ischemia and HTN

Question 1

What is atherosclerosis?

Answer 1

Deposition of cholesterol and lipid laden plaques in vessel walls

Question 2

What is acute coronary syndrome?

Answer 2

Condition brought on by sudden reduced flow to the heart

Question 3

What are examples of acute coronary syndrome?

Answer 3

Angina, MI (STEMI or NSTEMI), sudden death

Question 4

Describe the EKG changes and cardiac markers seen in unstable angina.

Answer 4

None!

Question 5

Describe EKG changes and cardiac markers seen in NSTEMI.

Answer 5

No changes but elevated markers

Question 6

Describe EKG changes and cardiac markers seen in STEMI.

Answer 6

Positive EKG changes as well as elevated cardiac markers

Question 7

What is angina pectoris? What are the subtypes?

Answer 7

Chest pain. Stable, unstable, or variant

Question 8

What groups may have abnormal presentation in terms of chest pain?

Answer 8

Women and diabetics

Question 9

MI is often due to what underlying pathology?

Answer 9

Atherosclerosis, specifically disruption of the plaque leading to thrombus formation

Question 10

What 3 factors cause death after MI within a few days?

Answer 10

Arrhythmia, pump failure/shock, rupture

Question 11

After infarct, irreversible damage occurs after ___ minutes.

Answer 11

20-40

Question 12

What area of the heart is most predisposed to damage?

Answer 12

Subendocardial as it is farthest from vessels and most prone to ischemia

Question 13

Transmural infarct involves ___% of wall thickness.

Answer 13

Greater than 50%

Question 14

Describe the heart 0-12 hours post MI.

Answer 14

Some dark mottling, coagulation necrosis, edema, hemorrhage

Question 15

Describe the heart 12-24 hours post MI.

Answer 15

Dark mottling, coagulation necrosis, pyknosis, contraction bands, neutrophilic infiltration

Question 16

Describe the heart 1-3 days post MI.

Answer 16

Yellow-tan mottling, coagulation necrosis with loss of nuclei and striations, neutrophils

Question 17

Describe the heart 3-7 days post MI.

Answer 17

Yellow-tan softening, disintegration of dead myofibers, dying neutrophils, phagocytosis of dead cells at infarct border

Question 18

describe the heart 10-14 days post MI

Answer 18

red-gray depressed infarct borders with well established granulation tissue, new vessels, and collagen

Question 19

describe the heart 2-8 weeks post MI

Answer 19

gray-white scar with increased collagen deposition and decreased cellularity

Question 20

at what point is scarring after an MI complete

Answer 20

2 months

Question 21

What are contraction bands?

Answer 21

Structures in heart muscle that can be seen as a result of infarct within 12 hours after the event; present before the cells start to die

Question 22

Yellowish discoloration in the heart muscle indicates ___, while gray discoloration indicates ___.

Answer 22

Necrosis vs granulation tissue

Question 23

When does granulation tissue begin forming after an MI?

Answer 23

1-2 weeks

Question 24

How long does it take to fully scar after an MI?

Answer 24

2 months; can’t tell the difference between an MI 2 months ago vs 20 years ago!

Question 25

What are some subacute/acute complications of MI?

Answer 25

Pericarditis, reinfarction, rupture

Question 26

What are some chronic complications of MI?

Answer 26

Aneurysm/thinning, mural thrombosis, HF, heart block

Question 27

What blood pressure is considered hypertensive?

Answer 27

130/80

Question 28

What does hypertension increase risk of?

Answer 28

Atherosclerosis, chronic kidney disease, stroke, dissection

Question 29

What is the most common surgically correctable cause of HTN?

Answer 29

Renal artery stenosis

Question 30

What factors cause cardiac hypertrophy?

Answer 30

Hypertension, valve disease, cardiomyopathies, obesity, stimulant use

Question 31

What is the normal weight of the heart?

Answer 31

350-400 g