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Parker- CV Path > Nichols- Myocardial Ischemia & Infarction > Flashcards

Nichols- Myocardial Ischemia & Infarction Flashcards

1
Q

Is myocardial ischemia reversible or irreversible?

A

Reversible

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2
Q

List 5 causes of myocardial ischemia

A

Cici’s!

  1. Coronary stenosis
  2. Increased myocardial demand
  3. Coronary vasospasm
  4. Interplaque hemorrhage
  5. Superimposed thrombosis
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3
Q

How do acutely ischemic myocytes look under LM?

A

Normal! They look fine, but they dont work

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4
Q

What do myocytes look like under LM for chronic ischemia?

A

Myocytolysis takes place where the myocytes “hunker down” metabolically to preserve energy.. Abundant cytoplasm

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5
Q

Sometimes during periods of brief ischemia, protective proteins are made so that, next time, the heart will better respond to ischemia. This phenomenon is known as?

A

Ischemic preconditioning

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6
Q

This is an irreversible necrosis of heart muscle

A

MI

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7
Q

What are most MI’s caused by?

A

Thrombosis superimposed on atherosclerosis

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8
Q

Describe the gross appearance of a classic unreperfused acute phase of 0-12 hours. What about LM?

A

Gross: Looks normal
LM: maybe thin wavy myocytes (1-3 hrs); coagulation necrosis- loss of striations & hypereosinophilia (4-12 hrs)
Also, neutrophils start to show at 6-12 hours, peak at day 3

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9
Q

Gross appearance of classic MI at 12-24 hr?

A

Progressive pallor

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10
Q

Gross appearance of classic MI at 2-3 days? LM?

A

Gross: Yellow & softened
LM: neutrophil infiltration- peaks at DAY 3!; also some CONTRACTION BAND NECROSIS

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11
Q

Describe the gross appearance of a classic MI in the subacute phase of 4-7 days. LM?

A

Gross: Red granulation tissue is present
LM: macrophages and fibroblasts

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12
Q

Gross MI in subacute phase of 1-6 weeks?

A

Gradual replacement of yellow infarct by red granulation tissue

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13
Q

Gross MI in subacute phase of 6-12 weeks?

A

Gradual white scarring

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14
Q

Acute phase (days 1-3) LM?

A

Thin wavy myocytes –> coagulation necrosis –> neutrophil infiltration BEGINS –> contraction band necrosis

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15
Q

Early subacute phase (days 4-10) LM?

A

Day 2: lymphocytes
Day 3: macrophages
Day 4: fibroblasts

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16
Q

Late subacute phase (day 11-week 12) LM?

A

Angiogenesis + fibroblast proliferation = GRANULATION TISSUE

17
Q

There are 9 reperfusion effects. What are they?

A
  1. Smaller
  2. Patchier
  3. Hemorrhage
  4. More contraction band necrosis
  5. Accelerated repair
  6. Diffusion of inflammation/repair
  7. Fewer neutrophils
  8. More macrophages
  9. More interstitial fibrosis
18
Q

Gross reperfused MI acute phase (days 1-3)?

A

Dark mottling and hemorrhage

19
Q

Due to what, healing of a large infarct can be accelerated from 12 to 7 weeks?

A

Reperfusion

20
Q

With reperfusion, you get patches of preserved myocardium interspersed with scar. What problem can this lead to?

A

Re-entrant ventricular arrhythmias

Parker- CV Path (9 decks)

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