ana 5 Flashcards
(25 cards)
What is ischemic heart disease (IHD)?
A group of related syndromes arising from insufficient blood supply to the myocardium relative to functional demand.
What are the primary causes of myocardial ischemia?
- Vessel occlusion
- Coronary atherosclerosis
- Coronary emboli
- Myocardial vessel inflammation
- Vascular spasm
- Increased myocardial demand
- Hypoxemia
- Systemic hypotension
What percentage of global deaths did ischemic heart disease account for in 2011?
11.2%
Which countries account for the largest number of deaths from ischemic heart disease?
- Russia
- United States of America
- Ukraine
True or False: Ischemic heart disease has equal incidence in white and black populations.
True
What are the modifiable risk factors for ischemic heart disease?
- Hypertension
- Hyperlipidemia
- Obesity
- Reduced physical exercise
- Significant alcohol intake
What are the absolute risk factors for ischemic heart disease?
- Male gender
- Age
- Positive family history
What are the relative risk factors for ischemic heart disease?
- Smoking
- Hypertension
- Diabetes mellitus
- Haemostatic factors
- Physical inactivity
- Obesity
- Alcohol
- Other dietary factors
- Personality types
- Social deprivation
List the clinical syndromes in which ischemic heart disease can present.
- Acute myocardial infarction
- Angina pectoris
- Chronic ischemic heart disease with heart failure
- Sudden cardiac death
What is the main cause of ischemic heart diseases?
Atherosclerosis, a progressive inflammatory disease of the arterial wall.
What are the early stages of atherosclerosis characterized by?
- Abnormal endothelial function
- Binding of inflammatory cells to endothelial receptors
- Migration of cells to the intima
- Formation of lipid-laden foam cells
- Migration of smooth muscle from media to intima
- Formation of atheromatous plaque
What are the main cells involved in advanced atherosclerosis?
- Macrophages
- Smooth muscle cells
What triggers platelet aggregation and thrombosis in atherosclerosis?
Breach of the integrity of the plaque that exposes the content to blood.
What is stable angina?
Chest discomfort precipitated by activity and relieved by rest or vasodilators.
What is unstable angina?
Discomfort or frank pain precipitated by progressively lower levels of physical activity or occurring at rest.
What is Prinzmetal angina?
Angina caused by vasospasm, unrelated to physical activity, heart rate, or blood pressure.
What is myocardial infarction?
Death of cardiac muscle due to prolonged severe ischemia.
What percentage of myocardial infarcts occur in people younger than age 40?
10%
What are the major causes of myocardial infarction?
- Coronary arterial occlusion (90%)
- Vasospasm
- Emboli
- Ischemia without detectable coronary atherosclerosis and thrombosis
- Vasculitis, SCD, amyloidosis, shock, vascular dissection
What does the LAD branch of the left coronary artery supply?
- Apex of the heart
- Anterior wall of the left ventricle
- Anterior two-thirds of the ventricular septum
What does the RCA supply?
- Entire right ventricular free wall
- Posterobasal wall of the left ventricle
- Posterior third of the ventricular septum
What are the patterns of myocardial infarction?
- Transmural
- Sub-endocardial
- Multifocal micro-infarction
What is the gross finding of myocardial infarctions less than 12 hours old?
Usually not apparent on gross examination.
What are the complications of myocardial infarction?
- Contractile dysfunction
- Arrhythmias and conduction defects
- Extension of infarction or re-infarction
- Congestive heart failure
- Cardiogenic shock
- Pericarditis
- Mural thrombosis
- Myocardial wall rupture
- Papillary muscle rupture
- Ventricular aneurysm formation
