Ischemic Heart Disease (Pathoma) Flashcards
ischemia
refers to decrease in blood flow to an organ
angina
chest pain that is REVERSIBLE
stable angina
- no chest pain at rest
- develops chest pain with exertion or emotional stress
When does angina occur?
When there is >70% stenosis
How long does chest pain last in stable angina?
EKG findings in stable angina?
ST segment DEPRESSION (only subendocardial ischemia)
How is stable angina relieved?
- Rest (decrease O2 demand of myocardium)
- Nitro (venous dilation, decrease preload, decrease myocardial stress)
unstable angina
chest pain that occurs at rest
What causes unstable angina?
rupture of atherosclerotic plaque
Is unstable angina due to complete or incomplete occlusion of a coronary artery?
INCOMPLETE
EKG findings in unstable angina?
ST segment DEPRESSION (only subendocardial ischemia)
EKG findings in unstable angina?
ST segment DEPRESSION (only subendocardial ischemia)
Sx of Prinzmetal angina?
episodic chest pain unrelated to exertion
Complications of Fibrinolysis or Angioplasty?
- contraction band necrosis (return blood & calcium, cause contraction of dead tissue)
- reperfusion injury (return O2, release free radicals)
How is unstable angina relieved?
- Nitro
- High risk of progressing to MI
1-3 days after MI?
- Yellow pallor (due to leukocytes)
- Inflammation
- Neutrophils (clean up necrosis)
- Fibrinous pericarditis (chest pain with friction rub)
4-7 days after MI?
- Healing
- Macrophages
- Granulation tissue (fibroblasts, collagen, and blood vessels)
- Rupture of ventricular free wall, cardiac tamponade
Months after MI?
- White Scar
- Fibrosis
- Aneurysm, mural thrombosis, Dressler’s Syndrome (antibodies against pericardium 6-8 weeks out)
What is Dressler’s Syndrome?
- Autoimmune reaction 6-8 weeks post MI.
- Develop antibodies that attack pericardium.
What type of infarction does Fibrinous pericarditis occur with?
ONLY occurs with TRANSMURAL infarction
1-3 days post-MI
Myocardial infarction
necrosis of myocytes
What causes sudden cardiac death?
Fatal ventricular arrhythmia
Chest pain in MI?
> 20 min (not relieved by Nitro)
What is treatment for MI?
- Aspirin/Heparin
- Supplemental O2
- Nitrates (decrease preload, decrease demand)
- Beta-blocker (slow HR, decrease O2 demand, decrease risk for arrhythmia)
- ACE Inhibitor (decrease afterload, decrease LV dilation)
Complications of Fibrinolysis or Angioplasty?
- contraction band necrosis (return blood & calcium, cause contraction of dead tissue)
- reperfusion injury (return O2, release free radicals)
4-24 hours after MI?
- Dark discoloration
- Coagulative necrosis (remove nucleus of cell)
- Arrhythmia
1-3 days after MI?
- Yellow pallor
- Inflammation
- Neutrophils (clean up necrosis)
- Fibrinous pericarditis (chest pain with friction rub)
4-7 days after MI?
- Healing
- Granulation tissue (fibroblasts, collagen, and blood vessels)
Months after MI?
- White Scar
- Fibrosis
- Aneurysm, mural thrombosis, Dressler’s Syndrome
What is Dressler’s Syndrome?
- Autoimmune reaction 6-8 weeks post MI.
- Develop antibodies that attack pericardium.
What type of infarction does Fibrinous pericarditis occur with?
ONLY occurs with TRANSMURAL infarction
1-3 days post-MI
What are the most common etiologies of acute ischemia in sudden cardiac death?
- Pre-existing severe athersosclerosis (90%)
- Less common: mitral valve prolapse, cardiomyopathy, cocaine abuse (vasospasm)
What causes Chronic Ischemic Heart Disease?
Poor myocardial funciton due to chronic ischemic damage (with or without myocardial infarction)
What does Chronic Ischemic Heart Disease progress to?
CHF
