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MHD1/Pharm1 Exam 4 > (MHD) Ischemic Heart Disease > Flashcards

(MHD) Ischemic Heart Disease Flashcards

1
Q

Define Heart Failure

A

When the heart is inable to pump blood sufficiently to meet the needs of tissues because the ventricle is either unable to fill with or eject enough blood.

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2
Q

Systolic vs Diastolic Heart Failure

A

Systolic: Poor pumping

Diastolic: Ventricle doesn’t relax enough due to stiffness

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3
Q

Main causes for diastolic heart failure (3)

A
  1. Infiltrate
  2. Ischemia
  3. Hypertrophy which causes an inability for the heart to fill enough.
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4
Q

Greatest cause of right sided heart failure

A

Left sided heart failure

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5
Q

Right sided heart failure results in what general systemic/bodily effects?

A

Engorgement of systemic and portal venous circulation

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6
Q

Left sided heart failure results in what systemic/bodily effects?

A

Damning of blood in pulmonary circulation (pulmonary edema) and diminished peripheral blood flow.

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7
Q

Cor pulmonale

A

When only the right side of the heart is failing, but the left side is normal.

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8
Q

The risk factors for ischemic heart disease are the same risk factors as what other disease process?

A

Atherosclerosis

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9
Q

Name the (4) general manifestations of Ischemic Heart Disease

A
  1. Angina Pectoris (3 types)
  2. Acute MI
  3. Chronic Ischemic Heart Disease/Heart Failure
  4. Sudden Cardiac Death
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10
Q

Describe Stable (Typical) Angina Pectoris

A

Chronic coronary stenosing in which >75% of the lumen area is closed.

Myocytes become ischemic during physical activity, when there is an increased O2 demand, leading to angina

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11
Q

How does stable angina pectoris present and how is it relieved?

A

Presents: substernal chest pressure during physical activity or emotional excitement.

Relieved: vasodilator or nitroglycerin

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12
Q

Unstable Angina Pectoris

When does it occur?

A

Vulnerable, atherosclerotic plaque which causes only moderate stenosis (partially occluding thrombus), but can break off and cause plaque to break off.

Occurs somewhat frequently and requires less effort, can be at rest and last longer.

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13
Q

Stable vs Vulnerable Plaque

A

Vulnerable occludes less of the lumen but has a thinner cap and a more lipid rich atheroma.

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14
Q

Prinzmental Variant Angina

What is it? How is it diagnosed? How is it treated?

A

Chest pain as a result of coronary artery spasm, unrelated to anything in the patient’s control (physical activity, HR, BP)

Diagnosed by exclusion of other types

Responds to vasodilators

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15
Q

What is the most common cause of an MI?

A

Occlusive Thrombus Formation

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16
Q

At what point in time does irreversible ischemia begin during an MI?

A

Greater than 30 minutes

17
Q

Transmural vs Nontransmural infarcts

(what are they and what causes them?)

A

Transmural- the full thickness of the myocardium is infarcted at a particular location. It is the result of an occlusive thrombus.

Nontransmural- partial thickness infarct which is usually subendocardial (it is most distant from the coronary artery). Usually occurs because a clot was there but has been removed, there is severe hypotension or there are microinfarcts from some sort of drug usage (causing vasospasm).

18
Q

Gross/Microscopic Changes: 1/2 - 4 hours into an MI

A

No changes

19
Q

Gross/Microscopic Changes: 4-12 hours into an MI

A

Beginning of coagulation necrosis.

  1. Eosinophilia
  2. Loss of Nuclei
  3. Piknosis

No Gross Changes

20
Q

Gross/Microscopic Changes: 12 -24 hours into an MI

A
  1. Gross- dark mottling (due to hemorraging and blood moving through myocytes)
  2. Ongoing coagulation necrosis
  3. Pyknosis of nuclei
21
Q

Gross/Microscopic Changes: 1 - 3 days into an MI

A
  1. Gross- mottled
  2. Loss of nuclei and myocytes
  3. Neutrophil infiltrate
22
Q

Gross/Microscopic Changes: 3 - 7 days after an MI

A
  1. Myocyte disintegration
  2. Phagocytosis of dead cells
  3. Lots of neutrophil infilitrate
  4. Gross yellow color
23
Q

Gross/Microscopic Changes: 7 - 10 days after an MI

A
  1. Well-developed phagocytosis
  2. Early granulation tissue (lots of vascularization, scar tissue and collagen beginning to form)
24
Q

Gross/Microscopic Changes: 10 - 14 days after an MI

A

Some wisp of granulation tissue

25
Q

Gross/Microscopic Changes: 2 - 8 weeks after an MI

A

Scar formation

Dense collagen and visible scarring on tissue

26
Q

Presentation of an MI (6)

How does it sometimes differ in the elderly?

A
  1. Crushing substernal chest pain
  2. Dyspnea
  3. Diaphoresis
  4. Tachycardia
  5. Pulmonary Congestion
  6. Edema

Many elderly and diabetics have silent symptoms. They just feel a little “sick”.

27
Q

What are the molecules which increase in the blood following an MI?

A

CK, troponin, Myoglobin

28
Q

What does it mean if a part of the heart stains white with an LDH substrate?

A

It has ben infarcted.

LDH is in normal myocardium, but cells which have died leak it out so will not stain.

29
Q

MI treatment (general terms)

A

Anything which stops platelet aggregation/vasoconstriction, provides oxygen, and slows the work the heart is doing.

30
Q

Reperfusion Injury and MI’s (4 possible causes of injury)

A

The goal of reperfusion is to salvage the myocardium. There is a risk because restoration of blood flow can lead to:

  1. Free radical production
  2. Myocyte hypercontracture due to increased Ca
  3. Leukocyte aggregation
  4. Mitochondrial dysfunction (leading to apoptosis)
31
Q

List the potential MI complications

A
  1. Cardiogenic shock
  2. Arrhythmia
  3. Myocardial Rupture (muscle tears, hemorrhage)
  4. Acute pericarditis
  5. Ventricular aneurysm
  6. Progressive heart failure
32
Q

When is the heart most at risk for myocardial rupture post MI?

A

In the 3-7 day time period because the affected area has only dead myocytes and neutrophils (no scar tissue yet).

33
Q

What causes a ventricular aneurysm and what can happen as a result?

A

Loss of normal contractility can lead to outpouching which can dilate and allow for blood to pool and coagulate, which can lead to thrombus/embolus.

34
Q

Sudden Cardiac Death

What is it and what disease process is it associated with?

A

The result of a lethal arrhythmia due to some underlying chronic structural heart disease.

Chronic sever atherosclerotic heart disease found in 80-90% of cases.

35
Q

Patients with left-sided hypertensive heart disease are most at risk for what kind of heart failure? Why?

A

Diastolic heart failure due to hypertrophy which occurs as a result of the increased afterload.

MHD1/Pharm1 Exam 4 (26 decks)

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