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Pathoma - Cardiac Pathology > Ischemic Heart Disease (IHD) > Flashcards

Ischemic Heart Disease (IHD) Flashcards

1
Q

What is stable angina?

A

Chest pain that arises with exertion or emotional stress

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2
Q

What causes stable angina?

A

Atherosclerosis of coronary rates with > 70% stenosis (causes symptoms); decreased blood flow is not able to meet the metabolic demands of the myocardium during exertion.

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3
Q

What type of injury is stable angina?

A

Represents reversible injury (cellular swelling) to myocytes (no necrosis)

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4
Q

What does stable angina present as?

A

Chest pain (

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5
Q

What does the EKG show for stable angina?

A

ST-segment depression due to subendocardial ischemia

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6
Q

What relieves stable angina?

A

Rest or Nitroglycerin (vasodilator of veins –> decreases preload!)

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7
Q

What is unstable angina?

A

Chest pain that occurs at rest

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8
Q

What causes unstable angina?

A

Due to rupture of an atherosclerotic plaque with thrombosis and INCOMPLETE occlusion of a coronary artery

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9
Q

What type of injury is unstable angina?

A

Reversible injury to myocytes (no necrosis)

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10
Q

What does the EKG show for unstable angina?

A

ST segment depression due to subendocardial ischemia

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11
Q

What is used to treat unstable angina?

A

Nitroglycerin

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12
Q

What does unstable angina put you at high risk for?

A

Myocardial infarction

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13
Q

What is Prinzmetal angina?

A

Episodic chest pain unrelated to exertion

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14
Q

What causes Prinzmetal angina?

A

Coronary artery vasospasm

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15
Q

What type of injury does Prinzmetal angina cause?

A

Reversible injury to myocytes (no necrosis)

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16
Q

What does the EKG show in Prinzmetal angina?

A

ST-segment elevation due to transmural ischemia (entire wall damage/block in blood flow)

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17
Q

What can you use to treat Prinzmetal angina?

A

Nitroglycerin or Calcium channel blockers (relives vasospasm by blocking Ca2+)

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18
Q

What is myocardial infarction?

A

Necrosis of cardiac myocytes

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19
Q

What causes myocardial infarction?

A

Usually due to rupture of an atherosclerotic plaque with thrombosis and complete occlusion of a coronary artery
(other causes include coronary artery vasospasm (due to Prinzmetal angina or cocaine use), emboli, and vasculitis (Kawasaki disease))

20
Q

What are symptoms of MI?

A

Severe, crushing chest pain (>20 min) that radiates to left arm or jaw, diaphoresis and dyspnea (SOB - pulmonary congestion, anemia), symptoms NOT relieved by nitroglycerin

21
Q

What does infarction usually involve with MI?

A

LV (RV and atria are usually spared)

22
Q

What does an LAD occlusion cause?

A

Infarction of the anterior wall and anterior septum of LV

23
Q

What is the most commonly involved artery in MI?

A

LAD - 45% of cases!

24
Q

What does occlusion of the RCA cause?

A

Infarction of posterior wall, posterior septum and papillary muscles of LV (second most common infarct here)

25
Q

What does occlusion of the left circumflex cause?

A

Infarction of the lateral wall of the LV.

26
Q

What does the initial phase of infarction cause?

A

Subendocardial necrosis involving

27
Q

What happens after continued ischemia?

A

Transmural necrosis involving most of the myocardial wall (transmural infarction)
-EKG shows ST-segment elevation

28
Q

What is Troponin?

A

Most sensitive and specific marker (gold standard) for MI.

29
Q

What is the timeline for Troponin?

A

Levels rise 2-4 hours after infarction, peak at 24 hours, and return to normal by 7-10 days.

30
Q

What is CK-MB?

A

Useful for detecting re-infarction that occurs days after initial MI.
-CK-MB levels rise 4-6 hours after infarction, peak at 24 hours, return to normal by 72 hours

31
Q

What are the six treatments used for MI?

A
  1. Aspirin and/or heparin - limits thrombosis
  2. Supplemental O2 - minimizes ischemia
  3. Nitrates - vasodilate veins and coronary arteries (veins –> dec preload)
  4. Beta-blocker - Slows HR, decreasing O2 demand, and risk for arrhythmia
  5. ACE inhibitor
  6. Fibrinolysis or angioplasty - opens blocked vessel
32
Q

What two adverse side effects can reperfusion cause?

A
  1. Contraction band necrosis

2. Reperfusion injury

33
Q

What is contraction band necrosis?

A

Reperfusion of irreversibly-damaged cells results in calcium influx, leading to hyper contraction of myofibrils

34
Q

What is reperfusion injury?

A

-Return of oxygen and inflammatory cells may lead to free radical generation further damaging myocytes (why we continue to see elevated enzymes)

35
Q

What changes do you see in MI after

A

No gross changes
No microscopic changes
Complications: Cardiogenic shock (massive infarction), congestive heart failure, and arrhythmia

36
Q

What do you see in MI after 4-24 hours?

A

Gross: Dark discoloration
Microscopic: Coagulative necrosis (nuclei removed from cells)
Complications: Arrhythmia

37
Q

What do you see in MI after 1-3 days?

A

Gross: Yellow Pallor
Microscopic: Neutrophils
Complications: Fibrinous pericarditis (transmural)- presents as chest pain with friction rub!

38
Q

What do you see in MI after 4-7 days?

A

Gross: Yellow Pallor
Microscopic: Macrophages (eat debris - cause wall weakness)
Complications: Rupture of ventricular free wall (cardiac tamponade), inter ventricular septum (leads to shunt), or papillary muscle (leads to mitral insufficiency)

39
Q

What do you see in MI after 1-3 weeks?

A

Gross: Red border emerges as granulation tissue enters from edge of infarct.
Microscopic: Granulation tissue with plump fibroblasts, collagen, and blood vessels

40
Q

What do you see in MI after Months?

A

Gross: White scar (not as strong as myocardium)
Microscopic changes: Fibrosis
Complications: Aneurysm (dilation of wall), mural thrombus or Dressler syndrome

41
Q

What is Dressler syndrome?

A

Pericarditis caused by autoimmune antibodies against pericardium (6-8 weeks after infarction)

42
Q

What is sudden cardiac death?

A

Unexpected death due to cardiac disease; occurs without symptoms or

43
Q

What usually causes sudden cardiac death?

A

Fatal ventricular arrhythmia

44
Q

What is the most common etiology for sudden cardiac death?

A

Acute ischemia - 90% of patients have preexisting severe atherosclerosis

45
Q

What are less common causes of sudden cardiac death?

A

Mitral valve prolapse
Cardiomyopathy
Cocaine abuse (w/vasospasm)

46
Q

What is Chronic Ischemic Heart Disease?

A

Poor myocardial function due to chronic ischemic damage (with or without infarction); progresses to congestive heart failure (CHF)

Pathoma - Cardiac Pathology (7 decks)

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