Ischemic Heart Disease (Pathoma)

Question 1

ischemia

Answer 1

refers to decrease in blood flow to an organ

Question 2

angina

Answer 2

chest pain that is REVERSIBLE

Question 3

stable angina

Answer 3

• no chest pain at rest

- develops chest pain with exertion or emotional stress

Question 4

When does angina occur?

Answer 4

When there is >70% stenosis

Question 5

How long does chest pain last in stable angina?

Question 6

EKG findings in stable angina?

Answer 6

ST segment DEPRESSION (only subendocardial ischemia)

Question 7

How is stable angina relieved?

Answer 7

• Rest (decrease O2 demand of myocardium)

- Nitro (venous dilation, decrease preload, decrease myocardial stress)

Question 8

unstable angina

Answer 8

chest pain that occurs at rest

Question 9

What causes unstable angina?

Answer 9

rupture of atherosclerotic plaque

Question 10

Is unstable angina due to complete or incomplete occlusion of a coronary artery?

Answer 10

INCOMPLETE

Question 11

EKG findings in unstable angina?

Answer 11

ST segment DEPRESSION (only subendocardial ischemia)

Question 12

EKG findings in unstable angina?

Answer 12

ST segment DEPRESSION (only subendocardial ischemia)

Question 13

Sx of Prinzmetal angina?

Answer 13

episodic chest pain unrelated to exertion

Question 14

Complications of Fibrinolysis or Angioplasty?

Answer 14

• contraction band necrosis (return blood & calcium, cause contraction of dead tissue)
• reperfusion injury (return O2, release free radicals)

Question 15

How is unstable angina relieved?

Answer 15

• Nitro

- High risk of progressing to MI

Question 16

1-3 days after MI?

Answer 16

• Yellow pallor (due to leukocytes)
• Inflammation
• Neutrophils (clean up necrosis)
• Fibrinous pericarditis (chest pain with friction rub)

Question 17

4-7 days after MI?

Answer 17

• Healing
• Macrophages
• Granulation tissue (fibroblasts, collagen, and blood vessels)
• Rupture of ventricular free wall, cardiac tamponade

Question 18

Months after MI?

Answer 18

• White Scar
• Fibrosis
• Aneurysm, mural thrombosis, Dressler’s Syndrome (antibodies against pericardium 6-8 weeks out)

Question 19

What is Dressler’s Syndrome?

Answer 19

• Autoimmune reaction 6-8 weeks post MI.

- Develop antibodies that attack pericardium.

Question 20

What type of infarction does Fibrinous pericarditis occur with?

Answer 20

ONLY occurs with TRANSMURAL infarction

1-3 days post-MI

Question 21

Myocardial infarction

Answer 21

necrosis of myocytes

Question 22

What causes sudden cardiac death?

Answer 22

Fatal ventricular arrhythmia

Question 23

Chest pain in MI?

Answer 23

> 20 min (not relieved by Nitro)

Question 24

What is treatment for MI?

Answer 24

• Aspirin/Heparin
• Supplemental O2
• Nitrates (decrease preload, decrease demand)
• Beta-blocker (slow HR, decrease O2 demand, decrease risk for arrhythmia)
• ACE Inhibitor (decrease afterload, decrease LV dilation)

Question 25

Complications of Fibrinolysis or Angioplasty?

Answer 25

- contraction band necrosis (return blood & calcium, cause contraction of dead tissue) - reperfusion injury (return O2, release free radicals)

Question 26

4-24 hours after MI?

Answer 26

- Dark discoloration - Coagulative necrosis (remove nucleus of cell) - Arrhythmia

Question 27

1-3 days after MI?

Answer 27

- Yellow pallor - Inflammation - Neutrophils (clean up necrosis) - Fibrinous pericarditis (chest pain with friction rub)

Question 28

4-7 days after MI?

Answer 28

- Healing | - Granulation tissue (fibroblasts, collagen, and blood vessels)

Question 29

Months after MI?

Answer 29

- White Scar - Fibrosis - Aneurysm, mural thrombosis, Dressler's Syndrome

Question 30

What is Dressler's Syndrome?

Answer 30

- Autoimmune reaction 6-8 weeks post MI. | - Develop antibodies that attack pericardium.

Question 31

What type of infarction does Fibrinous pericarditis occur with?

Answer 31

ONLY occurs with TRANSMURAL infarction | 1-3 days post-MI

Question 32

What are the most common etiologies of acute ischemia in sudden cardiac death?

Answer 32

- Pre-existing severe athersosclerosis (90%) | - Less common: mitral valve prolapse, cardiomyopathy, cocaine abuse (vasospasm)

Question 33

What causes Chronic Ischemic Heart Disease?

Answer 33

Poor myocardial funciton due to chronic ischemic damage (with or without myocardial infarction)

Question 34

What does Chronic Ischemic Heart Disease progress to?

Answer 34

CHF