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INDIAN DENTAL ACADEMY •
Leader in continuing dental education
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"When you make a mistake, don't look back at it long. Take the reason into your mind, and then look forward. Mistakes are lessons of wisdom. The past cannot be changed. The future is yet in your power." Phyllis Bottome 1884-1963, Novelist and Lecturer •www.indiandentalacademy.com
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Pathology of CVS Dr. Venkatesh Murthy Shashidhar Associate Professor of Pathology Fiji School of Medicine.
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Atherosclerosis Hypertension Myocardial Infarction (MI) Stroke IHD - Ischemic Heart Disease VHD - Valvular Heart Disease RHD – Rheumatic Heart Disease CHD - Congenital Heart Disease
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“Chronic inflammatory disorder of intima of large blood vessels characterised by formation of fibrofatty plaques called atheroma”. Hardening of arteries - Arteriosclerosis •www.indiandentalacademy.com
Large elastic arteries – Starts in Intima Fat deposits, Hardening and destruction. Major cause of IHD, MI & Stroke. Incidence is decreasing since 1995 Better understanding & Change in life style.
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Non modifiable Age – middle to late. Sex – Males, complications Genetic - Hyperchol. Family history.
Potentially Modifiable Hyperlipidemia – HDL/LDL ratio. Hypertension. Smoking. Diabetes Life style, diet, excercise
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Unknown etiology – Hyperlipidemia, life style, hypertension, smoking, genetic etc. Starts with Initial intimal injury, inflammation, necrosis, Lipid accumulation, Fibrosis Atheroma. Leads to Obstruction or destruction of vessel Organ damage due to ischemia. Complications - Thrombosis, embolism, aneurism, dissection & rupture.
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Aorta, Carotid & Iliac. (large vessels) Major Vessels - Heart, Brain & Kidney. Coronary Renal Abdominal Limbs
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Fatty Dots Fatty Streaks Atheromatous – Soft Plaque Fibrofatty – Hard Plaque Complications
Ulceration, Rupture,Hemorrhage, Thrombosis Atheroemboli or cholesterol emboli.
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Stage VI III II •www.indiandentalacademy.com
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Heart attack – Myocardial infarction. Stroke – Cerebral infarction Gangrene – tissue infarction. Kidney failure – Kidney infarction. Aneurysms Rupture Thromboembolism.
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Haemorrhagic Necrosis
Hypercholesterolemia – Risk Hypertriglyceridemia - less significant LDL – Increased risk HDL – lowers the risk – Reverse transport
Mobilises the cholesterol from tissues to liver.
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Mono unsaturated fats Poly unsaturated fats Omega-3 fatty acids (Fish)
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• Good and Bad Fats? • Lower LDL, Increase HDL • Mono unsaturated fats • Poly unsaturated fats • Omega-3 fatty acids (Fish) • LDL indicate Positive lipid balance, HDL – negative. • No Cholesterol in any vegetable oil…? •www.indiandentalacademy.com
"Pleasure in the job puts perfection in the work." -- Aristotle
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Common Health problem. High Mortality & Morbidity. Etiology – common Atherosclerosis Two major types Angina & MI. Risk factors – Hypertension Hypercholesterolemia Diabetes Smoking, Life style, Diet, Genetic.
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Angina Pectoris:
Acute Myocardial Infarction:
Sudden cardiac death:
Obstruction to blood flow.
Atheroma, Thrombosis Embolism
Diminished coronary perfusion. Ischemia – Angina Infarction – Necrosis
Inflammation Granulation tissue Fibrous scarring.
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Myocardial Infarction-MI
“Death of heart tissue due to lack of blood supply” Atherosclerosis is the common cause. Coagulative necrosis – intact cell shape. Severe chest pain, breathlessness & sweating Complications –cardiogenic shock, Death or Cardiac failure.
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Myocardial Infarction-MI
1-18h – none 24h – Pale, edema 3-4D – Hemorrhage 1-3W – Thin, yellow 3-6W – Tough white
None Edema, inflammation Necrosis, granulation Granulation tissue Dense Fibrosis
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Cardiogenic shock, death
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Arrhythmias and conduction defects,
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Congestive heart failure (pul edema)
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Mural thrombosis, - embolization
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Myocardial wall rupture, tamponade
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Ventricular aneurysm
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LDH - 1-5 (1 - 2 flip) CK- Isoenzymes (Fractions)
MM - Muscles MB - Cardiac muscle. BB - Brain
Troponins
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 1. 2. 3.
Aimed to prevent complications. Rest & sedation* Supportive mesures Thrombolytic agents - Streptokinase
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www.indiandentalacademy.com • Leader in continuing dental education •
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