Path 2 Flashcards
causes of myocardial ischemia? lead to? conseq/cascade?
coronary embol, vasculitis, spasm, inc O2 demand
MI, stable angina, chronic IHD, sCD
metab abnlities -> abnl diastolic -> abnl systolic -> ST dep -> CP, angina
majority vs mild/mod ACS? hard vs soft plaque
from disrupted non-severe athero vs vuln/soft plaque <70% severity. small lipid core, thick fibrous cap, few inflamm cells, dense ECM vs big lipid core, thin fibrous cap, many inflamm cells, few smooth mm cells
what’s the major predictor of long term outcome of AMI?
infarct size. depends on severity & duration of obstruction, size of vasc bed that’s obstructed, O2 needs by myocardium at risk
Occlusion in major coronary a -> shift from aer to anaer metab
Anaer glycolysis -> dec ATP formation -> ATP to adenosine -> adenosine diffuse out of myocardiocytes -> arteriolar dil & anginal pain, loss intracell K+, accum Na+ & H2O
Anaer glycolysis -> lactic acid -> dec pH
Adenosine, lactate, K+ accum in great cardiac v -> loss myocardial ctx
transmural vs subendocardial MI
STEMI, Q waves; superimposed luminal thrombus vs NSTEMI, ST dep, invert T waves like UA but high cardiac markers; non-occlusive thrombus; circumferential infarct from supply/demand imbal from hem stroke or circ shock d/t chronic athero
Genetic causes of idio DCM. causes of 2ndary DCM?
TTN > LMNA > MHY7 -> connecting Z to M line for passive elasticity; lamin A/C & B heavy myosin chain mutation leading to premature codon. toxic, drug induced, birth, iron, viral myocarditis, excess catechol, Taksubo, Duchenne/Becker
complications of AMI?
arrhythmia, infarct extension/expansion, myocardial rupture 3-5d (free wall, septal, papillary; only for transmural), ventricular aneurysm (don’t rupture), mural thrombus, acute fibrinous pericarditis, RV infarct
pathology of AAA. dx?
more proteolytic than athero, more metalloproteinases –> variant of aortic athero, igG4-related autoimmune. US for screen, CT/MRI for detect
causes of true vs false aneurysm
athero –> saccular/fusiform appearance vs blunt/penetrate chest trauma, iatro, inflam/infxn
pathology of aortic dissect? assoc?
cystic medial nec w/ age -> destroyed elastin & collagen & rich ground substance disrupting elastin by mucin stain -> pseudocyst appearance. HTN, bicuspid aortic valve, Marfan, EhDan, Turner
sxs of type A vs B aortic dissect. assoc w/ syphilis aortitis
instant CP, dyspnea, stroke, hemopericardium -> cardiac tamponade vs abd/back pain, loss leg pulse, acute paraplegia. endoarteritis obliterans, aortic regurg, aortic ring dil, coronary ostial sten
examples of primary vs secondary cardiac tumors
atrial myxoma, papillary fibroelastoma, lipoma, lipomatous hypetroph atrial septum, cardiac rhabdo vs mets via lymph & hematogenous routes; malig melanoma > pleural mesothelioma, lung ca, brca, lymphoma
examples of vasc ectasia. reactive vasc hyperplasia?
spider angioma (dil preexisting arteriole), telangiectasia (atrophy skin by UV, irrad, glucocorticoids; SLE, scleroderma, varicose vv), hered hem telangiectasia (auto dom ENG -> epistax, GI bleed, anemia). pyogenic granuloma (gain fxn RAS, BRAF, GNA14 -> MAPK; from trauma; no pus -> bright red nodules), bacillary angiomatosis (hypoxia inducible factor -> VEGF -> red/purple ulcerS)
examples of benign vs intermediate vs malign vasc neoplasms
infantile/juvenile hemangioma, glomus tumors vs Kaposi’s, epithelioid hemangioendothelioma vs angiosarcoma
what happens in pressure overload? 3 causes of aortic sten? protein assoc w/ it?
concentric hypertrophy –> dec sV/CO & eject frxn –> pulm congestion, systolic murmur. calcified tricuspid valve, congen bicuspid aortic valve, rheum heart dz (mitral > aortic). bone morphogenetic protein 2
