LECTURE 3 Flashcards
1
Q
What are the manifestations of Rheumatic Fever?
A
- Subarthritis
- Erythema Annulare (Marginatum)
- Subcutaneous Nodules
- Sydenham’s Chorea
2
Q
What is Subarthritis associated with Rheumatic Fever?
A
Inflammation of the joints that are warm, painful and symmetrical occurs in one joint area for 2-5 days, then spontaneously subsides
- goes to ankles, then knees, then hands, then wrist
3
Q
Arthritis that moves around associated with Rheumatic Fever is known as _______
A
Migratory Arthritis
= No destruction of joint (does not leave any consequences)
4
Q
What is “Erythema Annulare (marginatum)” associated with Rheumatic Fever?
A
VASCULITIS of a circular erythema - sign of vasculitis
“Common with RF” Very RARE in REAL medical practice
5
Q
What are Subcutaneous Nodules associated with Rheumatic Fever?
A
Knuckle region (common with RF), but RARE in real practice
6
Q
What is Sydenham’s Chorea associated with Rheumatic Fever
A
Inability to draw straight line, involuntary jerking. Curable, mild vasculitis of cerebral vessels
- Atrophy of the midbrain (stria nuclei)
7
Q
What are the differences between Huntington’s Disease chorea and Sydenham’s chorea?
A
Huntington’s is genetic primary disease, begins at 30-35, male and female equally - INCURABLE
- Death in 10-15 years
8
Q
What are the main points of Sydenham’s Chorea?
A
Acquired, secondary to RF, mild vasculitis of cerebral vessels
- neurons NOT affected
- Develops in FEMALES no later than 15 y.o.
- CURABLE
9
Q
What are the different types of inflammation associated with Rheumatic Fever?
A
- Rheumatic Myocarditis
- Rheumatic Pericarditis
- Rheumatic Endocarditis
10
Q
What is Rheumatic Myocarditis associated with Rheumatic Fever?
A
90% of cases develops myocarditis - Inflammation of heart muscles - muscle is always involved in a form of inflammation
11
Q
What is Rheumatic Myocarditis manifested by?
A
Necrosis of Aschoff’s Nodes -> Fibrinoid Necrosis -> Pathognomic sign of RF
12
Q
What is Rheumatic Pericarditis?
A
Accumulation of exudate (formed by fibrinogen inflammation) in the area - can be fibrous due to fibrin strands causing friction
- Can cause issue in heart function and bruits will be heard
13
Q
Rheumatic Pericarditis is what type of inflammation?
A
Fibrinous Inflammation
14
Q
What is Rheumatic Endocarditis?
A
Major problem with RF
- Inflammation of VALVES
- Mitral Valve MC affected
15
Q
Cardiac valves that regulate blood flow in the heart are made of ______
A
Endocarditis —> Inflammation of valves
16
Q
With Endocarditis, what can happen simultaneously?
A
Both valvular insufficiency and stenosis can occur simultaneously - degree of involvement varies - both usually develop at the same time
17
Q
What is Valvular Insufficiency aka Valvular Regurgitation?
A
When there is inflammation in the endocarditis, there is inflammation of the valves as well
- Healing with CT on out layers of the valves, the valves shrink, and forms gaps/defects between the flaps of the valve
18
Q
Can the Mitral valve close completely with Valvular insufficiency aka valvular regurgitation?
A
No the Mitral valve cannot close completely -> left ventricular systole, blood backflows into the left atrium - in each cycle, there is more blood in the left atrium that there should be
19
Q
What type of stenosis is seen with Rheumatic Fever?
A
Stenosis of the Atrio-Ventricular opening (Mitral stenosis)
20
Q
What do the valves try to do in Mitral Stenosis?
A
They try to compensate by adhering portions that are not gapped together, this decreases the space of the lumen that was available for blood to flow through
21
Q
When stenosis of the Mitral Valve occurs, what will this lead to?
A
This decreases the amount of fluid allowed to flow through the space (stenosis), therefore blood from the left atrium is not allowed to flow out
22
Q
What happens when blood from the left atrium is not allowed to flow out?
A
Left atrium accumulates more and more blood which leads to distension of the left atrium, and leads to concentric hypertrophy of the left atrium
23
Q
Accumulation of fluid in the left atrium leads to _____
A
Increased hydrostatic pressure, and accumulation of blood leads to the equalization of the hydrostatic pressure in the pulmonary vein and left atrium
24
Q
What can hydrostatic pressure in the pulmonary vein and left atrium lead to?
A
Stoppage of blood in the system of the pulmonary artery = Enlargement of plaques
25
What can stenosis do to blood flow?
Leads to serious impairment of the blood flow -> affects the entire body
26
If stenosis is more than insufficiency _____
Diagnose as STENOSIS, if insufficiency is more than stenosis, diagnose as INSUFFICIENCY
27
What Can enlargement of any portion of the heart affect?
The trachea, bronchi, esophagus, Recurrent nerve, and cartilage rings
28
Hydrostatic pressure of the left atrium becomes so strong due to enlargement, what happens?
Leads to Change of position of the bronchi, which leads to cartilage rings jamming
29
What does squishing of the Recurrent nerve cause?
Hoarsening of the voice
30
What will a patient present with, if they have an enlarged atrium pressing on recurrent nerve?
Problem with blood circulation in addition to the common cold and hoarseness
31
How will enlargement of the heart create pressure on the esophagus?
It is typically vertical and is located behind the left atrium, enlargement of the left atrium compresses the esophagus and becomes curved
32
How would you determine if the esophagus is curved?
Through the use of radio plaque fluid that shows the deviation on X-ray
33
How do you determine the amount the atrium has enlarged in regard to the esophagus?
Measure the radius of the circumference of the heart (arc) - more dramatic enlargement of left atrium - will push the esophagus more posteriorly
- The shorter the radial deviation, the larger the atrial enlargement
34
Degree of radius determines the degree of enlargement of the _____
Left Atrium
35
Modification of blood flow =
Intracardiac Hemodynamics (movement of blood in the heart)
36
The significance of mitral stenosis indicates the rate of blood flow moving and _______
Speed of expelling in the right atrium is less than normal
37
What does Narrowing of the right AV opening cause?
Move blood from atrium to ventricle at a slower speed (less than normal)
- The blood within the left atrium flows at a slower speed
38
The reduction in the speed of blood flow during AV stenosis predisposes people to what?
Allows for thrombus formation (slower blood flow results in thrombi formation)
- Predisposing factor for thrombi formation
39
What is a physical manifestation of Mitral stenosis?
Formation of lines of Zahn (light = fibrin, dark = RBCs)
40
What is a thromboembolism?
Large portions of the thrombocytes may tear from body and flow through the heart
41
What happens in the case of a thromboembolism (what is the path)?
It can block the mitral opening/valve = death
*** BALL VALVE THROMBUS
42
Where can a “Ball-Valve” Thrombus form?
Left atrium - left ventricle - aorta - organs well supplied with blood (coronary arterty of heart, brain, spleen, kidney, etc)
43
What can Thromboembolism result in?
Blood pressure increase - dilation of heart chambers - decrease in contraction - BP decreases - blood comes back and prevent blood backflow in the ventricle - effects diastolic BP - increased resistance to systemic flow - increase in blood pushed into the coronary artery
44
What can an infract of the brain or heart lead to ?
STROKE
45
What can happen in the result of Strep Throat?
Strep throat that is not treated can result in the formation of rheumatic fever -> mitral stenosis -> thrombi -> thromboemboli-> DEATH
46
What is the surgery for Acquired Heart Disease?
Mitral Commissurotomy
47
What is Mitral Commissurotomy?
Tool can destroy the adhesion during the expansion (can’t only use fingers)
48
What is the 2nd most involved valve in Rheumatoid Fever?
Aortic Valve Stenosis
49
What is the (long) pathway of Aortic Valve Stenosis?
Narrowing of AV - atrophy - calcification stenosis - increased resistance - dramatic thickening of the ventricular wall due to the increased resistance - hypertrophy of ventricles - dilation of the ventricle - during systole, not all blood is expelled - blood remains in ventricle - more and more remains, more and more expansion , more and more cells die
50
What does hypertrophy of left ventricle result in?
Results in deviation of the heart to the left beyond the medial clavicular line - can result in HEART FAILURE
51
What does AV stenosis cause?
Left ventricular hypertrophy
52
What happens with Heart disease in Hypertension II?
Dramatic enlargement of the thickness of the wall - in hypertension there is no remaining blood in the ventricle
53
What is the exact process of Aortic valve insufficiency?
Characterized by disruption of cusps, resulting in the complete closure of the semilunar valves causing blood to backflow during diastole without any restriction
54
Normally the Aortic Valve does what?
Blocks the back flow - accounts for diastolic pressure - diastolic pressure is hallow or absent (normal systolic, low/absent diastolic)
55
What physiologically normally happens when the AV valve insufficiency happens?
- Increased systolic blood pressure
- Decreased/absent diastolic blood pressure
- Pulse pressure is equal to the systolic pressure (PP = SP - DP) since no diastolic
56
How would you diagnose Rheumatic Heart DIsease (aortic valve insufficiency) ?
Place stethoscope in cubital artery and listen for heart sounds - if you hear clicks and/or rubs it is an absolute indication of aortic valve insufficiency
57
What is Aortic valve insufficiency of Rheumatic Heart Disease more commonly caused by?
- bacterial endocarditis
- rheumatic fever
- tertiary syphilis
(Rarely caused by AS)
58
What is Tertiary Syphilis characterized by?
The CV pathology in 80% of this disease, affects only the nervous system in minor cases, but in most cases affects the CV system
59
What is De Masset’s sign associated with?
Tertiary Syphilis
60
WHat is De Musset ‘s sign?
Rhythmic nodding/bobbing of the head
- Absolute finding in aortic insufficiency because pulse pressure is equal to systolic pressure in absence of diastolic pressure
61
What is Ankylosing Spondylitis?
Disease of the spine can lead to aortic insufficiency artificial valves can be placed into the heart to replace the aortic valve - must take medication to prevent the formation of thrombocytes and inflammation
62
What are the most common (MC to least common) of Rheumatic heart disease stenosing?
1) Mitral Valve
2) Aortic Valve
3) Tricuspid (rare)
4) Pulmonary valve with RF (does not affect these valve)
63
What is Bacterial Endocarditis?
Infection can result in the heart valves, where there is a good environment for the bacteria to grow -> direct infection to the heart
64
What are the 2 major types of Bacterial Endocarditis?
- Acute Bacterial Endocarditis
| - Subacute Bacterial Endocarditis
65
What are the characteristics of Acute Bacterial Endocarditis?
- Sudden development and very high mortality rate
66
WHat is the cause of acute bacterial endocarditis?
Different bacteria, commonly staphylococcus aureus
- prognosis - BAD
67
What are the main characteristics of Subacute Bacterial Endocarditis?
Lower mortality rate, (able to survive and cure with proper treatment)
68
What is the cause of Subacute Bacterial Endocarditis?
Commonly Streptococcus Viridans aka Streptococcus Mitis
- An alpha hemolytic bacteria
- Forms non-transparent greenish layer around colonies
69
What can cause complications with Subacute Bacterial Endocarditis ?
> 50% are complicated by the development of an ischemic/hemorrhagic stroke
- Affects women more commonly
70
What are the portals of entry for subacute bacterial endocarditis?
Bad tooth/cavity
Prostate gland
Ovaries
Streptodermia
Lung chronic pneumonia
Gallbladder
71
How can Bad tooth/cavity be a problem in Bacterial Endocarditis?
Can lead to various chronic disease (other amyloidosis)
- Even a small cavity means there is a chronic bacterial infection in the mouth
72
What may bad tooth/cavity result in?
Destruction of the trachea and eventually the alveoli
- Need to fill cavity - Heard to treat if there is a cavity
73
What happens in the prostate gland with Bacterial Endocarditis?
Bacterial endocarditis can be found in 2/3 of male patients - acute that switched to chronic
74
How are the ovaries affected in Bacterial Endocarditis?
Involved in inflammatory process - infection will live there with ease with infection
75
What is Streptodermia associated with Bacterial Endocarditis?
Infection of the skin (widespread) - inflammation of sebaceous glands and could also be due to aging
76
WHat is Lung/Chronic Pneumonia associated with Bacterial Endocarditis?
WORST
Infection in the lungs causing chronic inflammation of the lung tissue, if not treated properly they will develop pneumonia (remains the rest of your life)
77
Can there be any problems with Lung/Chronic Pneumonia with Bacterial Endocarditis?
Problem with treatment of infection of antibiotics due to the spread of antibody resistant bacteria and difficulty accessing the area
78
What is a common source of chronic bacterial endocarditis?
Gallbladder
- Bacteria love to live there, decreased strength of immune system
79
What is Kidney Amyloidosis? **
One of the most incurable diseases in the body
- Amyloid the protein is triggered by chronic infection in specific areas of the body
80
Which valves are commonly affected by Kidney Amyloidosis?
Aortic valves which leads to insufficiency and stenosis, second most common is mitral valve
81
Where are colonies of bacteria in Kidney Amyloidosis?
Colonies of bacteria on the valves are located on permanently moving tissue - no matter how strong the attachment to the valve, the colonies will grow and slip off as a mass into the blood circulation = EMBOLUS **
82
What is possible to happen with Kidney amyloidosis?
EMBOLUS
83
WHat is Ductus Ateriosus?
Predisposing factor of bacterial endocarditis
84
What is the Ductus Arteriosus?
Tube connecting aorta and pulmonary artery in fetus -> non-obliterated ductus Arteriosus
85
After delivery, what happens to the ductus Arteriosus?
The ductus Arteriosus undergoes obliteration within several months of life (this connection should be destroyed after birth so that the infant can breathe)
86
What happens if the Ductus Arteriosus remains open?
It can result in the serious problem of congenital heart disease
87
What happens if you wait too long to have ductus Arteriosus closed?
For each month of living, there is hyalinization of the wall - the tube cannot be removed if it becomes too brittle
88
What can happen during the operation of closing the ductus Arteriosus ?
When the ductus Arteriosus is cut, it may rupture and break off leading to the profuse hemorrhage of the vessel - die within seconds
89
If the situation of not closing the ductus Arteriosus , what can develop?
If the situation develops, the patient will have bacterial endocarditis can then be moved into the left ventricle and then go to the lungs resulting in hemorrhagic lung infarction (red infarct)
90
What can be the complications of Bacterial Endocarditis?
Ischemic Hemorrhagic stroke
Hemorrhagic lung infarction
91
What is a predisposing lesion for Bacterial Endo carditis?
Patent Ductus Arteriosus
92
Hemorrhagic lung infarction can develop from _____
Patent ductus Arteriosus
93
WHat is Ischemic - Hemorrhagic stroke?
Colonies are loosely attached and can be dislodged into the circulation causing an ischemic stroke due to embolism by bacterial embolus
94
Once the bacterial embolus settles in Ischemic Hemorrhagic stroke, what happens?
The bacteria release destructive enzymes as waste products of metabolism that perforate the blood vessel walls, leading to hemorrhage
95
Is Ischemic Hemorrhagic Stroke typical?
NO, only common to bacterial endocarditis
96
What is Hemorrhagic Lung Infarction?
Due to non-obliterated ductus Arteriosus
- Vegetations of bacteria in the pulmonary trunks can go into the lungs
** VERY PAINFUL
97
WHat are the manifestations of Bacterial Endocarditis?
- Hemorrhages of retina
- Petechial rash
- Clubbing of nails
98
What is “Hemorrhage of the retina” in Bacterial Endocarditis?
Infection in the blood circulation leads to destruction of the arteries -> blood flows in the tissue and can lead to loss of vision
99
Where in the body can you see hemorrhage with bacterial endocarditis?
Inner surface of the cheeks
100
What happens to the hands in Bacterial Endocarditis?
Bulging of the fibers with petechial rash (dorsal portion) hemorrhage underneath the nails as well as clubbing of the fingers
(Watch like Sign) -> Due to doming of fingernails
101
What is a typical manifestation of Hypertrophic Pulmonary Osteoarthropathy?
Hands bulging of petechial rash (club nails)
102
What other syndrome (besides hypertrophic pulmonary osteoarthropathy) will make you develop clubbing nails?
Paraneoplastic Syndrome
103
What does paraneoplastic syndrome accompany?
Many malignant tumors that manifest to cancer
104
Most common malignant tumor associated with clubbing of the fingers is _______
Lung cancer
105
What will any pathology of the chest cause? (As well as some abdominal disorders)
Any can manifest as HPO, clubbing of fingers can be seen in completely healthy people as well (no associated disease)
- SPLEEN
- KIDNEY
- BRAIN
106
What can suppurative necrosis result from?
Strep Pyogenes that release waste products to cause intoxication and different negative consequences
107
What is the treatment of suppurative necrosis or bacterial
100 g of penicillin per day intravenously
108
Where will you see Petechial Rash in the manifestations of Bacterial endocarditis?
Hands and underneath nails, mouth, kidneys, and spleen
109
Arteriosclerosis :
Hardening of the arteries
110
What are the types of Arteriosclerosis?
- Atherosclerosis
- Monckeberg’s Medial Calcification Sclerosis
- Hyaline Arteriosclerosis
- Hyperplastic Arteriosclerosis
- Ischemic heart disease/coronary artery disease
111
Arthera aka
Mush, porridge due to plaques
112
What is Atherosclerosis characterized by?
The development of atherosclerotic plaque aka atheroma on the arterial walls
113
What are the constitutional risk factors for Atherosclerosis?
- age
- gender
- familial predisposition
114
Why is age significant with atherosclerosis ?
5 fold increase in morbidity between 40-60
115
What is the significance of women in atherosclerosis?
Reproducing women are more protected from progression than males (estrogen)
- 5 fold LESS chance of having than males of same age
- BC changes that!
116
What is the significance of familial predisposition to atherosclerosis?
Genes predispose progression, develops in males and death by 20 y.o. Due to MI as a result of progressed atherosclerosis
- Filtration can help prolong life
117
What are AQUIRED risk factors of atherosclerosis?
- hyperlipidemia
- hypertension
- smoking
- diabetes Mellitus
- birth control pills
118
What are the characteristics of LDL?
2/3 cholesterol (animal fats)
- If deficient, can develop stroke
- produced in the liver
119
What are the characteristics of HDL?
1/3 cholesterol (plant oils)
- have to keep a 4:1 ratio of LDL:HDL
- alcohol decreases blood viscosity which decreases thrombosis
120
WHat does hypertension lead to?
Endothelial damage - most important factor for promotion of thrombosis promotes dramatic progression of atherosclerosis
121
Why does smoking cause atherosclerosis ?
NT that leads to vasoconstriction in the heart, cerebral, stomach wall, intestine, and leg arteries -> followed by vasodilation -> endothelial damage -> results in plaguing of lumen
122
What is the worst of all factors for Atherosclerosis?
DIABETES MELLITUS ( least controllable )
123
What is the process of Formation of Atheromas // Plaques?
Homocysteine accumulates in the tissues and promotes formation of plaques and can develop in Vit B6 and folic acid def. (deficiencies promote the production of homocysteine in the tissues)
124
What is endothelial damage associated with?
Bacterial, viral effects, hypertension, and atherosclerosis
- blood vessel is not normal and effects the epithelial cells to form gaps call subintimal space
125
What happens to the blood cells during endothelial damage?
Moving of the blood cells in subendothelial layer/subintimal space along with migration of smooth muscle of vessels into the same subendothelial layer
126
Accumulation of blood cells in subendothelial layer/subintimal space along with migration of smooth muscle of vessels into the same subendothelial layer ->
Creates bulging of the vessels/change of shape of the normal vascular wall -> change in blood flow -> turbulence
127
What will be the formation of atheroma?
Accumulation of fat (cholesterol) ->increases bulging
128
What will you eventually get with the formation of Atheroma?
Components: Blood cells/smooth muscle cells, fat/cholesterol, CT cap ***
129
If the lumen is narrowed, what will happen?
Less blood flow, leads to Hemoptysis of organs, complications can be irreversible
130
Calcium salts in atheroma =
Calcification
131
When calcium salts calcifies, the plaque is permanent and cannot decrease in size, what else can the plaque do?
Ulcerations and cracking
- When there is formation of a hole in the CT cap, there is communication of blood flow between the thrombus and the body
132
What is a complication of Ulcerations and cracking of the plaque?
Balloon of atheroma
133
What is the balloon of atheroma?
Blood flows through opening/crack/hole into atheroma -> ballooning/ distension of atheroma (grows in width and size) -> projects into the lumen -> narrowing of the blood vessels -> ischemia of organ
134
What is tissue debris in regard to atherosclerosis?
Tissue debris is removed similar to embolism - porridge goes through opening
- opening n the the hole allows debris to flow into circulation to form an embolus that can go anywhere, narrowing of the blood vessel, causing infarction
135
What is a Dissection of Atheroma?
Separation of layers occur, most commonly found in the aorta and causes full obstruction of blood flow and leads to immediate death - common in ascending and arch of aorta
136
What is Thrombosis?
Exposure to blood flow - activation of Platelets
137
What can thrombosis develop into?
Disruption of laminar blood flow -> Turbulence (most common predisposing factor of thrombosis) -> can lead to MI or ischemic stroke and immediate death
- changes in wall = changes in blood flow
138
What is Monckeberg Medial Calcification Sclerosis?
Ring like calcification within the tunica media of medium sized (ulnar, radial, femoral, and arteries to reproductive organs) to small muscular arteries of obscure course
139
What is actually calcified in Monckeberg Medial Calcific Sclerosis?
Calcification of the middle/muscular layer of arteries, but does NOT lead to narrowing of lumen (walls calcified)
140
What will Monckeberg Medial Calcific sclerosis result in?
Oxification (transferred into bones and form bone marrow) -> can then start producing blood cells
141
What arteries are affected in Monckeberg Medial Calcific Sclerosis?
Arteries of the extremities:
- Femoral
- Tibial
- Ulnar
- Radial
- Arteries supply sexual organs
142
WHen does Monckeberg Medial Calcific sclerosis develop?
In people > 50 y.o.
- CALCIFICATION OF FEMORAL ARTERY >>
143
Where does Hyaline Arteriosclerosis happen?
In the ARTERIOLES
144
What happens with Hyaline Arteriosclerosis?
Arterioles are designed to be very strong due to high BP, but when layer is replaced with hyaline, there is a loss of the properties of the wall and it can be brittle and rupture leading to hemorrhagic stroke
145
What happens in special cases of hypertension with Hyaline Arteriosclerosis?
Hypertonics push proteins in the blood into the extracellular space of wall of the arteries - between endothelial cells and deep layers of the arterioles forming Hyaline like tissue (extracellular Deposition of proteins)
146
What are the 2 problems of Hyaline Arteriosclerosis?
Dramatic narrowing/obstruction of lumen
Benign Nephrosclerosis
147
What happens with “Dramatic narrowing / obstructin of the lumen” with HYALINE ARTERIOSCLEROSIS?
Thickening is not outside the arterioles but into the lumen so it is even more dramatic leading to ischemia - lack of blood supply to tissue
148
What happens during “Benign Nephrosclerosis” in HYALINE ARTERIOSCLEROSIS?
Should not be called benign because there is emptying of the glomeruli and the glomeruli are lost — leads to the atrophy of the glomeruli due to ischemia
149
What is the pathognomonic sign of Hyperplastic Arteriosclerosis?
ONION SKINNING **
150
What is “Onion Skinning” in regards to Hyperplastic arteriosclerosis?
Onion skinning aka dissection aka thickening of the basement membrane of the arterioles - into layers - instead of 1 thick layer it is multiple layers
151
What does Hyperplastic Arteriosclerosis lead to?
Increased thickness of the basement membrane
- HARDENING OF ARTERIOLES
152
What 2 things are associated with Hyper plastic Arteriosclerosis?
Malignant Hypertension
Necrotizing Arteriolitis
153
What is Malignant Hypertension associated with Hyperplastic Arteriosclerosis?
Minimal diastolic pressure is at least 120 or more (typically the systolic pressure) -> DEATH
154
What is Necrotizing associated with Hyperplastic Arteriosclerosis?
Inflammation: loss of blood supply to tissues and abnormal blood supply to the arterial wall
155
Ischemic Heart Disease aka
Coronary heart disease aka Coronary Artery Disease
156
Ischemic Heart disease refers to what?
It refers to the group of closely related syndromes caused by imbalance between the myocardial oxygen demand and the blood supply
157
What are the pathogenic factors of Ischemic Heart Disease?
Atherosclerosis (factors):
- hyperlipidemia
- hypertension
- smoking
- diabetes Mellitus
(People DONT feel any problems with the heart because it progresses slowly)
158
What is the “Clinical Occlusion” with Ischemic Heart disease?
If there is occlusion of 75% or more of the coronary artery lumen - people do not feel anything until this point - ONLY find out through angiograms
159
What is the most common cause of Acute Thrombosis?
Ischemic Heart Disease
160
What is the Pathogenesis of Ischemic Heart Disease?
1) Acute change in Plaque Morphology
2) Platelet Aggregation
3) Coronary Artery Thrombosis
4) Coronary Artery Vasospasm
161
What is the Acute change in plaque morphology?
There is some problem or increase in the size of atheroma or its complications
Increase size or atheroma
162
What does Acute change in Plaque Morphology lead to ?
Platelet Aggregation
163
What is Platelet Aggregation?
When there is an opening in the aorta, the fibers are open to the blood flow causing activation of Von Willebrand factor, which activates thrombocytes to form and activate platelets to form a platelet plug cascade to form fibrin strands
Occurs which traps blood cells to create a serious clot within the blood vessel to cause obstruction
164
What does platelet Aggregation cause?
Serious clot within the blood vessel to cause obstruction
165
What is the most common factor leading to Myocardial infarction?
Coronary artery thrombosis
166
In coronary artery thrombosis associated with Ischemic Heart Disease, what is the problem?
Atheroma causes change of physical properties of flowing blood: loss of laminar blood flow, turbulence, etc.
- THese factors are predisposing factors of developing thrombosis
167
What is Coronary artery vasospasm associated with Ischemic heart disease?
NOT COMMON
- Associated with the spasm of the coronary artery -> narrowing of the lumen-> MI
168
Coronary artery vasospasm usually develops ______
WITHOUT any arteriosclerosis/plaques
169
The presence of plaques in Coronary artery vasospasm results in ______
Activation of platelets - thromboxane (A1 and A2) - Platelet aggregation - vasospasm/vasoconstriction
170
Coronary artery vasospasm and “bad news” :
Bad news leads to stress - catecholamines from adrenal medulla - sudden vasoconstriction effect - vasoconstriction of the blood vessels - prevents blood flow to the heart
171
What does Angina Pectoris refer to?
Intermittent chest pain caused by transient, reversible myocardial ischemia
172
What can Angina Pectoris cause or is associated with?
Tachycardia - increase load to heart muscle, cannot account for adequate supply of oxygen - inadequacy of oxygen (ischemia) leads to severe pain in the heart
173
What is a sign you would see with Angina Pectoris?
Severe pain in heart, hand over heart and horror on face
- Severe diffuse burning squeezing retrosternal chest pain ****
174
WHat is “Pain in the heart?”
Cardialgia
175
WHat is Cardialgia?
Anything that hurts in the area of the heart
- Could be real heart pain or around the heart that could be confused of heart pain
176
Angina Pectoris is _____ Pain
DIFFUSE WIDESPREAD
177
Cardialgia is _____ pain
LOCALIZED
