MI and ischemic heart disease

Question 1

0-4 hr post MI: path features and complications

Answer 1

no path features. complications: arrhythmia, heart failure, shock, death

Question 2

4-12 hr post MI: path features

Answer 2

gross: dark mottling; pale with tetrazolium stain
LM: early coagulative necrosis with release of necrotic cell contents into the blood. edema, hemorrhage, and wavy fibers

Question 3

4-12 hr post MI complications

Answer 3

arrhythmia, shock, heart failure, death

Question 4

12-24 hr post MI path features and complications

Answer 4

dark mottling; pale with tetrazolium stain grossly
PMN infiltration on LM. reperfusion injury may cause contraction bands.
complications: arrhythmia, HF, cardiogenic shock, and death

Question 5

1-3 days post MI: path features

Answer 5

hyperemia and begining of yellow pallor.

on LM, see extensive coagulative necrosis. tissue around the infarct has acute inflammation and neutrophils.

Question 6

Complications 1-3 days post MI

Answer 6

fibrinous pericardiits: a chest pain and friction rub with that may be seen with transmural infarctions

Question 7

path features 3-14 days post MI

Answer 7

hyperemic border with central yellow-brown softening.

see macrophages, then granulation at the edges

Question 8

complications 3-14 days post MI

Answer 8

RUPTURE: free wall rupture (tamponade), papillary wall rupture (mitral regurg), IV septal rupture, LV pseudoaneurysm (mural thrombus “plugs” a hole in the myocardium)
pseudoaneurysm formation risk greates 1 wk post-MI; ruptures greatest 6-14 days post-MI

Question 9

complications 2 weeks to months after MI

Answer 9

Dressler syndrome: an autoimmune pericarditis seen 6-8 wks post-MI; heart failure, arrhythmias, true ventricular aneurysm with dyskinesia.

Question 10

use of troponin vs. CK-MB testing

Answer 10

troponin-I rises after 4 hrs and is high for 7-10 days. it is the most specific
CK-MB testing: predominently found in the myocardium but can also be released from skeletal muscle. used in diagnosing reinfarction after acute MI because levels return to normal within 48 hrs.

Question 11

V1-V4 Q waves implies…

Answer 11

anterior wall problem- LAD

Question 12

V1-V2 Q waves implies…

Answer 12

anteroseptal LAD

Question 13

V4-V6 Q waves implies…

Answer 13

anterolateral (LAD or LCX)

Question 14

I and aVL Q waves implies…

Answer 14

lateral wall (LCX)

Question 15

II, III, and aVF Q waves implies…

Answer 15

inferior wall (RCA)

Question 16

What is fibromuscular dysplasia?

Answer 16

a cause of secondary hypertension. fibromuscular dysplasia is seen in young patients as a “string of beads” appearance on the renal artery.

Question 17

What is the pathologic picture for HTN in the kidney?

Answer 17

see renal arterial hyalinosis on the PAS stain.

Question 18

what is Monckeberg arteriosclerosis?

Answer 18

uncommon finding. you see calficication in the MEDIA of arteries, esp. in the radial or ulnar artery. it is usually benign. You may see “pipestem” arteries on x-ray. it does NOT obstruct blood flow

Question 19

what are the two common types of arteriosclerosis? What kind of locations are common?

Answer 19

hyaline: thickening of the small arteries in essential HTN or in DM, or hyperplastic: onion skinning seen in severe HTN.
these would be small vessel diseases- think kidney, retina, etc.