9&10- Cardiac Pathology I Flashcards
leading discharge diagnosis in patients over 65 in US
CHF
variable degrees of decreased CO and tissue perfusion as well as pooling of blood in the venous system which may cause pulmonary edema, peripheral edema or both
CHF defined
two most common causes of HF
- coronary a disease
- high blood pressure
ejection fraction of heart failure
below 45%
normal should be 50-70%
how is systolic dysfunction different than diastolic dysfunction
- systolic dysfunction has a low EF
- diastolic dysfunction has a normal EF, but the total volume of blood being ejected is lower
previous or current symptoms of heart failure in the context of n underlying structural heart problem, but managed with medical treatment: what stage CHF?
stage C
A- high risk
B- no symptoms
D- advanced need hospital
what does b-type natriuretic peptide idnicate?
CHF
BNP > 100 pg/mL
how does the kidney sense CHF?
activates RAAS because it senses it as a low volume state (give diuretics to treat)
trouble breathing, lungs fill with fluid
left sided CHF
VJD, splenohepatomegaly
right sided CHF
what is biventricular CHF
left heart failure causes right sided failure
heart failure cells
left sided CHF
paroxysmal nocturnal dyspnea
left sided CHF
what is the major cause of ischemic heart disease?
chronic atherosclerosis
leading cause of death worldwide for men and women
ischemic heart disease
due to an imbalance between the supply and demand of the heart for oxygenated blood
ischemix heart disease
what is coronary artery disease?
reduced blood flow due to obstructive atherosclerotic lesions in the coronary arteries CAD
major risk factor for atherosclerosis
cigarette smoking
what level of obstruction is required for ischemia?
75% or greater for symptomatic ischemia
90% of the lumen can lead to inadequate coronary blood flow even at rest
components of coronary plaque
necrotic grumous core
cholesterol clefts
foam cells
smooth muscle cells
describe a vulnerable plaque
- soft w/ lipid filled core
- eccentric
- only 40-60% stenotic
vulnerable –> rupture –>
thrombus –> MI
bleeding into plaque can accompany rupture
ischemia v. infarction
ischemia is reversible and infarction is irreversible
physical activity, emotional excitement, or any other increased cardiac worload results in an imbalance in coronary perfusion relative to demand. Relieved by rest or nitro
stable angina
most common form
pattern of increasingly frequent pain precipitated by progressively lower levels of physical activity or at rest. Caused by disruption of a plque with partial thrombosis or embolization or vasospasm
unstable or crescendo angina
warning that an acute MI may be imminent
episodic myocardial ischemia caused by coronary artery spasm. Not retaled to activity, HR or BP. Responds promptly to vasodilators.
prinzmetal variant angina
uncommon
what is the ankle brachial pressure index?
value of greater than 1.3 is considered abnormal and suggeste calcification
under 0.5 is sever arterial disease
ST segment depression
ischemia
ST segment elevation
MI
if you do an angiogram 14 hrs after MI will you see stenosis
only 60% of time
some occlusion resolve
most common site for MI
LAD
anterior wall of left ventricle near apex, anterior portion of ventricular septum and apex circumferentially
when would you see a wavy fiber histo?
half hour to 4 hr post MI
dark mottling is indicative of..
early coagulation necrosis, 12-24 hrs post MI
yellow-tan infarct indicates …
1-3 days post MI
peak neutrophils
when is risk of myocardial rupture greatest?
post MI 3-7 days
overly ischemic tissue loses its ability to contract =
contractile dysfunction
rupture of free wall of LV –>
cardiac tamponade
rupture of papillary muscle –>
acute mitral valve incompetence
rupture of ventricular septum –>
acutely acquired VSD
what is dressler’s syndrome?
autoimmune inflammatory rxn to myocardial neo-antigens formed as a result of the MI
acute MI mortality for 30 days after discharge
16%
5% for every year after
which graft is better for CABAG?
internal mammary a. because 90% are patent at 10 yr compared to saphenous (50%)
