Ischemic heart disease manifestations

Question 1

three types of angina

Answer 1

prinzmetal - spasm; tobacco, cocaine, triptans
stable - pain on exertion
unstable - ST depression, no relief with nitro

Question 2

coronary steal syndrome

Answer 2

post obstructive loss of blood when dilated arteries

Question 3

MI

Answer 3

acute thrombosis, STEMI is transmural, NSTEMI subendocardial

Question 4

sudden cardiac death most common cause

Answer 4

lethal arrhythmia (VFib)

Question 5

most commonly occluded arteries

Answer 5

LAD>RCA>LCX

Question 6

evolution of the MI 0-4 hours

Answer 6

gross changes none
micro: nothing
arrhtym, HF, Cardio shock

Question 7

4-24 hours

Answer 7

gross: pale, and dark mottling with tetrazolium
light micro: coag necrosis, PMN, edema, fibrin, reperfusion injury - contraction bands
arrythm, HF, cardio shock

Question 8

1-3 days

Answer 8

gross: hyperemia (bloody)
micro: coag necrosis, PMN
fibrinous pericarditis

Question 9

3-14 days

Answer 9

gross: yellow-brown softening (10 days max. soft)
micro: coag necrosis, PMN, macrophages, granulation tissue
free wall rupture, tamponade, septal rupture, papillary muscle rupture (macrophages structural degradation), LV pseudo aneurysm

Question 10

2 weeks to several months

Answer 10

gross: white scar
micro: contracted scar complete
arrhthym, vent. aneurysm, thrombi, heart failure, Dressler syndrome

Question 11

diagnosis of MI

Answer 11

EKG gold standard in the first six hours
Trop I rises after 4 hours, 7-10 days
CK-MB 6-12 hours, useful for reinfarction (can monitor baseline, returns to normal after 48 hours)

Question 12

EKG changes in MI

Answer 12

STEMI, ST depression, T waves inverted, spiked, LBBB, U wave

Question 13

ECG leads for diagnosis

Answer 13

LAD & LCX: V5-6
LAD (anteroseptal): V1-2
LAD (anteroapical): V3-4
LCX: I and aVL
RCA: II, III, aVF