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Pathoma > Cardiac: Ischemic heart disease (IHD) > Flashcards

Cardiac: Ischemic heart disease (IHD) Flashcards

1
Q

what is the most common cause of ischemic heart disease

A

atherosclerosis of coronary arteries

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2
Q

what are risk factors for ischemic heart disease

A
  • similar to atherosclerosis

- incidence increases with age

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3
Q

Ischemic heart disease can lead to 1 of the 4 problems in a person

A
  1. angina
  2. myocardial infarction
  3. Sudden cardiac death
  4. chronic ischemic heart disease
  5. Coronary steal syndrome
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4
Q

when does stable angina occur

A

chest pain with exertion or emotional stress

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5
Q

what causes stable angina

A

atherosclerosis of coronary arteries with greater than 70% stenosis

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6
Q

what happens to the myocytes in stable angina

A

reversible injury

-no necrosis

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7
Q

what happens to a person during stable angina and how long does it last

A
  • pain radiates to left arm or jaw, diaphoresis and shortness of breath, chest pain
  • less than 20 minutes
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8
Q

what is the EKG reading for stable angina and why do we see that

A

ST-segment depression due to subendocardial ischemia

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9
Q

what relives stable angina

A

rest and nitroglycerin

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10
Q

what is unstable angina

A

chest pain occurring at rest

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11
Q

what usually causes unstable angina

A
  • rupture of an artherosclerotic plaque with thrombosis and INCOMPLETE occlusion of a coronary artery
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12
Q

what happens to the myocytes in unstable angina

A

reversible injury

- no necrosis

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13
Q

what does the EKG show for unstable angina and why

A

ST-segment depression due to subendocardial ischemia and/or T wave occlusion

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14
Q

what relieves unstable angina

A

nitroglycerin

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15
Q

when a patient has unstable angina, they are at a high risk for what

A

myocardial infraction

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16
Q

what is prinzmetal angina

A

episodic chest pain unrelated to exertion

- coronary artery vasospasm

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17
Q

what happens to the myocytes in prinzmetal angina

A
  • reversible injury

- no necrosis

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18
Q

what is the EKG reading for Prinzmetal angina and why

A

ST-segment elevation due to tranmural ischemia

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19
Q

what relieves prinzmetal angina

A

nitroglycerin

calcium channel blockers

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20
Q

what is myocardial infarction

A

necrosis of cardiac myocytes

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21
Q

what causes myocardial infarction

A
  • rupture of atherosclerotic plaque with thrombosis and COMPLETE occlusion of a coronary artery ( due to Prinzmetal angina or cocaine use)
  • coronary artery vasospasm
  • emboli
  • vasculitis (kawasaki disease)
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22
Q

what are clinical symptoms for myocardial infarction

A
  • severe, crushing chest pain
  • lasts greater than 20 minutes
  • radiates to left arm or jaw
  • diaphoresis
  • dyspnea
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23
Q

what relieves myocardial infarction

A

not nitroglycerin

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24
Q

myocardial infarction usually involves what part of the heart

A

left ventricle and right ventricle

- both atria generally spared

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25
Q

occlusion of the left descending artery (LAD) leads to infarction of the?

A
  • anterior wall of left ventricle
  • anterior interventricular septum
  • apex of heart
26
Q

occlusion of the right coronary artery (RCA) leads to infarction of ?

A
  • posterior wall
  • posterior septum
  • papillary muscles of the left ventricle
27
Q

Occlusion of the left circumflex artery leads to infarction of what?

A

lateral wall of left ventricle

28
Q

initial phase of infarction in MI leads to what? what will the EKG look like?

A

subendocardial necrosis involving less than 50% of myocardial thickness
-ST-segment depression

29
Q

continued or severe ischemia in MI leads to what? what will the EKG show?

A
  • transmural necrosis involving most of myocardial wall

- ST-segment elevation

30
Q

what are 2 cardiac enzymes that can be used to detect a MI

A

Troponin I

CK-MB

31
Q

what is the most sensitive and specific marker (gold standard) for MI

A

Troponin I

32
Q

describe troponin I levels after a MI

A

rise 2-4 hours after infaction

  • peak at 24 hours
  • return to normal 7-10 days
33
Q

What is CK-MB levels good at detecting

A

reinfarction that occurs days after an initial MI

34
Q

describe CK-MB levels after a MI

A
  • rise 4-6 hours after infarction
  • peak 24 hours
  • return to normal by 72 hours
35
Q

name 6 treatment options for MI and why they are given?

A
  1. aspirin/heparin - limits thrombosis
  2. Supply O2 - minimize ischemia
  3. nitrates - vasodialates veins and coronary artery
  4. Beta-blocker- slow heart rate, decrease O2 demand, decrease risk of arrhythmia
  5. ACE inhibitor - decrease LV dilation
  6. Fibrinolysis or angioplasty - opens blocked vessel
36
Q

Reperfusion of irreversibly-damaged cells results in what

A

calcium influx, leading to hyperconctraction of myofibrils

- contraction band necrosis

37
Q

when you return oxygen and inflammatory cells to MI cells results in what

A
  • free radical generation, further damaging myocytes
38
Q

MI: gross change 4-7days

A

yellow pallor

39
Q

MI: complications 4-24 hours

A

Arrhythmias

40
Q

MI: microscopic changes 1-3 days

A

neutrophils

41
Q

MI: gross changes less than 4 hours

A

none

42
Q

MI: complications 1-3 weeks

A

none

43
Q

MI: microscopic changes 4-7 days

A

macrophages

44
Q

MI: gross changes months

A

white scar

45
Q

MI: complications 4-7 days

A

rupture of ventricular free wall

  • interventriciular septum ( leads to shunt)
  • papillary muscle ( leads to mitral insufficiency)
46
Q

MI: microscopic changes less than 4-24 hours

A

coagulative necrosis

47
Q

MI: gross changes 1-3 weeks

A

Red border merges as granulation tissue enters from edge of infarct

48
Q

MI: complications months (3)

A
  • Aneurysm
  • mural thrombus
  • Dressler syndrome
49
Q

MI: microscopic less than 4 hours

A

none

50
Q

MI: gross changes 1-3 days

A

yellow pallor

51
Q

MI: complications 1-3 days

A 
Fibrinous pericarditis ( only in tranmural infarction)
-presents as chest pain with friction rub
52
Q

MI: microscopic 1- 3 weeks

A

Granulation tissue with plump fibroblasts, collagen, and blood vessels

53
Q

MI: complications less than 4 hours

A
  • cardiogenic shock ( massive infarction)
  • congestive heart failure
  • arrhythmia
54
Q

MI: microscopic months

A

Fibrosis

55
Q

MI: gross 4-24 hours

A

dark discoloration

56
Q

Coronary steal syndrome

A

alteration of circulation patterns lead to a reduction in the blood directed to the coronary circulation.

57
Q

What is sudden cardiac death

A
  • unexpected death due to cardiac disease

- without symptoms or less than 1 hour after symptoms arise

58
Q

what is the most common etiology of sudden cardiac death

A

acute ischemia –> ventricular arrhythmia

- in addition, 90% patients have severe atherosclerosis

59
Q

what are less common causes of sudden cardiac death

A
  • mitral valve prolapse
  • cardiomyopathy (dilated/hypertrophy)
  • cocaine abuse
  • hereditary ion channelopathies (long QT syndrome, Brugada syndrome)
60
Q

what is chronic ischemic heart disease

A

poor myocardial function due to chronic ischemic damage (with or without infarction)

61
Q

chronic ischemic heart disease can progress to what

A

congestive heart failure

Pathoma (38 decks)

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