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TERM 3 BIOL2292 PATHO 2 > CARDIAC LECTURE 1: Epidemiology & coronary heart disease > Flashcards

CARDIAC LECTURE 1: Epidemiology & coronary heart disease Flashcards

1
Q

Cardiac disease is the ____ cause of death in Canada

A

2nd

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2
Q

What is the most common type of heart disease in Canada?

A

Ischemic

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3
Q

What are 5 causes of heart disease?

A
  1. Rupture
  2. Obstruction
  3. Improper flow (backward, diverted)
  4. Failure to pump (contraction, emptying, relaxing)
  5. Conduction defect
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4
Q

What is the general term for diseases where insufficiency of oxygen leads to damage of the myocardium?

A

Coronary heart disease

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5
Q

What are 2 ways cardiac myocytes initially adapt to hypoxia?

A
  1. Generates anastomoses to bypass blockage
  2. Vasodilation
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6
Q

At what point are the effects of CHD felt?

A

When the vessel is about 70% occluded

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7
Q

What are 2 main consequences of ATP depletion in a hypoxic state?

A
  1. Na+/K+ pump cannot work, causing influx of Na+ and fluid (swelling)
  2. Anaerobic metabolism, causing acidity
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8
Q

What are 3 other consequences of ATP depletion in a hypoxic state?

A
  1. Ribosome detachment
  2. Decreased protein synthesis
  3. Lipid deposition
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9
Q

What is the mechanism behind angina?

A

Injured cells release chemicals that activate nociceptors

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10
Q

Why is anginal pain often felt at other places than the heart?

A

Referred pain: Sensations from upper abdomen, shoulders, arms, neck, lower jaw travel along same pathways and enter spinal cord at same region

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11
Q

What are 3 patterns of angina?

A
  1. Stable angina
  2. Vasospastic angina
  3. Unstable/crescendo angina
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12
Q

What kind of angina normally manifests when cardiac workload is increased, and reduces at rest?

A

Stable angina

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13
Q

What is the mechanism behind stable angina?

A

Stenotic/atherosclerotic coronary vessels dilate poorly in response to increased demand

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14
Q

What kind of angina is characterized by unpredictable attacks, predominantly at rest?

A

Vasospastic (Prinzmetal, variant) angina

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15
Q

What are 3 possible mechanisms behind vasospastic angina?

A
  1. Vascular smooth muscle hyperreactivity
  2. ANS imbalance
  3. Endothelial dysfunction
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16
Q

What are 2 treatments for vasospastic angina?

A
  1. CCBs
  2. Nitro
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17
Q

What kind of angina is characterized by increasingly frequent pain with progressively less exertion?

A

Unstable/crescendo angina

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18
Q

What is the mechanism behind unstable angina?

A

Stenotic coronary artery is further blocked by a ruptured plaque or embolism and leads to a severe obstruction

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19
Q

What are 2 possible outcomes for unstable angina?

A
  1. Clot dissolves before myocardial tissue dies
  2. Myocardial infarction
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20
Q

What is the term for necrossi of cardiac muscle due to prolonged ischemia?

A

Myocardial infarction

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21
Q

How long until ischemia leads to irreversible changes/necrosis?

A

20-30 minutes

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22
Q

Why may the outside of the heart appear healthy despite necrosis occuring?

A

The epicardium is affected last by MI

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23
Q

Which layer of the heart feels the effects of MI the most, and why?

A

Endocardium, as it is the farthest away from the blood supply

24
Q

What is the term for the plasma membrane of cardiomyocytes?

A

Sarcolemma

25
Q

What morphological changes occur in the heart after 6 hours post MI?

A

Coagulative necrosis

26
Q

What is the eventual end result of the necrotic area of the heart?

A

Becomes scar tissue

27
Q

What are 4 atypical symptoms of MI that may occur in females?

A
  1. Breathlessness
  2. Sweating
  3. Nausea/vomiting
  4. Anxiety, tireness
28
Q

On an ECG strip, where is the ST segment located?

A

The flat portion right after the peak (R)

29
Q

What are 2 ECG readings that are considered NSTEMI?

A
  1. ST depression
  2. T inversion
30
Q

What is the treatment for ST elevation MI?

A

Immediate reperfusion therapy

31
Q

What is the treatment for non-ST elevation MI?

A

Antiplatelet and anticoagulation therapy

32
Q

What is the best serum biomarker used to diagnose MI?

A

Troponin I and T

33
Q

How long does it take for troponin to build up in the blood?

A

A few hours

34
Q

How long will troponin levels remain elevated after MI?

A

Up to 2 weeks

35
Q

What are 3 other biomarkers used to diagnose MI?

A
  1. Creatine kinase
  2. Myoglobin
  3. Lactate dehydrogenase
36
Q

What are the 5 steps in diagnosing MI?

A
  1. Presentation
  2. Working diagnosis (ACS)
  3. ECG
  4. Cardiac biomarkers
  5. Final diagnosis
37
Q

The patient’s ECG shows ST elevation, and they have positive biomarkers. What is the diagnosis?

A

STEMI

38
Q

The patient’s ECG does not have ST elevation, and their biomarkers are negative. What is the diagnosis?

A

Unstable angina

39
Q

The patient’s ECG does not have ST elevation, but their biomarkers are positive. What is the diagnosis?

A

NSTEMI

40
Q

What are 3 methods of immediate reperfusion treatment?

A
  1. Percutaneous coronary intervention (PCI)
  2. Fibrinolysis (clot busters)
  3. Coronary artery bypass graft (CABG)
41
Q

What are possible consequences due to reperfusion?

A
  1. Hemorrhage
  2. Arrhythmias
  3. Inflammation
42
Q

What histological changes may be observable in cardiac muscle tissue after reperfusion?

A

Contraction bands

43
Q

What is the underlying cause for arrhythmias following MI?

A

Dead cells block conduction pathways

44
Q

What would cause a patient to experience cardiogenic shock following MI?

A

A large region of the muscle in the left ventricle is destroyed

45
Q

What is the underlying cause for myocardial rupture following MI?

A

Damaged tissue is weakened until scar tissue forms

46
Q

What is the term for a complication of MI where there is underlying myocardial inflammation leading to scarring?

A

Pericarditis

47
Q

What is the term for a complication of MI where new necrosis develops next to the area of infarction?

A

Infarct extension

48
Q

What is the term for a complication of MI where weakness in the affected tissue leads to stretching, thinning, and dilation?

A

Infarct expansion

49
Q

What is the term for a complication of MI where thing scar tissue of the ventricular wall bulges with contraction?

A

Ventricular aneurysm

50
Q

Why is mural thrombus a possible complication following MI?

A
  1. Abnormal contractility causes stasis
  2. Damage to endocardium creates a thrombogenic surface
51
Q

Which muscles of the ventricles may experience dysfunction following MI, and what may this lead to?

A

Papillary muscles

Lead to rupture and mitral valve regurgitation

52
Q

What is the term for unexpected death from cardiac causes, within 1 hour of onset of symptoms?

A

Sudden cardiac arrest/death

53
Q

What is the underlying cause of suddent cardiac death?

A

Ischemia produces V-fib

54
Q

What is the term for progressive heart failure caused by slow atrophy and death of cardiomyocytes from chronic ischemia?

A

Chronic ischemic cardiomyopathy

55
Q

How is chronic ischemic cardiomyopathy different from MI?

A

Dead cells are spread throughout the heart instead of localized

TERM 3 BIOL2292 PATHO 2 (19 decks)

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