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Pathoma pathology > Ishemic heart disease > Flashcards

Ishemic heart disease Flashcards

1
Q

What is ischemic heart disease?

A

Coronary artery disease (CAD) also known as atherosclerotic heart disease, coronary heart disease,or ischemic heart disease (IHD), is the most common type of heart disease and cause of heart attacks. The disease is caused by plaque building up along the inner walls of the arteries of the heart, which narrows the arteries and reduces blood flow to the heart.

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2
Q

Which disease is the leading cause of death in th US?

A

IHD is the leading cause of death in the US.

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3
Q

What is the usual cause of IHD?

A

Usually due to atherosclerosis of coronary arteries, which decreases blood flow to the myocardium

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4
Q

What are the risk factors for IHD?

A

Risk factors for IHD are similar to those of atherosclerosis; incidence increases with age.

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5
Q

What is angina?

A

Angina is a type of chest pain caused by reduced blood flow to the heart muscle. Angina is a symptom of coronary artery disease. Angina is typically described as squeezing, pressure, heaviness, tightness or pain in your chest.

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6
Q

What is stable angina?

A

Stable angina is chest pain that arises with exertion or emotional stress

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7
Q

What is the main cause of stable angina?

A

Due to atherosclerosis of coronary arteries with > 70% stenosis; decreased blood flow is not able to meet the metabolic demands of the myocardium during exertion

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8
Q

Is there necrosis in stable angina?

A

Represents reversible injury to myocytes (no necrosis)

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9
Q

Describe the pain in stable angina?

A

Presents as chest pain (lasting < 20 minutes) that radiates to the left arm or jaw, diaphoresis, and shortness of breath

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10
Q

What are the findings in EKG?

A

EKG shows ST-segment depression due to subendocardial ischemia

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11
Q

How do you relieve stable angina pain?

A

Relieved by rest or nitroglycerin

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12
Q

What is unstable angina?

A

Unstable angina is chest pain that occurs at rest.

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13
Q

What is the usual cause of unstable angina?

A

Usually due to rupture of an atherosclerotic plaque with thrombosis and incomplete occlusion of a coronary artery

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14
Q

Is there necrosis in unstable angina?

A

Represents reversible injury to myocytes (no necrosis)

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15
Q

What are the EKG findings in unstable angina?

A

EKG shows ST-segment depression due to subendocardial ischemia.

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16
Q

How do you relieve unstable angina?

A

Relieved by nitroglycerin

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17
Q

What is the risk of unstable angina?

A

High risk of progression to myocardial infarction

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18
Q

What is prinzmetal’s angina?

A

Prinzmetal’s or Prinzmetal angina(also known as variant angina, angina inversa, or coronary vessel spasm) is a syndrome typically consisting of angina (cardiac chest pain) at rest that occurs in cycles. It is caused by vasospasm, a narrowing of the coronary arteries caused by contraction of the smooth muscle tissue in the vessel walls rather than directly by atherosclerosis

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19
Q

Is there necrosis in prinzmetal’s angina?

A

Represents reversible injury to myocytes (no necrosis)

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20
Q

What are the EKG findings in prinzmetal’s angina?

A

EKG shows ST-segment elevation due to transmural ischemia

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21
Q

How do relieve prinzmetal’s angina?

A

Relieved by nitroglycerin or calcium channel blockers

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22
Q

What is myocardial infartion?

A

Myocardial infarction or acute myocardial infarction is the event where blood stops flowing properly to part of the heart and the heart muscle is injured due to not receiving enough oxygen.

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23
Q

What is the usual cause of myocardial infartion?

A

Usually due to rupture of an atherosclerotic plaque with thrombosis and complete occlusion of a coronary artery

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24
Q

Is there necrosis in myocardial infartion?

A

Yes, Necrosis of cardiac myocytes

25
Q

Besides the usual cause by rupture of an atherosclerotic plaque what are the other cause of myocardial infarction?

A

Other causes include coronary artery vasospasm (due to Prinzmetal angina or cocaine use), emboli, and vasculitis (e.g., Kawasaki disease).

26
Q

What are the clinical features in myocardial infartion?

A

Clinical features include severe, crushing chest pain (lasting > 20 minutes) that radiates to the left arm or jaw, diaphoresis, and dyspnea; symptoms are not relieved
by nitroglycerin.

27
Q

What areas of the heart are usually affected in myocardial infartion?

A

Infarction usually involves the left ventricle (LV); right ventricle (RV) and both atria are generally spared.

28
Q

What artery leads to infarction of the anterior wall and anterior septum of the LV?

A

Occlusion of left anterior descending artery (LAD)

29
Q

Which artery is the most commonly invloved in MI?

A

Left anterior descending artery (LAD) is the most commonly
involved artery in MI (45% of cases)

30
Q

Which artery leads to infarction of the posterior
wall, posterior septum, and papillary muscles of the LV?

A

Occlusion of right coronary artery (RCA)

31
Q

Which artery is the 2nd most
commonly involved in MI?

A

Right coronary artery (RCA) is the 2nd most commonly involved artery in MI.

32
Q

Which artery leads to infarction of lateral wall of the LV?

A

Occlusion of left circumflex artery

33
Q

Is there necrosis in the initial phase of infarction?

A

Initial phase of infarction leads to subendocardial necrosis involving < 50% of the myocardial thickness

34
Q

What are the EKG findings in the initial phase of infarction?

A

EKG shows ST-segment depression.

35
Q

In MI is there necrosis in continued or severe ischemia?

A

Continued or severe ischemia leads to transmural necrosis involving most of the myocardial wall (transmural infarction)

36
Q

What are the EKG findings in continued or severe ischemia in MI?

A

EKG shows ST-segment elevation.

37
Q

What cardiac enzymes are tested in MI?

A

Troponin I and CK-MB

38
Q

What is troponin I?

A

Troponin I is the most sensitive and specific marker {gold standard) for Ml, Levels rise 2 - 4 hours after infarction, peak at 24 hours, and return to normal by
7-10 days.

39
Q

What is CK-MB?

A

CK-MB is useful for detecting reinfarction that occurs days after an initial Ml; creatine kinase MB (CK-MB) levels rise 4 - 6 hours after infarction, peak al 24 hours, and return to normal by 72 hours.

40
Q

What is the treatment of MI?

A
  1. Aspirin and/or heparin—limits thrombosis
  2. Supplemental O2,—minimizes ischemia
  3. Nitrates—vasodilate coronary arteries
  4. beta-blocker—slows heart rate, decreasing O2, demand and risk tor arrhythmia
  5. ACE inhibitor—decreases LV dilation
  6. Fibrinolysis or angioplasty—opens blocked vessel
41
Q

In MI what happens in reperfusion of irreversibly damaged cells?

A

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

42
Q

What happens in reperfusion injury in MI?

A

Return of oxygen and inflammatory cells may lead to free radical generation,further damaging myocytes

43
Q

What are the complications of myocardial Infarction?

A

Complications of myocardial Infarction are closely related to gross and microscopic changes

44
Q

What are the gross and microscopic changes in myocardial infarction < 4 hours time from the infarction?

A

No microscopic or gross changes?

45
Q

What are the gross and microscopic changes in myocardial infarction 4-24 hours time from the infarction?

A

Gross changes:Dark discoloration

Microscopic changes:Coagulative necrosis

46
Q

What are the gross and microscopic changes in myocardial infarction 1-3 days time from the infarction?

A

Gross changes:Yellow pallor

Microscopic changes:Neutrophils

47
Q

What are the gross and microscopic changes in myocardial infarction1-3 weeks time from the infarction?

A

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

48
Q

What are the gross and microscopic changes in myocardial infarction Months time from the infarction?

A

Gross changes:White scar

Mircoscopic changes:Fibrosis

49
Q

What are the complications of myocardial infarction < 4 hours time from the infarction?

A 
Cardiogenic shock (massive infarction),
 congestive heart failure, and arrhythmia
50
Q

What are the complications of myocardial infarction 4-24 hours time from the infarction?

A

Arrhythmia

51
Q

What are the complications of myocardial infarction1-3days time from the infarction?

A

Fibrinous pericarditis; presents as
chest pain with friction rub

52
Q

What are the complications of myocardial infarction 4-7days time from the infarction?

A

Rupture of ventricular free wall; leads
to cardiac tamponade, interventricular septum
(leads to shunt), or papillary muscle;
(leads to mitral insufficiency)

53
Q

What are the complications of myocardial infarction months time from the infarction?

A

Aneurysm , mural thrombus, or
Dressier syndrome

54
Q

What is sudden cardiac death?

A

Unexpected death due to cardiac disease; occurs without symptoms or < 1 hour after symptoms arise

55
Q

What is the usual cause of sudden cardiac death?

A

Usually due to fatal ventricular arrhythmia

56
Q

What is the most common etiology for sudden cardiac death?

A

Most common etiology is acute ischemia; 90% of patients have preexisting severe atherosclerosis.

57
Q

What are the less common causes of sudden cardiac death?

A

Less common causes include mitral valve prolapse, cardiomyopathy, and cocaine
abuse.

58
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 pathology (7 decks)

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