Ischemic and Hypertensive Heart Disease

Question 1

Types of acute plaque change (3):

Answer 1

• Rupture or fissuring
• Erosion or ulceration
• Hemorrhage into the atheroma

Question 2

Unstable angina is due to:

Answer 2

Disruption of atherosclerotic plaque with superimposed partially occluding thrombus

Question 3

Prinzmetal angina is due to:

Answer 3

Coronary artery spasm

Question 4

Majority of subendocardial infarcts are due to:

Answer 4

Diffuse stenosing coronary atherosclerosis with reduction of blood flow, NO plaque disruption and NO superimposed thrombus

Question 5

Left anterior descending artery supplies (3):

Answer 5

• Most of apex
• Anterior wall of left ventricle
• Anterior 2/3 of ventricular septum

Question 6

Left circumflex artery supplies:

Answer 6

Lateral wall of left ventricle

Question 7

Right coronary artery supplies:

Answer 7

Entire right ventricular wall
If right dominant:
- Posterior 1/3 of ventricular septum
- Posterobasal wall of left ventricle

Question 8

Gross morphology of MI up to 10 days:

Answer 8

Becomes more sharply defined, soft, yellow-tan

Question 9

Gross morphology of MI 10 days to 2 weeks:

Answer 9

Yellow-tan zone surrounded by hyperemic zone (red) of granulation tissue

Question 10

Gross morphology of MI 2 to 8 weeks:

Answer 10

Scar tissue

Question 11

Microscopic morphology of MI 4 - 12 hours (3):

Answer 11

• Wavy fibers may be evident
• Beginning of coagulative necrosis
• Hemorrhage and edema

Question 12

Microscopic morphology of MI 12 - 24 hours (2):

Answer 12

• Ongoing coagulative necrosis

- Begin neutrophil infiltrate

Question 13

Microscopic morphology of MI 1 - 3 days (2):

Answer 13

• Coagulation necrosis with loss of nuclei and striations

- Acute inflammation (neutrophils)

Question 14

Microscopic morphology of MI 3 - 7 days (3):

Answer 14

• Beginning disintegration of dead myofibers
• Dying neutrophils
• Macrophages with ongoing phagocytosis of necrotic cells

Question 15

Microscopic morphology of MI 7 - 10 days (2):

Answer 15

• Nearly complete removal of necrotic myocytes by phagocytosis
• Early formation of fibrovascular granulation tissue

Question 16

Microscopic morphology of MI 2 - 4 weeks (2):

Answer 16

• Granulation tissue is more prominent

- Becomes less vascularized and more fibrous

Question 17

Microscopic morphology of MI > 6 weeks (2):

Answer 17

• Necrotic myocardium has been replaced by fibrosis (scar)

- Residual myocytes have hypertrophied

Question 18

Microscopic morphology of reperfused myocardium:

Answer 18

Contraction bands
- Intensely eosinophilic transverse bands of closely packed sarcomeres which contract when exposed to fresh Ca2+ in plasma

Question 19

CK-MB timeline (3):

Answer 19

• Rises in first 2-4 hours
• Peaks at 24 hours
• Returns to normal in 72 hours

Question 20

Troponins remain elevated for:

Answer 20

7 - 10 days

Question 21

MI complication - myocardial rupture happens in:

Answer 21

3 - 7 days

Question 22

MI complication - pericarditis happens in:

Answer 22

2 - 3 days

Question 23

Morphology of chronic ischemic heart disease:

Answer 23

Heart is enlarged and heavy due to hypertrophy and dilation

Question 24

Minimal criteria for systemic (left-sided) hypertensive heart disease (2):

Answer 24

• LV hypertrophy (usually concentric) with NO heart pathology that explains it
• History or pathologic evidence of HTN