
![Page 52: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/52.jpg)
![Page 53: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/53.jpg)
![Page 54: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/54.jpg)
![Page 55: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/55.jpg)
![Page 56: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/56.jpg)
![Page 57: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/57.jpg)
![Page 58: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/58.jpg)
![Page 59: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/59.jpg)
![Page 60: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/60.jpg)
![Page 61: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/61.jpg)
![Page 62: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/62.jpg)
![Page 63: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/63.jpg)
Complicaciones
Mecánicas: Ruptura de pared libre. Ruptura de músculo papilar. Ruptura de septum interventricular. Pseudoaneurisma
Eléctricas: Arritmias ventriculares: taquicardia ventricular, fibrilación ventricular , ritmo idioventricular acelerado, taquicardia de la unión. Arritmias supraventriculares: Fibrilación auricular, flutter auricular, taquicardia paroxística. Bradiarritmias: bloqueos A-V, ritmo de la unión.
Hemodinámicas: edema pulmonar agudo, shock cardiogénico.
![Page 64: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/64.jpg)
Tratamiento
El tratamiento del IAM contiene 3 pilares:
♦ Restauración del flujo coronario mediante fármacos o procedimientos invasivos.
♦ Eliminación de episodios isquémicos recurrentes a través de tratamientos antitrombóticos optimizados.
♦ Prevenir y mitigar las consecuencias de la necrosis miocárdica.
![Page 65: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/65.jpg)
![Page 66: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/66.jpg)
![Page 67: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/67.jpg)
![Page 68: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/68.jpg)
![Page 69: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/69.jpg)
![Page 70: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/70.jpg)
![Page 71: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/71.jpg)
![Page 72: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/72.jpg)
![Page 73: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/73.jpg)
![Page 74: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/74.jpg)
![Page 75: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/75.jpg)
![Page 76: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/76.jpg)
![Page 77: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/77.jpg)
![Page 78: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/78.jpg)
![Page 79: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/79.jpg)
![Page 80: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/80.jpg)
AREAS CRITICAS - HRL
![Page 81: Fisiopatologia - Cardiopatia Isquémica](https://reader036.fdocuments.in/reader036/viewer/2022062423/563dbb92550346aa9aae56e5/html5/thumbnails/81.jpg)