Cardiac Path 4 (CAD/MIs)

Question 1

What disease is the following in reference to?

• Atherosclerosis of the coronaries which presents as myocardial ischemia owing to a slowly progressive narrowing by atherosclerosis or a sudden occlusion due to a thrombus.
• Chronic ischemia leads to CHF

Answer 1

Coronary Artery Disease

Question 2

What disease is the following in reference to?

-Chronic progressive ischemia results in hypoperfusion of the myocardium and slowly evolving CHF

Answer 2

CAD

Question 3

• Acute coronary thrombosis is more common in arteries already narrowed by __________

Answer 3

Atherosclerosis

Question 4

What does sudden occlusion of a major coronary artery cause and does the location of the arterial occlusion differ?

Answer 4

Results in an Myocardial Infarct in an anatomically defined area

Question 5

An anterior wall infarct is typically caused by occlusion of the ____________ coronary artery

Answer 5

Left anterior descending

Question 6

An infarct of the lateral wall of the left ventricle is usually caused by occlusion of the ________ coronary artery.

Answer 6

left circumflex

Question 7

An infarct of the right ventricle and posterior wall of the left ventricle is usually caused by occlusion of the ________ coronary artery.

Answer 7

Right Coronary Artery

Question 8

Occlusion of the _______ accounts for over 50%

Answer 8

LAD

Question 9

Occlusion of the _______ accounts for 30-40%

Answer 9

RCA

Question 10

Occlusion of the ____________ accounts for the remaining 10-20% of all cases.

Answer 10

Left Circumflex Artery

Question 11

Distribution of Myocardial Infarcts (picture)

Answer 11

Question 12

Occlusion of _______coronary artery is most common

Answer 12

LAD (over 50%)

Question 13

Pathology of which disease?

• The coronaries involved by atherosclerosis are transformed into rigid, heavily calcified cylinders
• On cross-section- lumina are narrowed from the prominent fibrotic plaques and atheromas. The wall contains deposits of calcium salts and cholesterol clefts.

Answer 13

Coronary Artery Disease

Question 14

What is an acute Myocardial infarction?

Answer 14

Rapid, sudden occlusion of a coronary artery

Question 15

80-90% of transmural myocardial infarcts are caused by ____________.

Answer 15

thrombosis of a coronary artery

Question 16

Other causes of ________=

ulceration of an embolized atherosclerotic plaque or prolonged vasospasm.

Answer 16

Causes of Acute MI

Question 17

Myocardial infarction:

What is the cause of Sudden Cardiac Death?

Answer 17

Most cases is from a major cardiac arrhythmia (i.e. V-fib) or later complete heart block and pump failure

Question 18

Myocardial infarction:

Sudden cardiac death occurs in approx. ___% of cases,

Answer 18

25%

–> the other 75% survivie

Question 19

What is this picture showing?

Answer 19

Opened LAD with Thrombosis and Acute Myocardial Infarct

Question 20

The following happens to who?

• most develop signs of heart failure and cardiogenic shock.
• multisystemic major organ failure develops (from lack of perfusion)
• Cerebral ischemia (most dangerous)–> can lead to permanent mental injury/ loss of CNS function

Answer 20

What happens to the 75% of people who survive the onset of an MI

Question 21

Grossly, what are the 2 types of MI’s?

Answer 21

Morphologically, there are 2 types:

1. Transmural

2. Subendocardial or intramural

Question 22

Which type of myocardial infarction involves all three layers of the heart, and usually involves the free wall of the left ventricle and/or the interventricular septum.

***This is more dangerous and can result in LV rupture

Answer 22

Transmural myocardial infarction

Question 23

Which type of myocardial infarction is usually concentric around the subendocardial layer of the left ventricle.

Answer 23

Subendocardial or Intramural Myocardial infarct