Ischemic Heart Disease Flashcards
Stable angina definition and EKG findings
pain only when active
ST-segment depression due to subendocardial ischemia
Angina is allowed to last this long before it becomes an infarction
up to 20 min
Unstable angina
definition and EKG findings
usually also at rest
due to rupture of atherosclerotic plaque
often progresses to MI in coming days
ST-depression due to subendocardial ischemia
Prinzmetal/Variant Angina
pathology
EKG findings
coronary vasopasm (Raynaud’s association)
ST-elevation due to transmural ischemia
relieved by NO or Ca2+ channel blockers
Most commonly occluded artery in MI
LAD
(left anterior descending–anterior interventricular)
Occlusion of the right coronary artery leads to what important pathology?
ischemia of posterior interventricular septum
and
papillary muscles
(may cause mitral insufficiency)
Progression of EKG findings in acute MI
initially ST-segment depression
(due to subendocardial ischemia)
then ST-segment elevation
(due to transmural ischemia)
Troponin as MI marker
most sensitive and specific marker
rise 2-4 hours after infarction
return to normal after 7-10 days
What marker do you use to test for re-infarction if within 7-10 day period when troponin remains elevated from a primary infarction?
CK-MB
CK-MB as marker for MI
levels rise 4-6 hours after infarction
peak at 24 hours
normal at 72 hours
Morphological Changes After Infarction
< 4 hr
Gross Changes
Microscopic Changes
Complications
no gross changes
no microscopic changes
cardiogenic shock (massive infarction), CHF, arrhythmia
Morphological Changes After Infarction
4-24 hr
Gross Changes
Microscopic Changes
Complications
dark discoloration
coagulative necrosis (removal of nucleus)
arrhythmia
Morphological Changes After Infarction
1-3 days
Gross Changes
Microscopic Changes
Complications
yellow pallor
neutrophils (acute healing)
fibrinous pericarditis (transmural infarctions), presents as chest pain w/ friction rub
Morphological Changes After Infarction
4-7 days
Gross Changes
Microscopic Changes
Complications
yellow pallor
macrophages (cleaning up)
cardiac wall rupture (cardiac tamponade), interventricular septum defect, mitral regurg (if right coronary artery, ie posterior interventricular)
Morphological Changes After Infarction
1-3 weeks
Gross Changes
Microscopic Changes
Complications
red border, granulation tissue enters from edge
granulation tissue w/ plump fibroblasts, collagen, and blood vessels
