MI and ischemic heart disease Flashcards
0-4 hr post MI: path features and complications
no path features. complications: arrhythmia, heart failure, shock, death
4-12 hr post MI: path features
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
4-12 hr post MI complications
arrhythmia, shock, heart failure, death
12-24 hr post MI path features and complications
dark mottling; pale with tetrazolium stain grossly
PMN infiltration on LM. reperfusion injury may cause contraction bands.
complications: arrhythmia, HF, cardiogenic shock, and death
1-3 days post MI: path features
hyperemia and begining of yellow pallor.
on LM, see extensive coagulative necrosis. tissue around the infarct has acute inflammation and neutrophils.
Complications 1-3 days post MI
fibrinous pericardiits: a chest pain and friction rub with that may be seen with transmural infarctions
path features 3-14 days post MI
hyperemic border with central yellow-brown softening.
see macrophages, then granulation at the edges
complications 3-14 days post MI
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
complications 2 weeks to months after MI
Dressler syndrome: an autoimmune pericarditis seen 6-8 wks post-MI; heart failure, arrhythmias, true ventricular aneurysm with dyskinesia.
use of troponin vs. CK-MB testing
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.
V1-V4 Q waves implies…
anterior wall problem- LAD
V1-V2 Q waves implies…
anteroseptal LAD
V4-V6 Q waves implies…
anterolateral (LAD or LCX)
I and aVL Q waves implies…
lateral wall (LCX)
II, III, and aVF Q waves implies…
inferior wall (RCA)
What is fibromuscular dysplasia?
a cause of secondary hypertension. fibromuscular dysplasia is seen in young patients as a “string of beads” appearance on the renal artery.
What is the pathologic picture for HTN in the kidney?
see renal arterial hyalinosis on the PAS stain.
what is Monckeberg arteriosclerosis?
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
what are the two common types of arteriosclerosis? What kind of locations are common?
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.
