10. Ischemia and HTN Flashcards
another name for ischemic heart disease?
most common cause?
CAD
atherosclerotic coronary artery obstruction
wt % of fixed lesion causes symptomatic ischemia during exercise?
rest?
> 75% - exercise
>90% - rest
cause of stable angina?
unstable/crescendo?
prinzmetal?
stable- fixed lesion
unstable- atherosclotic plaque w partial thrombus
prinzmetal - coronary artery spasm
4 clinical manifestations of ischemic heart disease?
angina
MI
chronic IHD w heart failure
sudden cardiac death
wt causes 90% of MI?
2 other causes?
Acute plaque disruption –> platelet adherence and activation –> vasospasm
vasospasm (w/o acute change) and emboli
wt occurs at the following times during myocardial eschemia:? first seconds - >2min - 20-40 min - >1 hr - 6 hours -
first seconds - stop glycolysis, dec ATP/CPK >2min - loss of contractility 20-40 min - irreversible injury >1 hr - microvascular injury 6 hours - necrosis complete
wt causes STEMI? non-STEMI?
Major physiologic cause of nonSTEMI?
STEMI = transmural infarct non-STEMI = subendocardial infarct (diffuse stenosing)
wt supplies blood to anterior 2/3 of ventricular septum?
wt supplies post. 1/3 in left dominant?
right dominant?
2/3 ant- Left Anterior Descending
left dominant 1/3 post. - Left Circumflex
right dominant - Right Coronary Artery
order or arteries causing MI?
LAD > RCA > Circumflex
2 microscopic events occurring 0-24 hrs into MI?
Coagulative necrosis
Wavy fibers
2 microscopic events occurring 1-3 days into MI? cells?
extensive coagulative necrosis acute inflammation (neutrophils) of surrounding tissue
microscopic event occurring 3-14 days into MI?
Macrophages come in
then granulation tissue
Cause of ST depression?
subendocardial MI
microscopic evidence of reperfusion secondary to MI?
gross evidence?
Contraction bands (eosinophilic transverse bands) Hemorrhage
4 symptoms of MI?
Dyspnea
Diaphoresis (sweating)
Chest pain
Nausea
gold standard for diagnosing MI?
2 biomarkers of MI?
wc is specific?
wc goes away faster?
ECG - gold standard
CK-MB
- normal in 48 hrs
troponin
- specific
- elevated for 7 days
wt complicaiton of MI causes hypotension and pulmonary vascular congestion?
Contractile dysfunction
3 ruptures that can occur post MI? possible complication of each?
papillary - mitral regurgitation
interventricular - L to R shunt
ventricular free wall - tamponade
2 complications of MI that occur weeks post MI?
Ventricular aneurysm
Dressler syndrome
pt presents 3 weeks post MI with persistent fever, chest pain and friction rub:
diagnosis?
cause?
Dressler syndrome
Autoimmune
2 complications of MI caused by large transmural infarcts?
cardiogenic shock
Arrhythmia
3 complications of MI caused by anterior transmural infarcts?
Aneurysm
Rupture
thrombi
complication of MI caused by inferior transmural infarcts?
Conduction block
define shock
inadequate perfusion to organs
Mech of sudden cardiac death?
arrhythmia
3 acute coronary symptoms?
common pathophysiologic basis of all?
Angina
Acute MI
Sudden cardiac death
atherosclerotic plaque disruption –> thrombus formation
type of hypertrophy seen in hypertension?
concentric
criteria for left-sided/systemic HTN disease?
LV hypertrophy w/o heart pathology
cause of cor pulmonale?
Pulmonary HTN
pt presents with severe chest pain during exercise,
diagnosis?
stable angina
wt part of the heart is almost always involved in tranmural infacts?
L ventricle
when does the heart appear yellow post MI?
10 days
