Ischemic heart disease Flashcards
Inability of the coronary arteries to deliver oxygen to myocardium
Ischemic heart disease
This is a risk/etiology for ischemic heart disease
Atherosclerosis
3 other causes of ischemic heart disease
Thromboemboli
Coronary artery vasospasm
Increased cardiac workload and oxygen demand
Number 1 cause of ischemic heart disease
Coronary artery disease
3 clinical manifestations of coronary artery disease / ischemic heart disease
Angina pectoris
chronic ischemic heart disease
Myocardial infarction
Most common clinical form of ischemic heart disease
Chronic ischemic heart disease
Chronic ischemic heart disease leads to
left sided congestive heart failure
(Increase risk of other 2 clinical manifestations)
Not constant = episode. Sudden onset from myocardial ischemia
Angina pectoris
3 forms of angina pectoris
Stable angina
Unstable angina
Varient Angina
Pain from exertion, predictable, relieved by rest or nitrates (nitroglyceran = vasodilation), 15-20 min duration
Stable angina (classic)
What is the #1 cause of stable/classic angina
coronary artery disease
More frequent and lasts longer, pain at rest or with minimal exertion
Unstable angina (pre-infarction)
What needs to be ruled out with unstable angina
Non ST segment MI (NSTEMI)
what 3 things define unstable angina
pain at rest for longer than 20min
Severe pain of NEW onset
crescendo pattern of pain
No underlying coronary artery disease, CA vasospasm, occurs in younger ages, pain at rest and in the morning, resolves spontaneously
Varient (vasoplastic) angina
What two things increase risk of varient angina
Heavy Cig smokers and cold weather
Chest pain with an ST segment elevation
Varient angina
What are more likely with varient angina
arrhythmias
Insufficient supply of oxygenated blood to an area of the heart
Myocardial infarction
Irreversible injury with prolonged ischemia causes an MI, what type of necrosis is present
coagulative
MI’s are most frequently involving the
Left ventricle
Leading cause of an MI
Coronary artery atherosclerosis
3 ways to classify an MI
Degree of ventricular wall involvement
location of the infarct
presence or absence of an ST segment elevation on ECG
Full thickness of ventricle
Transmural infarctions
Inner 1/3 of the myocardium
Subendocardial infarctions
Which type of infarction has an ST segment elevation
Transmural (subendocardial = no ST segment elevation, or pathologic Q waves)
T/F: It is more common not to have an ST segment elevation
False! More common to have an MI with an ST segment elevation, Non-ST segment elevation MI is when the blockage is incomplete
Similar to angina but more severe and prolonged, and unrelieved by nitroglycerin
Acute MI
Is there an ST segment elevation in an AMI
Yes
Most AMI’s occur at __
rest
30 minutes after occlusion of coronary artery, leads to scar formation
Myocardial necrosis
Can be painless, and have non-characteristic chest pain
Atypical symptoms of an AMI
What groups are more likely to have an atypical AMI
Elderly
Female
Diabetes
Histological changes with an MI:
1. Earliest change within the first day
2. 1-2 days old
3. 2-3 days old
4. 3-4 days old
5. 1-2 weeks in age
6. 2-3 weeks
7. 2 months old
- contraction band necrosis
- dark contraction bands, no nuclei, begin acute inflammation
- Neutrophils, coagulative necrosis, dissolution of nuclei. Extensive hemorrhage with fiber necrosis
- acute inflammatory cell infiltration, necrotic fibers
- macrophages
- granulation tissue
- collagenous scar
3 ways to diagnose an MI
Ischemic type chest discomfort
ECG abnormalities
Elevated serum cardiac markers
Number 1 way of diagnosing an MI
Elevated serum cardiac markers
2 main cardiac markers
Cardiac-specific troponins T and I (cTnT, cTnI)
Creatine kinase (ck) isoenzymes
Which cardiac markers is more often used to diagnose and MI
Cardiac specific troponins T and I
After how many hours to cardiac specific troponins T and I rise and then peak
4-6 hours = rised
peak at 24 hours
Creatine kinase isoenzymes (MB(ck2))
CK-MB occurs in __ and is an indicator for __
cardiac muscle
myocardial necrosis
After __ hours CK-MB levels are abnormal and peak at __ hours
6-12
18-24
This is also elevated after an MI but is of low diagnostic value because it accumulates after any muscle damage
Myoglobin
__ is much less specific for MI than cardiac specific troponins or even CK-MB and can be elevated due to other things
Lactic dehydrogenase (LD or LDH)
3 major complications of an MI
Arrhythmias
Progressive heart failure
Ventricular aneurysm
What arrhythmia is the most sudden cause of cardiac death in the 1st hour post MI
Ventricular fibrillation
Progressive heart failure is when it involves __ of the left ventricle
20-25%
Progressive heart failure results in congestive heart failure with __ of left ventricle is effected, and this is considered __
more than or equal to 40%
cardiogenic shock
(Most common IN HOSPITAL cause of death with AMI’s)
Late complication in 12-20% of MI patients
Ventricular aneurysm
A ventricular aneurysm can result in a __ in 50% of cases because the heart cannot contract
Mural thrombi
Most common 4-7 days post infarction, responsible for up to 20% of all fatal MI’s
rupture of the myocardium
Symptoms compatible with acute myocardial ischemia
- unstable angina pectoris
- non ST segment elevation myocardial infarction
- ST segment myocardial infarction
Acute coronary syndrome
Unexpected death due to cardiac causes
Sudden cardiac death
