10. Ischemia and HTN

Question 1

another name for ischemic heart disease?

most common cause?

Answer 1

CAD

atherosclerotic coronary artery obstruction

Question 2

wt % of fixed lesion causes symptomatic ischemia during exercise?
rest?

Answer 2

> 75% - exercise

>90% - rest

Question 3

cause of stable angina?
unstable/crescendo?
prinzmetal?

Answer 3

stable- fixed lesion
unstable- atherosclotic plaque w partial thrombus
prinzmetal - coronary artery spasm

Question 4

4 clinical manifestations of ischemic heart disease?

Answer 4

angina
MI
chronic IHD w heart failure
sudden cardiac death

Question 5

wt causes 90% of MI?

2 other causes?

Answer 5

Acute plaque disruption –> platelet adherence and activation –> vasospasm

vasospasm (w/o acute change) and emboli

Question 6

wt occurs at the following times during myocardial eschemia:?
first seconds -
>2min -
20-40 min -
>1 hr -
6 hours -

Answer 6

first seconds - stop glycolysis, dec ATP/CPK
>2min - loss of contractility
20-40 min - irreversible injury
>1 hr - microvascular injury
6 hours - necrosis complete

Question 7

wt causes STEMI? non-STEMI?

Major physiologic cause of nonSTEMI?

Answer 7

STEMI = transmural infarct 
non-STEMI = subendocardial infarct (diffuse stenosing)

Question 8

wt supplies blood to anterior 2/3 of ventricular septum?
wt supplies post. 1/3 in left dominant?
right dominant?

Answer 8

2/3 ant- Left Anterior Descending
left dominant 1/3 post. - Left Circumflex
right dominant - Right Coronary Artery

Question 9

order or arteries causing MI?

Answer 9

LAD > RCA > Circumflex

Question 10

2 microscopic events occurring 0-24 hrs into MI?

Answer 10

Coagulative necrosis

Wavy fibers

Question 11

2 microscopic events occurring 1-3 days into MI? cells?

Answer 11

extensive coagulative necrosis
acute inflammation (neutrophils) of surrounding tissue

Question 12

microscopic event occurring 3-14 days into MI?

Answer 12

Macrophages come in

then granulation tissue

Question 13

Cause of ST depression?

Answer 13

subendocardial MI

Question 14

microscopic evidence of reperfusion secondary to MI?

gross evidence?

Answer 14

Contraction bands (eosinophilic transverse bands)
Hemorrhage

Question 15

4 symptoms of MI?

Answer 15

Dyspnea
Diaphoresis (sweating)
Chest pain
Nausea

Question 16

gold standard for diagnosing MI?

2 biomarkers of MI?
wc is specific?
wc goes away faster?

Answer 16

ECG - gold standard

CK-MB
- normal in 48 hrs

troponin

• specific
• elevated for 7 days

Question 17

wt complicaiton of MI causes hypotension and pulmonary vascular congestion?

Answer 17

Contractile dysfunction

Question 18

3 ruptures that can occur post MI? possible complication of each?

Answer 18

papillary - mitral regurgitation
interventricular - L to R shunt
ventricular free wall - tamponade

Question 19

2 complications of MI that occur weeks post MI?

Answer 19

Ventricular aneurysm

Dressler syndrome

Question 20

pt presents 3 weeks post MI with persistent fever, chest pain and friction rub:
diagnosis?
cause?

Answer 20

Dressler syndrome

Autoimmune

Question 21

2 complications of MI caused by large transmural infarcts?

Answer 21

cardiogenic shock

Arrhythmia

Question 22

3 complications of MI caused by anterior transmural infarcts?

Answer 22

Aneurysm
Rupture
thrombi

Question 23

complication of MI caused by inferior transmural infarcts?

Answer 23

Conduction block

Question 24

define shock

Answer 24

inadequate perfusion to organs

Question 25

Mech of sudden cardiac death?

Answer 25

arrhythmia

Question 26

3 acute coronary symptoms?

common pathophysiologic basis of all?

Answer 26

Angina
Acute MI
Sudden cardiac death

atherosclerotic plaque disruption –> thrombus formation

Question 27

type of hypertrophy seen in hypertension?

Answer 27

concentric

Question 28

criteria for left-sided/systemic HTN disease?

Answer 28

LV hypertrophy w/o heart pathology

Question 29

cause of cor pulmonale?

Answer 29

Pulmonary HTN

Question 30

pt presents with severe chest pain during exercise,

diagnosis?

Answer 30

stable angina

Question 31

wt part of the heart is almost always involved in tranmural infacts?

Answer 31

L ventricle

Question 32

when does the heart appear yellow post MI?

Answer 32

10 days