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sg5 > Nov22 M3-Pathology - Coronary Artery Disease > Flashcards

Nov22 M3-Pathology - Coronary Artery Disease Flashcards

1
Q

ischemic heart disease and causes

A

imbalance of supply demand to myocardium. 90% caused by CAD. also anemia, low flow states

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2
Q

critical stenosis definition + why this occurs

A

70% stenosis, no symptoms below that

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3
Q

90% stenosis what is the problem

A

symptoms of angina even at rest = unstable angina

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4
Q

stable vs unstable angina

A 
stable = pain occurs with exertion, at a predictable level of exercise
unstable = pain happening with less and less exertion
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5
Q

acute MI def

A

cardiomyocyte death

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6
Q

acute coronary syndrome includes what

A

unstable angina, acute MI, SCD (sudden cardiac death)

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7
Q

subendocardial vs transmural infarct causes

A

subendocardial if partially occlusive thrombus (can also give unstable angina). transmural MI if completely occlusive thrombus

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8
Q

angina phenomenon happening

A

ischemia

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9
Q

why is the infarct initially subendocardial and then develops to transmural?
IMP

A

because receives most pressure (most compression on vessels) + furthest from coronaries. infarction progresses towards epicardium

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10
Q

subendocardial infarct starts with _______

A

incomplete stenosis

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11
Q

subendocardial vs transmural MI on ECG

A

subend: no Q wave, ST depression, T wave inversion, NSTEMI

transmural MI: STEMI. Q waves, St elevation

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12
Q

LAD stenosis consequence

A

antero-septal subendocardial MI

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13
Q

posterior descending stenosis conseq

A

postero-septal subendocardial MI

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14
Q

RCA, LAD and LCX stenosis conseq

A

circumferential subendocardial MI

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15
Q

LAD complete occlusion conseq

A

anteroseptal transmural MI

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16
Q

RCA complete occlusion conseq

A

postero-septal transmural MI

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17
Q

microscope findings after infarct 1 day

A

wavy fibers, eosinophilic

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18
Q

microscope findings after infarct 2-3 days

A

PMNs infiltration

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19
Q

microscope findings after infarct 7-10 days

A

macrophages clean (eat dead myocyte) + neutrophils gone

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20
Q

microscope findings after infarct 14 days

A

new vessels, collagen (granulation tissue)

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21
Q

microscope findings after infarct 7 weeks+

A

collagen scar

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22
Q

main complications of MI

A

HF, cardiogenic shock, arrhythmias, vent rupture (tamponade), mural thrombus and embolism, septum shunt, valve dysfct (if pap muscle)

23
Q

unstable angina leads to ?

24
Q

what occurs in unstable angina?

A 
disruption of plaque
plaque rupture
platelet aggregation
thrombus formation
vasoconstriction

increase in duration and tempo of angina at less exertion & rest

25
Q

how does stable angina occur

A 
plaque 
vasoconstriction (by endothelial dysfunction)
26
Q

variant angina is what?

A

NO PLAQUE
ischemia due to VASOSPASM
occurs at REST

27
Q

what is unstable angina?

A

increase in tempo and duration of ischemia with LESS exertion and AT REST

28
Q

what are acute coronary syndromes?

A

MI and Unstable Angina

29
Q

when is the definition of stable angina?

A

predictable, transient chest discomfort during exertion or emotional stress

30
Q

types of ischemia

A

stable angina
unstable angina
variant angina
silent angina

31
Q

variant angina is also known as?

A

printzmetal angina

ONLY CAUSED BY VASOSPASM
NO PLAQUE!!!

32
Q

silent ischemia is what?

A

asymptomatic ischemia

occurs in elderly, diabetes, women

33
Q

angina referred to as what?

A 
tightness
burning
heaviness
pressure 
discomfort 
elephant sitting on chest***

lasts from few seconds to <5 minutes

NOT PAIN

34
Q

Angina sign?

A

Levine sign!!!

hand clenched over sternum
shows discomfort

35
Q

Angina where does it occur?

A

Diffuse

radiates to left sholders jaw back neck retrosternal inner arma

36
Q

Ischemic heart disease risk increases most with what risk factor?

A

higher cholesterol levels
hypertension
(higher in males than females)

37
Q

what factors favour occlusive thrombus?

A

procoagulant (tissue factor)

antifibrinolytic (PAI- plasminogen activator inhibitor)

38
Q

what factors resist thrombus accumulation?

A

anticoagulants (thrombomodulin, heparin)

profibrinolytic (tPA)

39
Q

describe vulnerable plaques

A

more inflammatory cells
large lipid pool
thin fibrous cap

40
Q

which cardiac biomarkers can tell you cardiovascular risk?

A

lipoprotein

C Reactive Protein (CRP)

41
Q

ATHEROSCLEROSIS CAUSES WHAT?!

42
Q

atherosclerosis epidemiology

A

leading cause of mortality and morbidity

43
Q

what are the three determinants of myocardial oxygen demand?

A

wall stress
heart rate
contractility

44
Q

vasodilators from endothelium

A

prostacyclin
NO
EDHF

45
Q

vasoconstrictors from endiothelium (increase during endothelial dysfunction = injury = atherosclerotic plaque)

A

Endothelin -1

46
Q

stunned myocardium

A

after ischemia there is a prolonged systolic dysfunction
delayed recovery bc Ca+ overload
reversible
NO NECROSIS

47
Q

hibernating myocardium

A

multivessel CAD –> VENTRICULAR CONTRACTILE dysfunction

NO NECROSIS

48
Q

examples of contractile dysfunction by ischemia where there is NECROSIS?

A

stable angina

unstable angina

49
Q

Angina accompanying symptoms? (3)

A

tachycardia
diaphoresis
nausea

Also fatigue, weakness

50
Q

Angina is caused by what conditions

A

Exertion

conditions which increase O2 demand (wall stress, heart rate, contractility)

51
Q

risk factors for atherosclerosis –> CAD

A

cigs
dyslipidemia
HTN
= MODIFIABLE

-family history

52
Q

ischemia most common symptom?

A

angina pectoris =discomfort due to M.I.

53
Q

what is stable angina?

A

chronic pattern of transient angina pectoris by exertion or emotional upset

ST depression

sg5 (55 decks)

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