10. Ischemia and HTN Flashcards
another name for ischemic heart disease?
most common cause?
CAD
atherosclerotic coronary artery obstruction
wt % of fixed lesion causes symptomatic ischemia during exercise?
rest?
> 75% - exercise
>90% - rest
cause of stable angina?
unstable/crescendo?
prinzmetal?
stable- fixed lesion
unstable- atherosclotic plaque w partial thrombus
prinzmetal - coronary artery spasm
4 clinical manifestations of ischemic heart disease?
angina
MI
chronic IHD w heart failure
sudden cardiac death
wt causes 90% of MI?
2 other causes?
Acute plaque disruption –> platelet adherence and activation –> vasospasm
vasospasm (w/o acute change) and emboli
wt occurs at the following times during myocardial eschemia:? first seconds - >2min - 20-40 min - >1 hr - 6 hours -
first seconds - stop glycolysis, dec ATP/CPK >2min - loss of contractility 20-40 min - irreversible injury >1 hr - microvascular injury 6 hours - necrosis complete
wt causes STEMI? non-STEMI?
Major physiologic cause of nonSTEMI?
STEMI = transmural infarct non-STEMI = subendocardial infarct (diffuse stenosing)
wt supplies blood to anterior 2/3 of ventricular septum?
wt supplies post. 1/3 in left dominant?
right dominant?
2/3 ant- Left Anterior Descending
left dominant 1/3 post. - Left Circumflex
right dominant - Right Coronary Artery
order or arteries causing MI?
LAD > RCA > Circumflex
2 microscopic events occurring 0-24 hrs into MI?
Coagulative necrosis
Wavy fibers
2 microscopic events occurring 1-3 days into MI? cells?
extensive coagulative necrosis acute inflammation (neutrophils) of surrounding tissue
microscopic event occurring 3-14 days into MI?
Macrophages come in
then granulation tissue
Cause of ST depression?
subendocardial MI
microscopic evidence of reperfusion secondary to MI?
gross evidence?
Contraction bands (eosinophilic transverse bands) Hemorrhage
4 symptoms of MI?
Dyspnea
Diaphoresis (sweating)
Chest pain
Nausea
gold standard for diagnosing MI?
2 biomarkers of MI?
wc is specific?
wc goes away faster?
ECG - gold standard
CK-MB
- normal in 48 hrs
troponin
- specific
- elevated for 7 days
wt complicaiton of MI causes hypotension and pulmonary vascular congestion?
Contractile dysfunction
3 ruptures that can occur post MI? possible complication of each?
papillary - mitral regurgitation
interventricular - L to R shunt
ventricular free wall - tamponade
2 complications of MI that occur weeks post MI?
Ventricular aneurysm
Dressler syndrome
pt presents 3 weeks post MI with persistent fever, chest pain and friction rub:
diagnosis?
cause?
Dressler syndrome
Autoimmune
2 complications of MI caused by large transmural infarcts?
cardiogenic shock
Arrhythmia
3 complications of MI caused by anterior transmural infarcts?
Aneurysm
Rupture
thrombi
complication of MI caused by inferior transmural infarcts?
Conduction block
define shock
inadequate perfusion to organs
