Pathophysiology of ischaemia and infarction (part 2) Flashcards

1
Q

how does infacrts appear to the naked eye in the fiorst 24 hours?

A

not much to see upon visual inspection

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2
Q

What can be seen (infarction) form a few hours to 24hours?

A

see swollen mitochondria on electron microscopy

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3
Q

what is the visual appearance of infarction from 24-48 hours?

A

pale infarct

red infarct

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4
Q

What tissues/organs have a pale infarct?

A

myocardium, spleen, kidney, solid tiossues

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5
Q

What tissues/organs have a red infarct?

A

lung, liver, loose tissues, previously congested tissues; second/continuing blood supply, venous occlusion

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6
Q

What occurs microscopically (24-48 hours infarction) at the edge of infarct?

A

loss of specialized cell features

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7
Q

Does the red infarct change ~72 hours onwards?

A

little change

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8
Q

Does the pale infarct change ~72 hours onwards?

A

yellow/white and red periphery

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9
Q

How do the infarcts apppear microscopically ~72 hours onwards?

A

chronic inflammation; macrophages remove debris; granulation tissue; fibrosis

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10
Q

What is the end result of infarction?

A

scar replaces area of tissue damage

shape depends on territory of occluded vessel

repurfusion injury

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11
Q

What is reperfusion injury?

A

return of oxygen supply to an area after ischaemia - not ideal - inflammation to area

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12
Q

What is the reoparative processs of MI?

A

cell death

acute inflammation

macrophage phagocytosis of dead cells

granulation tissue

collagen deposition (fibrosis)

scar formation

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13
Q

What occurs 4-12 hours MI?

A

early coagulation necrosis, oedema, haemorrhage

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14
Q

What happens 12-14 hours MI?

A

ongoing coagulation necrosis, myocyte changes, early neutrophilic infiltrate

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15
Q

What happens 1-3 days MI?

A

coagulate necrosis, loss of nuclei and striations, brisk (lots) neutrophilic infiltrate

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16
Q

What happens 3-7 days MI?

A

disintegration of dead myofibres, dying neutrophils, early phagocytosis

17
Q

What happens 7-10 days MI?

A

well developed phagocytosis, granulation tissue at margins

18
Q

What happens 10-14 days MI?

A

well established granulation tissue with new blood vessels and collagen depositionW

19
Q

What happens 2-8 weeks MI?

A

increased collagen deposition, decreased cellularity

20
Q

What happens >2 months MI?

A

dense collagenous scar

21
Q

What is transmural infarction?

A

ischaemia necrosis affects full thickness of the myocardium

22
Q

Whatis subendocardial infarction?

A

ischaemic necrosis mostly limited to a zone oof myocardium under the endocardial lining of the heart

23
Q

Compare the length of time for granulation tissue stage followed by fibrosis for transmural infarction vs subendocardial infarction?

A

in subendocardial infarct possibly slightly shortened compared to transmural infarct

24
Q

What are the acute myocardial infarcts classified according to?

A

whether there is elevation of the ST segment on the ECG

25
Q

What happens if there is no ST segment elevation but significantly elevated serum troponin level?

A

non-STEMI

26
Q

What is non-STMI, in relation to ST segment and troponin levels?

A

no ST segment elevation

significantly elevated serum troponin level

27
Q

What does non-STEMI correlate with?

A

subendocardial infarct

28
Q

What are factors effecting the effects of infarction?

A

site dependent - within body and organ

size of infarct

(may cause) death, dysfunction (pain)

contribution of previous disease/infarction - there will be decreased reserve in the person to cope with infarction

29
Q

What are the time categories of MI?

A

immediate

early

late