Ischemic Heart Disease

Question 1

What is congestive heart failure?

Answer 1

The ability of the heart to pump is unable to meet the needs of tissues

Question 2

Systolic Heart Failure

Answer 2

Deterioration of myocardial contraction and so myocytes cannot generate enough force in contraction

Question 3

Diastolic Heart Failure

Answer 3

Inability of heart chamber to relax, expand, and adequately fill during diastole

Question 4

Right Sided Heart Failure

Answer 4

Leads to the engorgement of the systemic and portal venous circulation that can cause edema

Question 5

Left Sided Heart Failure

Answer 5

Damning of blood in pulmonary circulation causes diminished peripheral blood flow that can lead to pulmonary edema

Question 6

Biventricular Heart Failure

Answer 6

Shows symptoms of both right and left sided heart failure

Question 7

What is the pathogenesis of heart failure?

Answer 7

It occurs as a result of decreased perfusion to the coronary arteries in a combination with increased myocardial demand.

Question 8

What is the main cause of right side heart failure?

Answer 8

Left sided heart failure

Question 9

What are the 3 types of angina?

Answer 9

Stable
Unstable
Prinzmetal

Question 10

What are the features of stable angina?

Answer 10

Large stenosis of the coronary artery due to atherosclerosis and in times of increased O2 demand such as exercise will cause chest pain that subsides with rest

Question 11

What are the features of unstable angina?

Answer 11

The necrotic core of an atheroma is exposed due to an atherosclerotic plaque disruption that causes thrombus formation that can occlude coronary arteries even at rest.

Question 12

What plaques are the most vulnerable for unstable angina?

Answer 12

Vulnerable plaques are ones with very thin fibrous caps

Question 13

What are the features of Prinzmetal angina?

Answer 13

Coronary artery vasospasm cause chest pain that occurs even at rest

Question 14

What is the pathogenesis of a myocardial infarction?

Answer 14

Plaque disruption leads to the formation of an occlusive thrombus that leads to infarction

Question 15

What is another mechanism of MI that does not involve thrombus?

Answer 15

Cocaine can cause vasospasm that lead to an MI

Question 16

What are the EKG changes with an MI?

Answer 16

Characteristically ST segment elevation on EKG

corresponding to distribution of occluded coronary artery

Question 17

Nontransmural Infarct

Answer 17

Ischemic necrosis limited to inner one third, or at most one half of ventricular wall AKA subendocardial

Question 18

Transmural Infarct

Answer 18

Ischemic necrosis involves full (or nearly full)

thickness of ventricle

Question 19

What is often the cause of nontransmural infarcts?

Answer 19

In majority of cases there is diffuse stenosing coronary atherosclerosis and reduction of coronary flow with rarely evidence of plaque disruption or superimposed thrombus

Question 20

What is often the cause of transmural infarcts?

Answer 20

Occlusive coronary thrombus overlying a disrupted atherosclerotic plaque

Question 21

What is the first tissue of the heart to infarct?

Answer 21

Subendocardium

Question 22

What compounding factor can cause a circumferential subendocardial infarct?

Answer 22

Global hypotension - coronaries are not well perfused

Question 23

MI Changes 30 minutes to 4 hours

Answer 23

o No gross or microscopic changes

Question 24

MI Changes 4-12 hours

Answer 24

o Beginning coaglulation necrosis

Question 25

MI Changes 12-24 hours

Answer 25

o Gross – dark myocardial mottling
o Microscopic – ongoing coagulation necrosis,
pyknosis of nuclei

Question 26

MI Changes 1 to 3 days

Answer 26

o Loss of myocardial nuclei and myocytes

o Neutrophilic infiltrate

Question 27

MI Changes 3-7 days

Answer 27

o Gross - yellow-tan softening
o Microscopic - myocyte disintegration, phagocytosis
of dead cells

Question 28

MI Changes 7 to 10 days

Answer 28

o Well-developed phagocytosis and early granulation tissue

Question 29

MI Changes 10 to 14 days

Answer 29

o Granulation tissue

Question 30

MI Changes 2 to 8 weeks

Answer 30

o Scar formation

Question 31

What is the main lab finding for MI?

Answer 31

Elevated troponin

Question 32

What is reperfusion injury?

Answer 32

Restoration of blood flow leads to local myocardial damage

Question 33

What is cardiogenic shock?

Answer 33

Severe pump failure and often occurs with large infarcts

Question 34

What are some complications of MI?

Answer 34

• Arrhythmia
• Myocardial Rupture
• Pericarditis
• Ventricular Aneurysm

Question 35

What is the mechanism of sudden cardiac death?

Answer 35

Lethal arrhythmia - usually not acute MI