CARD 42- Pathology: Ischemic Heart Disease Flashcards
What are all ischemic heart diseases a product of?
What is the most common thing that IHD is secondary to?
How long does this take to develop before becoming symptomatic?
List and describe the 4 main cardiac symptoms of IHD
Epidemiology of IHD
- How common is IHD? How common is death from IHD?
- Why has IHD mortality decreased in the last 50 years?
Pathogenesis of IHD
- What is the most common cause of IHD?
- What are the other 2 “common” causes of IHD?
- What coronary arteries are most implicated in IHD?
Using vessel occlusion percentage and symptom manifestations, differentiate between asymptomatic IHD, stable angina, and unstable angina
What event is the common trigger of acute coronary syndromes (Unstable angina, MI, SCD)
Ischemic Heart Disease: Acute Plaque Change
- In patients who suffer MI, what phenomenon occurs that makes it impossible to predict the risk of plaque rupture?
Angina Perctorus
- Is Angina Pectoris caused by myocardial injury or death?
- What molecules cause the pain associated with it?
Stable (typical) angina
- What causes the pain to occur?
- Where does the pain start and radiate to?
- What can relieve the pain?
Prinzmetal (variant) angina
- What causes this? When does it occur?
- What vessels does this affect?
- What can relieve the pain associated with this?
Unstable angina (crescendo angina)
- When does this occur, and what is noted about the frequency of associated pain?
- When happens in the vessels that this is usually associated with?
- What major cardiac event is this associated with?
Myocardial Infarction
- What is the major underlying cause of MI?
- What causes an increased risk of MI?
- Name the series of events that occur during a typical MI?
MI: Epidemiology
- What group of people have increased risk for MI?
Pathogenesis of MI
- Full in the blacked out words
Pathogenesis of MI
- In an MI, what area of the heart is the first to have an irreversible injury due to ischemia?
- Why?
- How long does it take for the infarct achieve full extent?
What is a transmural infarct and why would an MI evolve into this?
What does the location, size, and morphologic features of an acute myocardial infarct depend on? (4)
Coronary Artery Occlusion and Affected Areas
- What areas does occlusion of the LAD artery effect?
Coronary Artery Occlusion and Affected Areas
- What areas does occlusion of the LCX artery effect?
Coronary Artery Occlusion and Affected Areas
- What areas does occlusion of the RCA effect?
Pathogenesis of MI
- When can an MI do the electrical condition of the heart? How?
- Sudden cardiac death is associated with myocardial ischemia. What type of dysrhythmia is most associated with this?
Morphology of MIs
- Gross and microscopic appearance depend on the age of injury ○ Areas of damage progress through a highly characteristic sequence of morphologic changes. List these changes, and their order (4)
Morphology of MIs
- What is notable about the gross appearance of MIs that are less than 12 hours old?
- If and an MI is older than 4 hours old, what can you do to visualize it using histological stains? (Remember the molecule name and the substrate for it)
Morphology of MIs
- What are the gross morphological features of the following timelines of MI?
- MI after 12 to 24 Hours
- MI after 24 hours
- MI after 10-14 days
- Weeks
Microscopic features of MI
- When do the typical features of coagulative necrosis become detectable?
- What else is notable about the histological morphology at this time? What does this histological feature represent?
Microscopic features of MI
- When does acute inflammation become noticeable?
- At 5-10 days after an MI, what are the noticeable features on a histological level?
- How long does it take for granulation tissue to form? Scar tissue?
Clinical Features of MI
- What type of pain is described in this? Where does it radiate to?
- How long does the pain last?
- What is notable about pain relief compared to angina pectoris?
Clinical Features of MI
- What kind of patients can present with atypical MI symptoms and signs?
- What is noticeable about the Pulse of MI patients?
- What kind of MI is associated with diaphoretic or nauseous patients?
- Why do patients get dyspnea, and what 2 conditions would dyspnea an indication of?
- What is the cardiac manifestation of MIs that affect over 40% of the left ventricle?
Clinical Features of MI
- How do Transmural MIs manifest on an ECG?
Dx of MI
- What are the 4 types of molecules that you can measure that leak out of injured myocardial cells during an MI?
- For the 2 types of molecules that are now used in diagnostic tests for MI
- Which is preferred?
- What are the timelines for both in terms of when you can detect them, when they peak, and when levels return to normal?
- For the 2 types of molecules that are now used in diagnostic tests for MI
How does a submitochondrial infraction manifest on an ECG?
ST depression
3/4 of pts experience one or more complications after an acute MI
- List all 8 of them?
- Memory Device?
Fury Paged CAPtain Mar Vell then Ruptured
Consequences and Complications of Myocardial Infarction
- Contractile dysfunction
- In general, MIs affect left ventricular pump function in proportion to the volume of damage. How does left ventricular failure manifest?
- Arrhythmias
- What are the common electrical disturbances associated with MIs?
Consequences and Complications of Myocardial Infarction
- Pericarditis
- How man days after an MI would Fibrinous or fibrino-hemorrhagic pericarditis?
- Why would it develop?
- How man days after an MI would Fibrinous or fibrino-hemorrhagic pericarditis?
- Myocardial Rupture
- What kind of rupture is most common?
- What kind of rupture would result in left to right shunting of blood?
- What kind of rupture would lead to mitral regurgitation?
- When is this most common and why?
Consequences and Complications of Myocardial Infarction
- Ventricular aneurysm
- What is the reason this would form?
- Do these rupture? What other conditions can this lead to?
- Mural thrombus
- What are the 3 main reasons that contribute to the formation of this?
- What does this eventually lead to?
Consequences and Complications of Myocardial Infarction
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Large transmural infarcts
- What are the 3 conditions that have a higher probability of occurring after this?
-
Anterior Transmural Infarct
- What 4 conditions do these kinds of infarcts increase the risk for?
-
Posterior Transmural Infarct
- What 2 conditions are likely to complicate this kind of infarct?
- Compare the prognosis of patients with anterior infarcts vs patients with posterior infarcts.
- Long term prognosis after MI depends on many factors. What are the 2 most important ones?
- What is the mortality rate after the first year post-MI?
