Path slide set 3 Flashcards
Transient, often recurrent chest pain induced by myocardial ischemia insufficient to induce myocardial infarction
Angina pectoris
describe the pulmonary congestion of primary right sided heart failure
minimal
Vascular changes of the heart from aging
- coronary atherosclerosis
- stiffening of the aorta
Half of all MI deaths occur within 1 hour of onset and are usually secondary to what?
arrhythmia
what are 2 situations that can cause asymptomatic heart attacks?
- diabetics
- heart transplant patients can be denervated
What can cause isolated right sided heart failure?
anything that causes pulmonary hypertension
- parenchymal lung diseases (emphysema)
- primary pulmonary HTN
- pulmonary vasoconstriction
-episodic coronary ARTERY SPASM relieved by vasodilaters
Prinzmetal variant angina
Where does a ventricular aneurysm most frequently seen
apex and pops out during systole
Classic presentation of a myocardial infarction
- PROLONGED CHEST PAIN (>30 min)
- -crushing, stabbing, squeezing, tightness
- -radiating down left arm, or to left jaw
- DIAPHORESIS
- dyspnea
- Nausea-vomiting
- up to 25% are asymptomatic
What will not help in determining if there was an MI after a car wreck?
CK-Mb because of muscle damage
Most common arteries that cause ischemia to heart?
- LAD
- left circumflex
- right coronary
what are the risk factors for a myocardial rupture
- age
- large transmural ANTERIOR MI
- FIRST MI
- absence of LV hypertrophy
what is a complication of an MI due to the inflammatory process of neutrophils coming in
fibrinous pericarditis
- Pain, increasing in frequency, duration, and severity, eventually at rest
- usually RUPTURE of a plaque, with a partial thrombus
- 50% may have evidence of myocardial necrosis
Unstable (or “crescendo”) angina
- STENOTIC OCCLUSON of coronary artery
- “squeezing” or burning sensation relieved by rest or vasodilators
- symptoms come on with exercise or effort
Stable angina
in the setting of volume overload, describe the hypertrophy
myocytes elongate and ventricular dilation is seen
Morphology of MI 3-4 days
neutrophils
Morphology of MI 24 hours
coagulative necrosis
Morphology of MI 2 months
dense collagen
What is the best measure of hypertrophy?
heart weight
When does a myocarcial rupture occur
2-4 days post MI when inflammation and necrosis have weakened the wall
what is the most common cause of right sided heart failure?
left sided heart failure
Describe the venous system in primary right sided heart failure
markedly congested:
- lever congestion (nutmeg liver)
- splenic congestion (splenomegaly)
- effusions of peritoneal, pleural, and pericardial spaces (ascites)
- renal congestion
- edema, especially in dependent areas (ankles)
left sided heart failure is most commonly a result of what 4 things?
- myocardial ischemia
- HTN
- left-sided valve disease
- primary myocardial disease
Concentric hypertrophy causes what dysfunction?
Dilated?
diastolic
systolic
What morphological feature can be found in dead myocytes that are repurfused and why?
necrosis with contraction bands because dead myocytes are able to contract because of influx of calcium from repurfusion
a myocardial rupture after an MI typically requires what?
transmural infarct
What will stain normal cells red because they contain lactate dehydrogenase and will leave lysed or death cells pale or white?
triphenyltetrazolium chloride
What occlusion more commonly causes an arrythmia after MI
RCA
Left ventricular dysfunction can lead to left atrial dilation which can then lead to what?
- atrial fibrillation
- stasis
- thrombus
causes of myocardial infarction
- nearly 90% to atheromatous plaque
- embolus
- vasospasm (cocaine)
- ischemia secondary to vasculitis, shock, hematologic abnormality (sickly cell)
left sided heart failure leading to Decreased ejection fraction may result in decreased glomerular perfusion which will cause what?
- stimulation of renin and increased volume
- Prerenal Azotemia
how long does it take a zone of necrosis during an MI to become transmural
6-24 hours
Pressure overload from systemic HTN gives what kind of hypertrophy
myocytes become thicker and the left ventricular wall thickness increases concentrically
What are the clinical effects of left sided heart failure due to?
- congestion in pulmonary circulation
- decreased tissue perfusion
What usually precipitates sudden cardiac death
coronary artery disease. could be subclinical
morphology of MI 7-10 days
macrophages
Valve changes with aging
- Aortic and mitral valve annular calcification
- fibrous thickening
- mitral valve leaflets buckling towards left atrium-> increased left atrium size
- LAMBLE EXCRESCENCES
Morphology of MI 10-14 days
early granulation tissue. some collagen
when do troponins peak
24 hours
myocardium and chamber changes of the heart with aging
- Decreased LV size
- increased epicardial fat
- Myocardial lipofuscin and basophilic degeneration
- fewer myocytes and increased collagen in myocardium
best lab test for MI
troponins I and T most specific for cardiac myocyte
Leading cause of death in U.S.
ischemic heart disease
what situations cause cardiac myocytes to become hypertrophic?
- sustained pressure or volume overload
- sustained trophic signals (B-adrenergic stimulation)
