1. Coronary Artery Disease 2
Pictorial Presentation
Mike Clark, M.D.

2. (a) The major coronary arteries
Aorta
Pulmonary
trunk
Superior
vena cava
Left atrium
Anastomosis
(junction of
vessels)
Left
coronary
artery
Right
atrium
Circumflex
artery
Right
coronary
artery
Left
ventricle
Right
ventricle
Anterior
interventricular
artery
Right
marginal
artery
Posterior
interventricular
artery
(a) The major coronary arteries
Figure 18.7a

3. Coronary Artery supply
Different areas of the heart are supplied by different coronary arteries.

4. Coronary Artery supply

5. An occlusion in this artery would give
ischemia to areas of the heart served
by this blood vessel.

6. Areas of the body where
Ischemic heart disease can
Be felt.

7. Standard EKG Waves & Segments

9. The EKG Looks at Heart Areas

11. The patient would have a normal S-T segment, but has he/she
Increases speed and grade on the treadmill the S-T segment begins to sag.

12. This is the cath lab where heart catherization occurs; the doctors are
performing coronary angiography.

13. During heart catherization to examine the coronary arteries, a catheter is generally
introduced in the thigh in the femoral artery and is threaded up the aorta until
its tip is placed in the opening of the coronary arteries.

14. Note the narrowing in
the coronary artery.
How much the artery is
closed is stated as a
percentage in terms of
occlusion. How much it
is open is stated in terms
of percent of patentcy.
For example, if an artery
is 45% occluded, then it
is 55% patent.

15. This is a stent placed in the wall of a coronary artery to open it up and attempt to
keep it open.

16. An atherectomy is a procedure to remove plaque.

19. The crushing chest pain (angina pectoris) of a heart attack (myocardial infarction).

20. Blood Clot in Coronary Artery

21. Infarction

23. The steeply elevated ST segments mean
the patient is currently suffering a
myocardial infarction (heart attack).

24. The EKG Looks at Heart Areas

25. Drawing blood in the emergency room to obtain blood to evaluate the
cardiac isoenzymes and troponin.

26. Cardiac markers are biomarkers measured to evaluate heart function
Cardiac markers are biomarkers measured to evaluate heart function. They are often discussed in the context of myocardial infarction, but other conditions can lead to an elevation in cardiac marker level.
Most of the early markers identified were enzymes, and as a result, the term "cardiac enzymes" is sometimes used. However, not all of the markers currently used are enzymes. For example, in formal usage, troponin would not be listed as a cardiac enzyme.[

27. Troponin
The most sensitive and specific test for myocardial damage. Because it has increased specificity compared with CK-MB, troponin is a superior marker for myocardial injury
Peaks in 12 hours
Troponin is released during MI from the cytosolic pool of the myocytes. Its subsequent release is prolonged with degradation of actin and myosin filaments. Differential diagnosis of troponin elevation includes acute infarction, severe pulmonary embolism causing acute right heart overload, heart failure, myocarditis. Troponins can also calculate infarct size but the peak must be measured in the 3rd day. released in 2–4 hours and persists for up to 7 days.

28. Q-wave of MI