(MHD) Ischemic Heart Disease Flashcards
(35 cards)
Define Heart Failure
When the heart is inable to pump blood sufficiently to meet the needs of tissues because the ventricle is either unable to fill with or eject enough blood.
Systolic vs Diastolic Heart Failure
Systolic: Poor pumping
Diastolic: Ventricle doesn’t relax enough due to stiffness
Main causes for diastolic heart failure (3)
- Infiltrate
- Ischemia
- Hypertrophy which causes an inability for the heart to fill enough.
Greatest cause of right sided heart failure
Left sided heart failure
Right sided heart failure results in what general systemic/bodily effects?
Engorgement of systemic and portal venous circulation
Left sided heart failure results in what systemic/bodily effects?
Damning of blood in pulmonary circulation (pulmonary edema) and diminished peripheral blood flow.
Cor pulmonale
When only the right side of the heart is failing, but the left side is normal.
The risk factors for ischemic heart disease are the same risk factors as what other disease process?
Atherosclerosis
Name the (4) general manifestations of Ischemic Heart Disease
- Angina Pectoris (3 types)
- Acute MI
- Chronic Ischemic Heart Disease/Heart Failure
- Sudden Cardiac Death
Describe Stable (Typical) Angina Pectoris
Chronic coronary stenosing in which >75% of the lumen area is closed.
Myocytes become ischemic during physical activity, when there is an increased O2 demand, leading to angina
How does stable angina pectoris present and how is it relieved?
Presents: substernal chest pressure during physical activity or emotional excitement.
Relieved: vasodilator or nitroglycerin
Unstable Angina Pectoris
When does it occur?
Vulnerable, atherosclerotic plaque which causes only moderate stenosis (partially occluding thrombus), but can break off and cause plaque to break off.
Occurs somewhat frequently and requires less effort, can be at rest and last longer.
Stable vs Vulnerable Plaque
Vulnerable occludes less of the lumen but has a thinner cap and a more lipid rich atheroma.
Prinzmental Variant Angina
What is it? How is it diagnosed? How is it treated?
Chest pain as a result of coronary artery spasm, unrelated to anything in the patient’s control (physical activity, HR, BP)
Diagnosed by exclusion of other types
Responds to vasodilators
What is the most common cause of an MI?
Occlusive Thrombus Formation
At what point in time does irreversible ischemia begin during an MI?
Greater than 30 minutes
Transmural vs Nontransmural infarcts
(what are they and what causes them?)
Transmural- the full thickness of the myocardium is infarcted at a particular location. It is the result of an occlusive thrombus.
Nontransmural- partial thickness infarct which is usually subendocardial (it is most distant from the coronary artery). Usually occurs because a clot was there but has been removed, there is severe hypotension or there are microinfarcts from some sort of drug usage (causing vasospasm).
Gross/Microscopic Changes: 1/2 - 4 hours into an MI
No changes
Gross/Microscopic Changes: 4-12 hours into an MI
Beginning of coagulation necrosis.
- Eosinophilia
- Loss of Nuclei
- Piknosis
No Gross Changes
Gross/Microscopic Changes: 12 -24 hours into an MI
- Gross- dark mottling (due to hemorraging and blood moving through myocytes)
- Ongoing coagulation necrosis
- Pyknosis of nuclei
Gross/Microscopic Changes: 1 - 3 days into an MI
- Gross- mottled
- Loss of nuclei and myocytes
- Neutrophil infiltrate
Gross/Microscopic Changes: 3 - 7 days after an MI
- Myocyte disintegration
- Phagocytosis of dead cells
- Lots of neutrophil infilitrate
- Gross yellow color
Gross/Microscopic Changes: 7 - 10 days after an MI
- Well-developed phagocytosis
- Early granulation tissue (lots of vascularization, scar tissue and collagen beginning to form)
Gross/Microscopic Changes: 10 - 14 days after an MI
Some wisp of granulation tissue
