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cardiovascular system > Pathophysiology of Ischaemia & Infarction > Flashcards

Pathophysiology of Ischaemia & Infarction Flashcards

1
Q

What is ischaemia?

A

Restriction in the blood supply to tissues, causing a shortage of oxygen that is needed for cellular respiration (to keep the tissue alive)

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2
Q

What is a restriction of blood supply to a tissue called?

A

Ischaemia

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3
Q

What is hypoxia?

A

Condition where part of the body is not recieving enough oxygen

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4
Q

What is the condition where part of the body is not recieving enough oxygen?

A

Hypoxia

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5
Q

What are some different kinds of hypoxia?

A

Hypoxic

Anaemic

Stagnant

Cytotoxic

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6
Q

What is hypoxic hypoxia?

A

Low inspired oxygen levels or normal inspired oxygen levels but low PaO2

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7
Q

What kind of hypoxia is low inspired oxygen levels or normal inspired oxygen levels but low PaO2​?

A

Hypoxic

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8
Q

What is anaemic hypoxia?

A

Normal inspired oxygen but blood is abnormal

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9
Q

What is the hypoxia with normal inspired oxygen levels but blood is abnormal?

A

Anaemia

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10
Q

What is stagnant hypoxia?

A

Normal inspired oxygen but abnormal delivery, due to local (occlusion of the vessel) or systemic problems (shock)

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11
Q

What is the hypoxia due to normal inspired oxygen but abnormal delivery, due to local (occlusion of the vessel) or systemic problems (shock)?

A

Stagnant hypoxia

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12
Q

What is cytotoxic hypoxia?

A

Normal inspired oxygen but abnormal at tissue level

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13
Q

What hypoxia is due to normal inspired oxygen but abnormal at tissue level?

A

Cytotoxic hypoxia

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14
Q

What are some factors that affect oxygen supply?

A

Inspired oxygen

Pulmonary function

Blood constituents

Blood flow

Integrity of vasculature

Tissue mechanisms

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15
Q

What are factors that affect oxygen demand?

A

Tissues itself (different tissues have different requirements)

Activity of the tissue above baseline value

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16
Q

What are the 2 general things that ischaemic heart tissue can be due to?

A

Supply issues

Demand issues

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17
Q

What are some examples of supply issues that can cause ischaemic heart disease?

A

Coronary artery atheroma

Cardiac failure (flow)

Pulmonary function (other disease or pulmonary oedema)

Anaemia

Previous myocardial infarction

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18
Q

What is an example of a demand issue that can cause myocardial ischaemia?

A

Heart has high intrinsic demand, possible due to exertion or stress

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19
Q

What is atheroma/atherosclerosis?

A

Localised accumulation of lipid and fibrous tissue in intima of arteries

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20
Q

What is localised accumulation of lipid and fibrous tissue in intima of arteries called?

A

Atheroma/atherosclerosis

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21
Q

What are some of the clinical impacts of atheroma?

A

Stable angina

Unstable angina

Ischaemia/infarction by thrombosis

Aneurysm (atheroma in the aorta)

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22
Q

What is stable angina?

A

Established atheroma in coronary arteries

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23
Q

What does an established atheroma in the coronary arteries cause?

A

Stable angina

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24
Q

What is unstable angina?

A

Complicated atheroma in the coronary arteries

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25
What is a complicated atheroma in the coronary arteries called?
Unstable angina
26
What are some possible clinical consequences due to atheroma?
Myocardial infarction Transient ischaemic attack (TIA) Cerebral infarction Abdominal aortic aneurysm Peripheral vascular disease Cardiac failure
27
What does TIA stand for?
Transient ischaemic attack
28
What is a transient ischaemic attack?
Brief interruption of blood flow to part of the brain that causes temporary stroke like symptoms
29
What is peripheral vascular disease?
Blood circulation disorder that causes the blood vessels outisde of your art and brain to narrow, block or spasm (happens in arteries or veins)
30
What is a brief interruption of blood flow to part of the brain that causes temporary stroke like symptoms called?
Transient ischaemic attack
31
What is a cerebral infarction?
Area of necrotic tissue in th ebrain resulting from a blockage or narrowing in the arteries supplying it with blood
32
What is an area of necrotic tissue in th ebrain resulting from a blockage or narrowing in the arteries supplying it with blood called?
Cerebral infarction
33
What is an abdominal aortic aneursm?
Localised enlargement of the abdominal aorta so the diameter is greater than 3cm
34
What is localised enlargement of the abdominal aorta so the diameter is greater than 3cm called?
Abdominal aortic aneurysm
35
What is it called when the heart does not pump blood as well as it should?
Heart failure
36
What is blood circulation disorder that causes the blood vessels outisde of your art and brain to narrow, block or spasm (happens in arteries or veins) called?
Peripheral vascular disease
37
What is cardiac failure?
Heart does not pump blood as well as it should
38
What does coronary artery disease lead to, and then what does this lead to?
Coronary artery disease -\> myocardial infarction -\> cardiac failure
39
In terms of formular, why does an atheroma have an impact on blood flow?
Atheroma decreases the radius of the vessel, causing decrease in flow (to the power of 4) This decreases the delivery of oxygen and causes myocardial infarction
40
What are the different categories of ischaemia?
Acute Chronic Acute-on-chronic
41
How does ischaemia effect cells biochemically?
Decreased oxygen means aerobic respiration is not possible So cell performs anaerobic respiration Which does not produce enough energy Cell death occurs
42
What can be said about the impact of ischaemia on different tissues?
Different tissues have variable oxygen demands and so have variable susceptibility to ischaemia
43
What cannot be performed in a cell without oxygen?
Aerobic respiration
44
What are the clinical effects of ischaemia?
Dysfunction Pain Physical damage
45
What are the possible outcomes of ischaemia?
No clinical effect Resolution verses therapeutic intervention Infarction
46
What is infarction?
Obstruction of the blood supply to an organ or region of tissue causing death of the tissue
47
What is infarction due to?
Cessation of blood flow
48
What is the aetiology of infarction?
Thrombosis Embolism Strangulation Trauma
49
What does the scale of damage due to ischaemia/infarction depend on?
Time period Tissue/organ Pattern of blood supply Previous disease
50
What is the biochemical process of infarction?
1) Anaerobic respiration 2) Cell death 3) Liberation of enzymes 4) Breakdown of tissue
51
What are examples of infarction?
Coagulative necrosis Colliquative necrosis
52
What is coagulative necrosis?
Accidental cell death typically caused by ischaemia or infarction, architecture of dead tissue is preserved for a few days so if surrounded by healthy tissue regeneration can occur
53
What is accidental cell death typically caused by ischaemia or infarction, architecture of dead tissue is preserved for a few days so if surrounded by healthy tissue regeneration can occur called?
Coagulative necrosis
54
What is colliquative necrosis?
Type of necrosis that results in transformation of the tissue into liquid viscous mass
55
What is the type of necrosis that results in transformation of the tissue into liquid viscous mass called?
Colliquative necrosis
56
Where does coagulative necrosis occur?
Heart and lungs
57
Where does colliquative necrosis occur?
Brain
58
What is the process of myocardial infarction?
1) Coronary artery obstruction 2) Decrease in blood flow to region of the myocardium 3) Ischaemia and rapid myocardial dysfunction 4) Myocyte death
59
What does myocardial infarction lead to?
Anaerobic respiration, onset of ATP depletion (within seconds) Loss of myocardial contractility which leads to heart failure (within 2 minutes) Ultrastructural changes (after a few minutes) Myocyte necrosis (20-40 minutes) Injury to the microvasculature (after 1 hour)
60
What are examples of microstructure changes that occurs due to myocardial infarction?
Myofibrillar relaxation Glycogen depletion Cell and mitochrondrial swelling
61
How does the appearance of infarcts change within less than 24 hours?
No change on visual inspection A few hours to 12 hours post insult see swollen mitochondria on electron microscopy
62
How does the appearance of infarcts change between 24-48 hours?
PALE INFARCT Solid tissues RED INFARCT Loose tissues Previously congested tissues Second/continuing blood supply Venous occlusion MICROSCOPICALLY Acute inflammation initially at edge of infarct, leading to loss of specialisd cell features
63
How does the appearance of infacts change after 72 hours?
MACROSCOPICALLY ``` Pale infarct (yellow/white and red periphery) Red infarct (little change) ``` MICROSCOPICALLY Chronic inflammation Macrophages remove debris Granulation tissue Fibrosis
64
What are examples of pale infarcts?
Myocardium Spleen Kidney
65
What are examples of red infarcts?
Lung Liver
66
What is the end appearance of infarction?
Scar replaces area of tissue damage Shape depend on territory of occluded vessel Possibly reperfusion
67
What is reperfusion?
Tissue damage caused when blood supply returns to a tissue after a period of ischaemia
68
What is tissue damage caused when blood supply returns to a tissue after a period of ischaemia called?
Reperfusion
69
What is the reparative process after infarction?
1) Cell death 2) Acute inflammation 3) Macrophages phagocytosis of dead cells 4) Granulation tissue 5) Collagen deposition (fibrosis) 6) Scar formation
70
What is the microscopic process of myocardial infarction?
4 TO 12 HOURS Early coagulation necrosis Oedema Haemorrhage 12 TO 24 HOURS Ongoing coagulation necrosis Myocyte changes Early neutrophilic infiltrate 1 TO 3 DAYS Coagulation necrosis Loss of nuclei and striations Brisk neutrophilic infiltrate 3 TO 7 DAYS Disintegration of dead myofibrils Dying neutrophils Early phagocytosis 7 TO 10 DAYS Well developed phagocytosis Granulation tissue at margins 10 TO 14 DAYS Well established granulation tissue with new blood vessels and collagen deposition 2 TO 8 WEEKS Increased collagen deposition Decreased cellularity MORE THAN 2 MONTHS Dense collagenous scar
71
What are the 2 different kinds of myocardial infarction?
Transmural infarction Subendocardial infarction
72
What is a transmural infarction?
Ischaemic necrosis affects full thickness of the myocardium
73
What is it called when ischaemic necrosis affects full thickness of the myocardium?
Transmural infarction
74
What is subendocardial infarction?
Ischaemic necrosis mostly limited to a zone of the myocardium under the endocardial lining of the heart
75
What is it called when ischaemic necrosis mostly limited to a zone of the myocardium under the endocardial lining of the heart?
Subendocardial infarction
76
How do the histological features compare between transmural and subendocardial infactions?
They are the same (same repair time and granulation tissue stage followed by fibrosis)
77
Clinically, what are acute infarcts classifed according to?
Whethere there is an elevation of the ST segment on the ECG: NSTEMI STEMI
78
Clinically, what are the 2 kinds of acute infarcts?
STEMI NSTEMI
79
What does STEMI stand for?
ST elevated myocardial infarction
80
What does NSTEMI stand for?
Non-ST elevated myocardial infarction
81
What kind of myocardial infarction is NSTEMI thought to correlate with?
Subendocardial infarction
82
What does the effects of infarction depend on?
Site of infarct (within body and organ) Size of infarct Contribution of previous disease/infarction
83
What are some possible effects of infarction?
Death Dysfunciton (pain)
84
What can complications of myocardial infarction be classified as?
Immediate Early Late
85
What are some examples of complications of myocardial infarctions?
Sudden death Arrhythmias Angina Cardiac failure Cardiac rupture (ventricular wall, septum or papillary muscle Reinfarction Pericarditis Pulmonayr embolism secondary to deep vein thrombosis Mitral incompetence Ventricular aneurysm

cardiovascular system (41 decks)

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