Atherosclerosis and ischemic heart disease

Question 1

What is coagulative necrosis?

Answer 1

Question 2

What is the pathogenesis of ischemic heart disease?

Answer 2

Question 3

Answer 3

Question 4

What is atherosclerosis?

What underlies it?

Which vessels are mostly affected?

Answer 4

Question 5

Go through the steps from healthy artery to atheroma formation?

Which layer is the atheroma formed?

Answer 5

Question 6

What are each of the arrows pointing to?

Answer 6

Question 7

What is the early stage of atherosclerosis formation?

Answer 7

Fatty streaks

Question 8

Explain what ‘hardening’ of arteries mean?

how does an aneurysm form?

Answer 8

Hardening of the arteries occurs because the tunica media can become ischemic because the diffusion of the blood cannot reach the muscle. It then becomes fibrous tissue instead. This can weaken the wall and a secular dilation of the wall can occur causing an aneurysm.

Question 9

The main complications of atherosclerosis?

Answer 9

• Acute plaque change also.

Question 10

What is this and why does it occur?

Answer 10

AAA: Abdominal aortic aneurysm

Right and left iliac artery bifurcation.

It often occurs here.

There is always a thrombus here because of the endothelial injury, stasis of the blood and hypercoagulability states (thrombogenic substances often).

A ruptured aneurysm often causes hypovolemic shock and death.

Question 11

What causes an acute plaque change?
What are the consequences?

Answer 11

Question 12

Stable vs vulnerable plaque

Answer 12

Question 13

What is this showing?

Answer 13

Question 14

What is this showing?

Answer 14

Question 15

What is considered to be a critical stenosis amount?

Answer 15

Chronic vascular occlusion of 70-75% of vessel (one or more of the LAD, RCA, LCX occluded).

Question 16

What are the 4 main presentations of IHD?

Answer 16

Question 17

Stable angina, vs unstable angina, vs prinzmetal angina?

Answer 17

Question 18

What occurs in an MI that doesnt occur in angina?

How does it present differently?

Answer 18

Question 19

What blood tests can you do for an MI?

Answer 19

Question 20

What is a STEMI?

Where does necrosis start first?
How can you avoid getting one?

Answer 20

Necrosis starts at the subendocardial area as it is furthest from the blood supply. More time it involved the whole wall of the left ventricle.

Mur means wall in french.

Relieving the obstruction as quickly as possible will save muscle.

STEMI (pronunced stemy): ST elevation of an MI. ST elevation are typical on the ecg of a transmural MI.

Question 21

Arteris involved and percentage of occurance?

Answer 21

Question 22

Answer 22

Question 23

How late is this infarct and how do you know?

Answer 23

Question 24

How old is this infarct and how do you know?

Answer 24

Hyperemic=large amounts of blood=granulation tissue.

Question 25

HOw old is this infarct? What is the problem with it?

Answer 25

Question 26

Answer 26

Eosinophilia=uptakes more of the eosin stain because of the loss of the rna (which takes up the haemolotoxin). Nucleas dissapears.

Question 28

How old is this infarct?

Answer 28

Myocytes are devoid of nuclei (cental nucleus normally). Lack striations. L.

Question 29

How old is this infarct?

Answer 29

Question 30

How old is this infarct?

Answer 30

Question 31

MI complications? Right side vs left side complications?

Answer 31

- Pericarditis: 1-2 days after transmural infarct. - Mural (wall) thrombus formation: due to stasis, endothelial damage. This may embolise (anticoagulants given). - Ventricular aneurysm formation: late scarring and bulging of ventricle wall, can lead to mural thrombus formation.

Question 32

What are each of these complications?

Answer 32

Question 33

What is cardiogenic shock? how does it relate to an MI?

Answer 33

Cardiogenic shock is when your heart cannot keep up with the demands of the body. Cardiogenic shock is responsible for 2/3 of deaths in acute MI.

Question 34

Answer 34

Question 35

Explain how IHD can lead to heart failure? Left sided vs right sided lead to what?

Answer 35

Question 36

What are these complications of? Explain each

Answer 36

- Congestion of the liver in certain areas which gives it a mottled appearance: call it nutmeg liver: cut a nutmeg in half. - Crepitations: listen to the lungs you can hear something like water bubbling. You are hearing air going inside the alveoli which have water in them.