Ischemic Heart Disease

Question 1

Time Before Necrosis

Answer 1

20 minutes

Question 2

ST Segment Depression

Answer 2

Whenever you have just subendocardial ischemia

Question 3

Stable Angina

Answer 3

Chest pain with exertion/emotional stress due to incomplete blood flow not meeting demands of heart. Everything reversible and subendocardial and shit

Question 4

Unstable Angina

Answer 4

Chest pain at rest from rupture of atherosclerotic plaque that incompletely occludes the artery. Also reversible and shit but can progress to MI

Question 5

Myocardial Infarction

Answer 5

Death of myocytes usually due to complete occlusion artery, usually involving ventricles but sparing atria

Question 6

Printzmetal Angina EKG

Answer 6

ST elevation because transmural ischemia

Question 7

Artery Infarction Patterns

Answer 7

LAD - most common, anterior wall and anterior septum of LV
RCA - Posterior wall, posterior septum and papillary muscles
Left Circumflex - Lateral wall of LV

Question 8

MI EKG Pattern

Answer 8

Initially subendocardial necrosis so ST depression, but if continued or severe then get transmural so ST elevation

Question 9

2 Cardiac Enzyme Markers

Answer 9

Troponin I is most sensitive and specific, withing 2-4 hours and peak at 24 then resolve within 7 days
CK-MB is good for detecting reinfarction because subsides within 3 days

Question 10

3 Phases of MI (& timeframe)

Answer 10

Coagulative necrosis 4-24 hours
Inflammation first week
Healing first month

Question 11

Coagulative Necrosis Gross Changes and Complication

Answer 11

Dark discoloration

Arrhythmia because conduction system is either fucked up fairly early or fine

Question 12

Inflammation Gross Changes and 1 Nphilic Complication (days 1-3) and 3 Macrophage Complication (4-7)

Answer 12

Yellow pallor
Fibrinous pericarditis if transmural infarct, causing friction rub
Rupture of ventricular free wall -> cardiac tamponade
Rupture of interventricular septum causing shunt
Rupture of papillary muscle leading to mitral insufficiency

Question 13

Healing Gross Changes and 2/3 Complications

Answer 13

Red border entering as granulation tissue from edge of infarct, eventually forming white scar
Aneurysm and mural thrombus
Dressler syndrome - Autoimmune attack on cardiac tissue bc it has been exposed to cardiac antigens now

Question 14

Sudden Cardiac Death (most common cause and etiology)

Answer 14

Usually from arrhythmia, and from severe ischemia due to severe atherosclerosis