Cardiac Pathology (Part 1)

Question 1

what is synonymous with CAD?

Answer 1

ischemic heart disease

Question 2

what is a right dominant heart?

Answer 2

a heart in which the right coronary artery supplies the posterior descending artery

Question 3

what does the posterior descending artery supply?

Answer 3

the AV node

Question 4

what are the most sensitive and specific biomarkers of myocardial damage?

Answer 4

troponin T and I

Question 5

which composition of creatinine kinase is specific to cardiac muscle?

Answer 5

ckMB

Question 6

when do levels of troponin I and T begin to rise?

Answer 6

3-12 hours after a MI

Question 7

what MI biomarkers return back to baseline sooner?

Answer 7

ckMB

Question 8

when does ckMB return back to baseline?

Answer 8

in 48-72 hours

Question 9

when does troponin return back to baseline?

Answer 9

within 5 days

Question 10

occlusion of the LAD causes infarction of what?

Answer 10

apex, LV anterior wall, and anterior 2/3 of septum

Question 11

occlusion of the circumflex artery causes infarction of what?

Answer 11

LV lateral wall

Question 12

occlusion of the right coronary artery causes infarction of what?

Answer 12

the RV free wall, LV posterior wall, and posterior 1/3 of septum

Question 13

when can a subendocardial infarct occur?

Answer 13

after a reperfusion of transmural infarct (regional) or after global hypotension (circumferential)

Question 14

when might you seen multifocal microinfarction?

Answer 14

embolic disease or in cocaine use

Question 15

what is the first histologic change seen in MIs?

Answer 15

there is a slight waviness of the fibers at the border

Question 16

what are the histologic changes that occur 4-12 hours after a MI?

Answer 16

very early coagulation necrosis and edema

Question 17

what are the histologic changes that occur 12-24 hours after a MI?

Answer 17

coagulation necrosis increases; pyknosis; hypereosinophilia

Question 18

what are the histologic changes that occur 1-3 days after a MI?

Answer 18

coagulation necrosis with loss of nuclei and striations; brisk infiltration of neutrophils

Question 19

what are the histologic changes seen 3-7 days after a MI?

Answer 19

macrophages

Question 20

when does scar tissue begin to be laid down following an MI?

Answer 20

after 2 weeks

Question 21

when does LDH leak out of dead myocytes?

Answer 21

after 2-3 hours

Question 22

when is the scar complete following an MI?

Answer 22

after 2 months

Question 23

what is contraction band necrosis?

Answer 23

with reperfusion, an influx of calcium causes the sarcomeres to contract

Question 24

when do the early complications associated with MIs occur?

Answer 24

within the first 24 hours

Question 25

what are the early complications associated with an MI?

Answer 25

life threatening arrhythmia and contractile dysfunction (shock)

Question 26

when do the intermediate complications associated with an MI occur?

Answer 26

from the 2-4 day mark onward up to 2 weeks

Question 27

what are the intermediate complications associated with an MI?

Answer 27

rupture of the free wall, septum, or papillary muscles; acute fibrinous pericarditis

Question 28

when do the late complications associated with an MI occur?

Answer 28

after 2 weeks

Question 29

what are the late complications associated with an MI?

Answer 29

chronic pericarditis (Dressler syndrome); ventricular aneurysm; continued risk of heart failure, life threatening arrhythmia

Question 30

what is the most common cause of death due to MI?

Answer 30

fatal arrhythmia

Question 31

rupture of the free wall can lead to what?

Answer 31

blood accumulating in the pericardial space

Question 32

what can papillary muscle rupture lead to?

Answer 32

valve incompetence and post infarct regurgitation