IHD patho

Question 1

What’s IHD?

Answer 1

reduced blood supply into the
myocardium due to obstruction or stenosis

Question 2

Describe the mechanism in atherosclerosis?

Answer 2

Change in elastic&smooth lining to hard stiff swollen due to Ca and fat deposits with inflammatory cellular
Formation of plaque (Fat and fibrin) causing obstruction
Death of myocardial cell then fibroses

Question 3

What the mechanism of High-grade coronary arterial stenosis?

Answer 3

Transient ischemia>ventricular arrhythmias>including ventricular fibrillation (VF)> finally death

Question 4

What is the mechanism of cardiac syndrome? X?

Answer 4

Chest pain>without larger blockage> microvascular dysfunction> seen in angiogram

Question 5

What is the communist area liable to infection?

Answer 5

Lt ventricle

Question 6

Site of infarction according of what?

Answer 6

To the occluded coronary artery

Question 7

Posterior infarction affect which artery?

Answer 7

The occlusion of right coronary artery supplying
a posterior wall of left ventricle
b posterior part of inter ventricular septum

Question 8

Lateral infarction affect which artery?

Answer 8

Affected left circumflex artery supplying
A lateral wall of lt v
B adjacent part of lt v

Question 9

Anterior infarction affect which artery?

Answer 9

Occlusion of Lt anterior descending artery supplying
A ant. Wall of Lt v
B ant. Part of IVS
C apex of the heart

Question 10

What’s the trans mural MI?

Answer 10

Regional او من خلال طبقات القلب
1.Localized & sub classified into:
anterior, posterior, inferior, lateral or septal.
2.It involves full thickness of heart muscle.
3.If large, it involves endocardium & pericardium. 4.Due to complete major coronary occlusion. 5.Usually associated with atheroma & thrombosis. 6.In ECG, elevated ST & deep Q waves are seen.

Question 11

What’s the laminar MI?

Answer 11

(Circumferential)
1. It involves a small laminar area of LV subendocardial layer
(the earliest layer liable to ischemia), interventricular
septum, subepicardial or papillary muscles.
2. Associated with coronary narrowing.
3. Often without thrombosis.
4. In ECG, ST depression is seen.

Question 12

Clinical manifestations of IHD?

Answer 12

١ ما يشتكون منه لسنوات طويلة بعدين يظهر المرض
٢ ما يشتكي silent MIs أغمى عليه مرة وحده ☺️ discovered later with ECG أو بالتشريح
٣ angina pectoris
Retro sternal chest pain radiate to the left neck>left arm>left fingers
Start on physical exercise or with emotional stress and relieved by rest
٤ ACP>severe pain> unrelieved by rest> evidence AHD نعطيهم nitrate supplements عشان تسوي توسيع vasodilation
٥ heart failure, dyspnea orthopnoea cyanosis and lower limbs edema
٦ فقدان الوعي

Question 13

Describe the 1st day of insufficiency (0-12)?

Answer 13

Gross: congestion + flabbiness
No microscopic but there will be an enzymatic changes
High (CK-MB, SGOT, LDH, TROPONIN I + T)

Question 14

Describe the >12-24h of insufficiency?

Answer 14

Gross: I’ll defined + pallor + friable
Enzymatic changes there will be a decrease in all serums after 1st day except troponin

Question 15

Describe the 2-4 days of insufficiency?

Answer 15

Gross: pale yellow soft structure less with (irregular margin)

Question 16

Describe the >4-10 days of insufficiency?

Answer 16

Gross: yellow soft and the same with previous days except for that there will not be an irregular margin (regular margin)
Myomalacia cordis قال تهمه

Question 17

The microscopic features from day 2 till 10?

Answer 17

1 atrophy & necrosis تفقد الخطوط وتزيد eosinophil
Nuclear changes (pyknosis. Karyorrhexis. Karyolysis)
2 PNLs infeltration
3 congestion zone
4 granulation tissue تظهر باليوم الثالث وقال تهمه مره لأنها تسمح بالهيلنق
5 troponin still high

Question 18

Describe the >10 days 6 week up to years of insufficiency?

Answer 18

Gross: progressive fibrosis (greyish white area) بعد ست أسابيع كل التعبان راح يتحول إلى فايبرتك وتعطي thin walled هذا الشيء بيأثر على contractility + COP
microscopic:granulation tissue مليانة كابلريز و active fibroblast
Scar tissue formation كابلريز قليلة وفايبروبلاست مب اكتف

Question 19

Effect & complications of acute phase?

Answer 19

Rupture of the soft infarct (myomalacia cordis) or myocardial
aneurysm causing hemopericardium & cardiac tamponade
(cardiac compression).

Question 20

Chronic effect?

Answer 20

1. Thromboembolism: A) Pulmonary embolism originating from deep venous thrombosis (DVT)
   in Lower limbs after prolonged recumbence & venous stasis
   b) Systemic embolism originating from: AML أمل ☺️
   1) Atrial thrombus in atrial fibrillation (A.F.).
   2) Mural thrombus over a recent MI.
   3) Laminated thrombus over cardiac aneurysm arising in healed MI.