CARD 42- Pathology: Ischemic Heart Disease

Question 1

What are all ischemic heart diseases a product of?

Answer 1

Question 2

What is the most common thing that IHD is secondary to?

How long does this take to develop before becoming symptomatic?

Answer 2

Question 3

List and describe the 4 main cardiac symptoms of IHD

Answer 3

Question 4

Epidemiology of IHD

• How common is IHD? How common is death from IHD?
• Why has IHD mortality decreased in the last 50 years?

Answer 4

Question 5

Pathogenesis of IHD

• What is the most common cause of IHD?
  
  • What are the other 2 “common” causes of IHD?
• What coronary arteries are most implicated in IHD?

Answer 5

Question 6

Using vessel occlusion percentage and symptom manifestations, differentiate between asymptomatic IHD, stable angina, and unstable angina

Answer 6

Question 7

What event is the common trigger of acute coronary syndromes (Unstable angina, MI, SCD)

Answer 7

Question 8

Ischemic Heart Disease: Acute Plaque Change

• In patients who suffer MI, what phenomenon occurs that makes it impossible to predict the risk of plaque rupture?

Answer 8

Question 9

Angina Perctorus

• Is Angina Pectoris caused by myocardial injury or death?
• What molecules cause the pain associated with it?

Answer 9

Question 10

Stable (typical) angina

• What causes the pain to occur?
• Where does the pain start and radiate to?
• What can relieve the pain?

Answer 10

Question 11

Prinzmetal (variant) angina

• What causes this? When does it occur?
• What vessels does this affect?
• What can relieve the pain associated with this?

Answer 11

Question 12

Unstable angina (crescendo angina)

• When does this occur, and what is noted about the frequency of associated pain?
• When happens in the vessels that this is usually associated with?
• What major cardiac event is this associated with?

Answer 12

Question 13

Myocardial Infarction

• What is the major underlying cause of MI?
• What causes an increased risk of MI?
• Name the series of events that occur during a typical MI?

Answer 13

Question 14

MI: Epidemiology

• What group of people have increased risk for MI?

Answer 14

Question 15

Pathogenesis of MI

• Full in the blacked out words

Answer 15

Question 16

Pathogenesis of MI

• In an MI, what area of the heart is the first to have an irreversible injury due to ischemia?
  
  • Why?
• How long does it take for the infarct achieve full extent?

Answer 16

Question 17

What is a transmural infarct and why would an MI evolve into this?

Answer 17

Question 18

What does the location, size, and morphologic features of an acute myocardial infarct depend on? (4)

Answer 18

Question 19

Coronary Artery Occlusion and Affected Areas

• What areas does occlusion of the LAD artery effect?

Answer 19

Question 20

Coronary Artery Occlusion and Affected Areas

• What areas does occlusion of the LCX artery effect?

Answer 20

Question 21

Coronary Artery Occlusion and Affected Areas

• What areas does occlusion of the RCA effect?

Answer 21

Question 22

Pathogenesis of MI

• When can an MI do the electrical condition of the heart? How?
• Sudden cardiac death is associated with myocardial ischemia. What type of dysrhythmia is most associated with this?

Answer 22

Question 23

Morphology of MIs

• Gross and microscopic appearance depend on the age of injury ○ Areas of damage progress through a highly characteristic sequence of morphologic changes. List these changes, and their order (4)

Answer 23

Question 24

Morphology of MIs

• What is notable about the gross appearance of MIs that are less than 12 hours old?
• If and an MI is older than 4 hours old, what can you do to visualize it using histological stains? (Remember the molecule name and the substrate for it)

Answer 24

Question 25

Morphology of MIs * What are the ***_gross morphological_*** features of the following timelines of MI? * MI after 12 to 24 Hours * MI after 24 hours * MI after 10-14 days * Weeks

Answer 25

Question 26

Microscopic features of MI * When do the typical features of coagulative necrosis become detectable? * What else is notable about the histological morphology at this time? What does this histological feature represent?

Answer 26

Question 27

Microscopic features of MI * When does **acute inflammation** become noticeable? * At **5-10 days** after an MI, what are the noticeable features on a histological level? * How long does it take for granulation tissue to form? Scar tissue?

Answer 27

Question 28

Clinical Features of MI * What type of pain is described in this? Where does it radiate to? * How long does the pain last? * What is notable about pain relief compared to angina pectoris?

Answer 28

Question 29

Clinical Features of MI * What kind of patients can present with atypical MI symptoms and signs? * What is noticeable about the Pulse of MI patients? * What kind of MI is associated with diaphoretic or nauseous patients? * Why do patients get dyspnea, and what 2 conditions would dyspnea an indication of? * What is the cardiac manifestation of MIs that affect over 40% of the left ventricle?

Answer 29

Question 30

Clinical Features of MI * How do Transmural MIs manifest on an ECG?

Answer 30

Question 31

Dx of MI * What are the 4 types of molecules that you can measure that leak out of injured myocardial cells during an MI? * For the 2 types of molecules that are now used in diagnostic tests for MI * Which is preferred? * What are the timelines for both in terms of when you can detect them, when they peak, and when levels return to normal?

Answer 31

Question 32

How does a submitochondrial infraction manifest on an ECG?

Answer 32

ST depression

Question 33

3/4 of pts experience one or more complications after an acute MI * List all 8 of them? * Memory Device?

Answer 33

**F**ury **P**aged **CAP**tain **M**ar **V**ell then **Ruptured**

Question 34

Consequences and Complications of Myocardial Infarction * Contractile dysfunction * In general, MIs affect left ventricular pump function in proportion to the volume of damage. How does left ventricular failure manifest? * Arrhythmias * What are the common electrical disturbances associated with MIs?

Answer 34

Question 35

Consequences and Complications of Myocardial Infarction * Pericarditis * How man days after an MI would Fibrinous or fibrino-hemorrhagic pericarditis? * Why would it develop? * Myocardial Rupture * What kind of rupture is most common? * What kind of rupture would result in left to right shunting of blood? * What kind of rupture would lead to mitral regurgitation? * When is this most common and why?

Answer 35

Question 36

Consequences and Complications of Myocardial Infarction * Ventricular aneurysm * What is the reason this would form? * Do these rupture? What other conditions can this lead to? * Mural thrombus * What are the 3 main reasons that contribute to the formation of this? * What does this eventually lead to?

Answer 36

Question 37

Consequences and Complications of Myocardial Infarction * **Large transmural infarcts** * What are the 3 conditions that have a higher probability of occurring after this? * **Anterior Transmural Infarct** * What 4 conditions do these kinds of infarcts increase the risk for? * **Posterior Transmural Infarct** * What 2 conditions are likely to complicate this kind of infarct? * Compare the prognosis of patients with anterior infarcts vs patients with posterior infarcts.

Answer 37

Question 38

* Long term prognosis after MI depends on many factors. What are the 2 most important ones? * What is the mortality rate after the first year post-MI?

Answer 38