Cardiac Path Part 1 Flashcards
What is the most common heart disease and the leading cause of death in heart diseases?
Coronary Artery Disease
What are the 2 common types of Ischemic Heart Disease (CAD)?
Myocardial Infarction
Angina
What are the risk factors for Ischemic Heart Disease (CAD)?
Increasing age - Males
Hypertension and Hyperlipidemia (LDL)
Smoking and Diabetes
What usually causes Ischemic Heart Disease?
Atherosclerosis
Coronary A. Emboli
What is the most common site of Coronary Artery Disease?
LAD
What determines dominance in the heart?
Supply of lower posterior heart through the Posterior Descending Artery
The Posterior Descending Artery supplies the ___ node
AV node
The posterior descending artery determines?
Dominance
Right Dominant Heart
The right coronary provides the Posterior Descending Artery and supplies the lower posterior heart
Left Dominant Heart
– less common
The left coronary provides the Posterior Descending Artery and supplies the lower posterior heart
Symptoms of Myocardial Infarction?
- Crushing/stabbing/squeezing substernal chest pain
- Radiates to shoulder, neck, jaw
- Rapid, weak pulses and profuse sweating
Symptoms of Myocardial Infarction?
- Crushing/stabbing/squeezing substernal chest pain
- Radiates to shoulder, neck, jaw
- Rapid, weak pulses and profuse sweating
What are the most sensitive and specific biomarkers of myocardial damage?
Troponin T and i
cTnT and cTnI
What are the most sensitive and specific biomarkers of myocardial damage?
Troponin T and i
cTnT and cTnI
What is a sensitive but NOT specific marker of cardiac injury?
Creatine Kinase
- MB Heterdimer (CKMB)
What is a sensitive but NOT specific marker for cardiac injury?
Creatine Kinase
- MB Heterodimers (CKMB)
What is the time to ELEVATION of CKMB, cTnT, cTnI with a MI?
3-12 hours with peak at 24 hours
Can a person be experiencing a MI without Troponin elevation?
YES – takes 3 hours for the troponins to elevate and MI symptoms can occur within 30 minutes
What is the time to NORMALIZATION for CKMB?
48-72 hours
What is the time to NORMALIZATION for cTnT and cTnI?
Longer than 5 days
What should you measure if you believe a person is having a MI but their troponins are not elevated?
Serial Troponins
LAD transmural infarct zone?
Apex and Anterior
Left Circumflex transmural infarct zone?
Left ventricle lateral wall
Right coronary transmural infarct zone?
Right and Posterior
With a MI, transmural infarcts are common. What is another pattern of injury and when does it occur?
= Subendocardial infarct
Occurs after:
1. Reperfusion of transmural infarct
2. Global hypotension
Reperfusion of transmural infarct that causes a subendocardial infarct is a ____ infarct
Regional
Global hypotension that occurs after a subendocardial infarct is a _____ infarct
Circumferential
Morphologic changes with an Irreversible injury of the heart
- less than 4 hours?
Waviness of fibers
Morphologic changes with an Irreversible injury of the heart
- 4-12 hours?
Edema and Coagulation necrosis
Morphologic changes with an Irreversible Injury of the heart
- 12-24 hours?
Coagulation necrosis continues, Contraction band and increased eosinophils
Morphologic changes with an Irreversible Injury of the heart
- 1-3 days?
Increased neutrophils and loss of nuclei
What does the gross infarct look like on the heart after 1-3 days?
Yellow-tan infarct center
Morphologic changes with an Irreversible Injury of the heart
- 3-7 days?
Disintegration of dead fibers by Macrophages
Morphologic changes with an Irreversible Injury of the heart
- 7-10 days?
Granulation tissue at margins
Morphologic changes with an Irreversible Injury of the heart
- 2 weeks and beyond?
Granulation tissue and Collagen Deposition
At 2-8 weeks post irreversible injury of the heart, how will the infarct area look?
Gray-white scar
Early complications of MI?
- Life threatening Arrhythmias
2. Contractile dysfunction
An early complication of a MI is life threatening arrhythmias. When do they occur and what are they the #1 cause of?
Occur within 1 hour of the onset
- #1 cause of death
An early complication of a MI is contractile dysfunction. What does that depend on and what does it lead to?
Depends on the size of the infarct
- Leads to cardiogenic shock within 24 hours of onset
Intermediate complications of a MI?
Myocardial rupture
When does a myocardial rupture occur and what are parts can rupture?
Occurs 2-4 days after a MI
- septal, papillary or free wall rupture
What can a Myocardial rupture lead to?
Acute Pericarditis
fibrinous, serofibrinous
Late complications of a MI?
- Dressler Syndrome
- Ventricular aneursym with life threatening arrhythmias
- Congestive Heart Failure
Dressler Syndrome
Immune reaction to myocardial proteins in the blood
= Fever, pleuritic pain and pericardial effusion
– Late complication of MI
Dressler Syndrome
Immune reaction to myocardial proteins in the blood
= fever, pleuritic pain and pericardial effusion
– late complication of MI
How does a Ventricular Aneurysm arise?
MI -> Transmural infarct -> thin-walled scar -> aneurysm
Angina Pectoris
Recurrent chest pain induced by myocardial ischemia that is insufficient to induce myocardial infarction
Recurrent chest pain induced by myocardial ischemia that is insufficient to induce myocardial infarction
Angina pectoris
3 types of Angina?
Stable Angina
Prinzmetal Variant Angina
Unstable Angina
Stable Angina is caused by?
Stenotic occlusion of Coronary A.
** (+) by physical activity!
What will trigger Stable Angina?
Physical activity or stress
What will relieve the pressure/squeezing pain of Stable Angina and Prinzmetal Variant Angina?
Rest or vasodilators
Prinzmetal Variant Angina is caused by?
Episodic Coronary A. spasm
Is Prinzmetal Variant Angina triggered by physical activity?
NO - unrelated to activity, BP or HR
Unstable Angina is caused by?
Rupture plaque with partial thrombus/occlusion
When will Unstable Angina present?
AT REST
What pattern of pain will be experienced with Unstable Angina?
Crescendo pattern
= Increasing severity or duration
Unstable Angina and NSTEMI present due to partial occlusions. What will be present with a NSTEMI but not unstable angina?
Elevated troponins
STEMI’s are ____ occlusions
Complete
If a patient presents with stereotypical signs of a MI, what kind should be suspected?
STEMI
If a MVC causes trauma to the heart, what will likely occur?
Cardiac contusion
If a cardiac contusion is full thickness, what can occur?
Contusion rupture and blood goes into the pericardial space = cardiac tamponade
If a cardiac contusion is full thickness, what can occur?
Contusion rupture and blood goes into pericardial space = cardiac tamponade
Results of cardiac tamponade?
HYPOtension and possibly death because the heart cannot pump well
Results of Cardiac Tamponade?
HYPOtension and possible death because the heart cannot pump well
