Pathology of the Heart III

Question 1

C reactive protein

Answer 1

marker for inflammation

levels of 1-3 - moderate risk for coronary heart disease

atherosclerotic plaques - cause sustained chronic inflammation

Question 2

prinzmetal angina

Answer 2

sustained vasospasm causing angina

Question 3

cardiac raynaud

Answer 3

cold or emotion induced cardiac vasospasm

-> 20 mins - can lead to MI

Question 4

takotsubo cardiomyopathy

Answer 4

dilated cardiomyopathy - secondary to emotional or physical stress with normal coronary angiogram

repeated bouts of vasospasm

Question 5

cocaine

Answer 5

can cause vasospasm

Question 6

sudden cardiac death

Answer 6

unexpected death from cardiac cause early after onset of symptoms (1-24 hours)

or sudden death from cardiac cause without acute symptoms

normally - lethal arrhythmia - V-fib

caused by IHD

Question 7

channelopathies

Answer 7

K, Na, Ca channel problems

-most autosomal dominant

Question 8

brugada syndrome

Answer 8

ST elevation and RBBB

syncope or sudden cardiac death during rest, sleep, after large meals

Question 9

CPVT syndrome

Answer 9

childhood life threatening arrhythmias
-stress induced

no EKG changes

change in diastolic Ca release

Question 10

non-ischemic SCD

Answer 10

people < 40yo

majority hypertrophic cardiomyopathy

Question 11

commotio cordis

Answer 11

set off arrhythmia by poking individual in chest

Question 12

chronic IHD

Answer 12

CHF in pt with previous MIs and angina

LVH and dilation

myocardial fibrosis - past MI

arrhythmia, CHF, MI develop

Question 13

myocyte hibernation

Answer 13

chronic ischemia that does not cause necrosis - hypokinetic myocardium

Question 14

angina pectoris

Answer 14

recurrent substernal discombort

ischemia falling short of inducing necrosis

Question 15

stable angina

Answer 15

with exertion

goes away with rest

Question 16

unstable angina

Answer 16

crescendo

• acute plaque change
• may occur at rest

Question 17

prinzmetal angina

Answer 17

coronary vasospasm

-relieved with rest, nitro, and CCBs

Question 18

longer than 20 minutes

Answer 18

kill myocytes

Question 19

MI

Answer 19

death of cardiac muscle from ischemia

more in men

> 65 yo higher risk

Question 20

stain for MI

Answer 20

triphenyltetrazolium chloride

• viable - red
• non-viable - pale

Question 21

transmural infarct

Answer 21

more than half - around 75%

Question 22

subendo infarct

Answer 22

less than half

Question 23

balloon angioplasty

Answer 23

do within 6 hours

-after this time - unsalvagable necrosis

Question 24

gross changes with MI

Answer 24

dark mottling by 12 hours

1-3 days yellow-tan infarct center
1 week hyperemic border with yellow-tan softening
10 days yellow-tan/soft depressed red-tan margins
2 weeks red-gray borders
2 months - white scar

Question 25

micro changes with MI

Answer 25

``` waviness - earliest change - 4 hours or so 4-12 hrs - coaguative necrosis 12-24 hours - neutrophils 1-3 days - lots of neutrophils 3-7 days early phagocytosis 7-10 days granulation tissue forms at margins 10-14 days lots of granulation tissue 2-8 weeks - collagen deposition 2 months - dense collagen scar ```

Question 26

MI with neutrophils

Answer 26

1-3 days old

Question 27

MI with no neutrophils

Answer 27

less than 1 day old

Question 28

MI with macrophages

Answer 28

1 week old

Question 29

MI with granulation tissue and collagen

Answer 29

2 weeks old

Question 30

MI with pure scar

Answer 30

months old

Question 31

occluded LAD

Answer 31

most common | widowmaker

Question 32

occluded RCA

Answer 32

arrhythmias

Question 33

MI reperfusion techniques

Answer 33

lysis - tPA, streptokinase, urokinase bypass graft -balloon angioplasty with thrombolytic drugs - cannot do procedure until drugs are gone**

Question 34

reperfusion after 6 hours

Answer 34

does not reduce MI size

Question 35

stunning

Answer 35

viable tissue but non-functional after MI -is reversible reperfusion 2-4 hours after MI

Question 36

pathology of reperfusion

Answer 36

arrhythmias hemorrhage with contraction bands no-reflow (capillary closure) -stunning

Question 37

MI clinical Sx

Answer 37

chest pain, radiate left arm, neck, jaw weak pulse rapid sweating nausea dyspnea

Question 38

STEMI

Answer 38

transmural

Question 39

NSTEMI

Answer 39

subendocardial

Question 40

troponins for heart

Answer 40

I and T slower rise and fall 5 to 10 days to fall

Question 41

CK for heart

Answer 41

CK-MB quick rise and fall decreased by 2-3 days

Question 42

myoglobin

Answer 42

used to exclude MI -no myoglobin - no MI yes myoglobin - could be lots of reasons quick rise and fall - decreased by 24 hours

Question 43

serial cardiac enzymes

Answer 43

taken every 2 hours or so

Question 44

CK-MB low and troponin high

Answer 44

more than 3 days ago

Question 45

CK-MB high and troponin high

Answer 45

current MI

Question 46

complications of MI

Answer 46

myocardial rupture - VSD, papillary (regurg), cardiac tamponade pericarditis right ventricular infarction infarct extension and expansion (dilation and thinning of heart) mural thrombus ventricular aneurysm