HEART II Flashcards
ISCHEMIC HEART DISEASE
___________ represents a group of related entities resulting from myocardial ischemia - an imbalance between myocardial supply (perfusion and cardiac demand for oxygenated blood)
IHD can declare itself through one or more of the following clinical presentations:
________ in which ischemia causes frank necrosis
________ in which ischemia is not severe enough to cause infarction, but the symptoms nevertheless portend to infarction risk
________ with heart failure
and __________
Ischemic heart disease
myocardial infarction
Angina pectoris
chronic IHD
sudden cardiac death
CONSEQUENCES OF MYOCARDIAL ISCHEMIA
__________ results from increases in myocardial oxygen demand that outstrip the ability of coronary arteries with fixed stenoses to increase oxygen delivery
__________ is caused by acute plaque change that results in thrombosis and/or vasoconstriction, and leads to incomplete or transient reductions in coronary blood flow to some cases, microinfarcts can occur distal to disrupted plaques due to thrombo emboli
________ is often the result of acute plaque change that induces an abrupt thrombotic occlusion, resulting in myocardial necrosis
__________ maybe caused by regional myocardial ischemia that induces a fatal ventricular arrhythmia
stable angina
unstable angina
MI
sudden cardiac death
Angina Pectoris
_________ is the most common form of angina; it is caused by an imbalance in coronary perfusion (due to chronic stenosing coronary atherosclerosis) relative to myocardial demand
__________ is an uncommon form of episodic myocardial ischemia caused by coronary artery spasm
_________ refers to a pattern of increasingly frequent prolonged (>20 min), or severe angina precipitated by progressively lower levels of physical activity or during rest
stable angina
prinzmetal variant angina
unstable or crescendo angina
MYOCARDIAL INFARCTION (PATTERNS OF INFARCTION):
__________- occur when there is occlusion of an epicardial vessel
transmural infarctions
MYOCARDIAL INFARCTION (PATTERNS OF INFARCTION):
________________ infarctions can occur as a result of a plaque disruption followed by a coronary thrombus that becomes lysed (therapeutically or spontaneously) before myocardial necrosis extends across the full thickness of the wall
subendocardial infarction
MYOCARDIAL INFARCTION (PATTERNS OF INFARCTION):
__________- refers to a pattern that is seen when there is pathology involving smaller intramural vessels
multifocal infarction
MYOCARDIAL INFARCTION (MORPHOLOGY)
MIs less than 12 hours old are usually not apparent on gross examination alone; however; if the infarct preceded death by at least 2-3 hours, it is possible to highlight the area of necrosis by immersion of tissue slices in a solution of ___________________
triphenyltetrazolium chloride
CLINICAL FEATURES OF MYOCARDIAL INFARCTION
cardiac troponins usually rise in ________ hours and peak at _________ after an acute infarct
2-4 hours
24-48 hours
CONSEQUENCES AND COMPLICATIONS OF MYOCARDIAL INFARCTIONS
_________ although isolated right ventricular infarction occurs in only 1%-3% of MIS, the right ventricle is affected by RCA occlusions leading to posterior septal or left ventricular infarction
right ventricular infarction
CONSEQUENCES AND COMPLICATIONS OF MYOCARDIAL INFARCTIONS
___________. In general, MI affect left ventricular pump function in proportion to the volume damage
damage is 40% on the left ventricle
contractile dysfunction
CONSEQUENCES AND COMPLICATIONS OF MYOCARDIAL INFARCTIONS
__________, transmural MIs can elicit a fibrinohemorrhagic_________ this is an epicardial manifestation of the underlying myocardial inflammation
fibrinohemorrhagic pericarditis
ARRYTHMIAS
_________ is a common cause of rhythm disorders
__________., if the SA node is damaged other fibers or even the AV node can take over pacemaker function, albeit at a much slower intrinsic rate (causing bradycardia)
__________. if the atrial myocytes become
“irritable” and depolarize independently and sporadically (as occurs with atrial dilation), the signals are variably transmitted through the AV node leading to the random “irregularly irregular” heart rate
__________. if the AV node is dysfunctional, varying degrees of heart block occur ranging from simple prolongation of the P-R interval on electrocardiogram (1st degree heart block), to intermittent transmission of the signal (2nd degree heart block), to complete failure (3rd-degree heart block)
ischemic injury
sick sinus syndrome
atrial fibrillation
heart block
ARRYTHMIAS
_________ are the most important of the primary electrical abnormalities of the heart that predispose to arrhythmias, it is caused by mutations in genes that are required for normal ion channel function.
channelopathies
SUDDEN CARDIAC THATH
the mechanism of SCD is most often a lethal ___________
arrythmia
HYPERTENSIVE HEART DISEASE
SYSTEMIC LEFT SIDED HYPERTENSIVE HEART DISEASE
Minimal pathologic criteria for the diagnosis of systemic HHD are the following:
1. _________
2._________
left ventricular hypertrophy in the absence of other cardiovascular pathology
clinical history or pathologic evidence of hypertension in other organs
RHEUMATIC FEVER AND RHEUMATIC HEART DISEASE
RH is an acute, immunologically mediated multisystem inflammatory disease classically occuring a few weeks after group A ____________
group A streptococcal pharyngiris
RHEUMATIC HEART DISEASE
distinct lesions in the heart called ________ are composed of foci of T lymphocytes, occasional plasma cells and plump activated macrophages called ————-
Aschoff bodies
Anitschkow cells
