Ischemic Heart Disease

Question 1

When does stable angina occur?

Answer 1

with exertion <20 min

Question 2

when does unstable angina occur?

Answer 2

at rest <20 min

Question 3

what is prinzmental angina ?

Answer 3

coronary spasm - leads to chest pain unrelated to exertion

Question 4

What does an EKG show for:

1. stable angina
2. unstable angina
3. prinzmental angina

Answer 4

1. stable angina - ST depression
2. unstable angina - ST depression
3. prinzmental angina - ST elevation

Question 5

What disease can cause an MI in children?

Answer 5

kawasaki vasculitis

Question 6

What parts of the heart are affected when each of the following are infarcted:

1. LAD
2. RCA
3. left circumflex

Answer 6

1. anterior wall of ventricle, anterior IV septum
2. posterior wall of LV, posterior IV septum
3. lateral wall of LV

Question 7

Troponin:
when does it rise?
when does it peak?
when does it return to normal?

Answer 7

• 2-4 hours
• 24 hours
• 7- 10 days

Question 8

CKMB
when does it rise?
when does it peak?
when does it return to normal?

what is it useful for?

Answer 8

4-6 hours
peaks at 24 hours
normal at 72 hours

diagnosing reinfarction

Question 9

In an infarction, what part of the heart is affected first?

Answer 9

endocardium (inside to out)

Question 10

what is a significant finding on pathology after giving someone fibrinolysis or angioplasty for their MI?

Answer 10

contraction band necrosis
-rush of Ca2+ causes contraction
dense perpendicular pink fibers

Question 11

Describe the appearance of the heart at 4-24 hours after an MI?

Answer 11

coagulative necrosis - dark
pyknosis, karorexis, karyolysis
wavy fibers - noncontractile ischemic myocytes are stretched

Question 12

What is a major complication after an MI in the first 4-24 hours?

Answer 12

arrythmia

Question 13

How does the heart appear 1-3 days after an MI?

Answer 13

yellow - neutrophils arrive

Question 14

What is a complication 1-3 days after an MI?

Answer 14

fibrinous pericarditis

Question 15

What cells are predominantly present 4-7 days after an MI?

Answer 15

macrophages

Question 16

What are some complications that occur 4-7 days after an MI?

Answer 16

rupture of:
ventircular free wall - tamponade
IV septum - L–>R shunt
papillary muscle

Question 17

How does the heart appear 1-3 weeks after an MI?

Answer 17

red border emerges

Question 18

What is a complication 1-3 weeks after an MI?

Answer 18

extension of the infarct

Question 19

Months after an MI, what is the appearance, and what complication can occur?

Answer 19

fibrous white scar

• aneurysm
• mural thrombus
• autoimmune pericarditis - dressler syndrome

Question 20

What types of patients are notorious for dying from silent MIs?

Answer 20

diabetics with autonomic dysfunction

cardiac transplant patients - heart is denervated

Question 21

What is the definition of congestive heart failure?

Answer 21

high atrial filling P relative to stroke volume

Question 22

What are some symptoms of Left CHF?

Answer 22

pulmonary edema and crackles
paraoxysmal nocturnal dyspnea and orthopnea
confusion and disorientation
fatigue and weakness

Question 23

What are heart failure cells, when are they seen?

Answer 23

left CHF - capillaries in the lungs rupture, macros consume blood - hemosiderin laden macros

Question 24

What is the most common cause of right CHF?

Answer 24

left CHF!!!

Question 25

What are some symptoms of right CHF?

Answer 25

• JVD
• HSM
• pitting edema

Question 26

What is the specific pathological appearance of the liver in right CHF?

Answer 26

nutmeg liver

Question 27

What kind of heart failure do most elderly patients suffer from?

Answer 27

diastolic heart failure - ventricles are stiff