Ischemic Heart Disease Flashcards Preview

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Flashcards in Ischemic Heart Disease Deck (35):
1

What is congestive heart failure?

The ability of the heart to pump is unable to meet the needs of tissues

2

Systolic Heart Failure

Deterioration of myocardial contraction and so myocytes cannot generate enough force in contraction

3

Diastolic Heart Failure

Inability of heart chamber to relax, expand, and adequately fill during diastole

4

Right Sided Heart Failure

Leads to the engorgement of the systemic and portal venous circulation that can cause edema

5

Left Sided Heart Failure

Damning of blood in pulmonary circulation causes diminished peripheral blood flow that can lead to pulmonary edema

6

Biventricular Heart Failure

Shows symptoms of both right and left sided heart failure

7

What is the pathogenesis of heart failure?

It occurs as a result of decreased perfusion to the coronary arteries in a combination with increased myocardial demand.

8

What is the main cause of right side heart failure?

Left sided heart failure

9

What are the 3 types of angina?

Stable
Unstable
Prinzmetal

10

What are the features of stable angina?

Large stenosis of the coronary artery due to atherosclerosis and in times of increased O2 demand such as exercise will cause chest pain that subsides with rest

11

What are the features of unstable angina?

The necrotic core of an atheroma is exposed due to an atherosclerotic plaque disruption that causes thrombus formation that can occlude coronary arteries even at rest.

12

What plaques are the most vulnerable for unstable angina?

Vulnerable plaques are ones with very thin fibrous caps

13

What are the features of Prinzmetal angina?

Coronary artery vasospasm cause chest pain that occurs even at rest

14

What is the pathogenesis of a myocardial infarction?

Plaque disruption leads to the formation of an occlusive thrombus that leads to infarction

15

What is another mechanism of MI that does not involve thrombus?

Cocaine can cause vasospasm that lead to an MI

16

What are the EKG changes with an MI?

Characteristically ST segment elevation on EKG
corresponding to distribution of occluded coronary artery

17

Nontransmural Infarct

Ischemic necrosis limited to inner one third, or at most one half of ventricular wall AKA subendocardial

18

Transmural Infarct

Ischemic necrosis involves full (or nearly full)
thickness of ventricle

19

What is often the cause of nontransmural infarcts?

In majority of cases there is diffuse stenosing coronary atherosclerosis and reduction of coronary flow with rarely evidence of plaque disruption or superimposed thrombus

20

What is often the cause of transmural infarcts?

Occlusive coronary thrombus overlying a disrupted atherosclerotic plaque

21

What is the first tissue of the heart to infarct?

Subendocardium

22

What compounding factor can cause a circumferential subendocardial infarct?

Global hypotension - coronaries are not well perfused

23

MI Changes 30 minutes to 4 hours

o No gross or microscopic changes

24

MI Changes 4-12 hours

o Beginning coaglulation necrosis

25

MI Changes 12-24 hours

o Gross – dark myocardial mottling
o Microscopic – ongoing coagulation necrosis,
pyknosis of nuclei

26

MI Changes 1 to 3 days

o Loss of myocardial nuclei and myocytes
o Neutrophilic infiltrate

27

MI Changes 3-7 days

o Gross - yellow-tan softening
o Microscopic - myocyte disintegration, phagocytosis
of dead cells

28

MI Changes 7 to 10 days

o Well-developed phagocytosis and early granulation tissue

29

MI Changes 10 to 14 days

o Granulation tissue

30

MI Changes 2 to 8 weeks

o Scar formation

31

What is the main lab finding for MI?

Elevated troponin

32

What is reperfusion injury?

Restoration of blood flow leads to local myocardial damage

33

What is cardiogenic shock?

Severe pump failure and often occurs with large infarcts

34

What are some complications of MI?

- Arrhythmia
- Myocardial Rupture
- Pericarditis
- Ventricular Aneurysm

35

What is the mechanism of sudden cardiac death?

Lethal arrhythmia - usually not acute MI

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