Myocardial Infarction

Question 1

Cause of MI ?

Answer 1

1. Rupture of the atherosclerosis with thrombosis
2. Complete occlusion of coronary artery
3. CA vasosapsm
4. Prinzmetal angina
5. Emboli
6. Vasculitis-Kawasaki Disease

Question 2

Cell injury in MI ?

Answer 2

Necrosis of cardiacx] myocytes

Question 3

Dyspnea manifesto in MI ?

Answer 3

Total function oif heart is impaired = Pulmonary congestionnand edema = Dyspnea

73

Question 4

Presenations of MI ?

Answer 4

1. Chest pain = >20minutes
2. Diaphoresis
3. Pain radiates left arm — jaw
4. Dyspnea

Not releived by nitroglycerine

Question 5

Involvement in MI ?

Answer 5

1. LV
2. RV
3. Both atria are spared

Question 6

EKG changes in MI ?

Answer 6

1. Initially = Subendocardial ischemia = ST depression
2. Severe ischemia = Traansmural ischemia = ST elevation

Question 6

Occlusion in MI ?

Answer 6

1. Left ant descending artery = ant wall & ant septum of LV = 45%
2. Right coronary artery = post wall & post septum & papillae muscle LV
3. left circumflex artery = lateral wall of LV

Question 7

Mmembrane damage fate in MI ?

Answer 7

Leakage of cardiac enzyme s= Marker of MI

74

Question 7

Hallmark of MI ?

Answer 7

Membrane damage

Question 8

Cardiac marker in mI ?

Answer 8

1. Troponin I
2. CK-MB

Question 9

Troponin I details time—

Answer 9

Rise 2-4 hr after infraction
peak = 24 hr
normal = 7-10 day

Question 10

CK-MB????

Answer 10

Level rise =4-6 hr
peak = 24 hr
normal = 72 hr

creatinine kinase MB

Question 11

Tx of MI ?

Answer 11

1. Aspirine/Heparin = Limit thrombosis
2. O2 = minimize ischemia
3. Nitrates = vasodialtion
4. Beta blocker = dec O2
5. ACEi = dec LV dilation
6. Fibrinolytic /angioplasty = open blocked vessels

74

Question 12

Reperfusion of irreversibly = C ainflux = Hypercontraction of myofibrills == Contraction band necrosis

Answer 12

in MI

Question 13

Further damaging myocytes
after return of O2 + inflammatory cells create = Free radicles

Answer 13

Reperfusion injury

Question 13

Which kind of necrosis in MI ?

Answer 13

Coagulative necrosis

Question 14

Day 1 necrosis time ?

Answer 14

<4 hour = changes = No changes

Question 14

Complications of MI ___+++

Answer 14

74 Whole CHART IN PATHOMA-

Question 15

Coagulative necrosis features ?

Answer 15

1. Pyknosis
2. Kariokinesis’
3. Kryptosis

3 feature of CN

Question 15

Day1 —– Week 1 ?

Answer 15

Inflammation by Neutrophil + Macrophage

Question 16

1-3 days heart condition ?

Answer 16

Fibrinous pericarditis
(Chest pain + Friction rub )

Question 17

4-7 days infarction ?

Answer 17

Rupture of ventricular wall
-cardiac temponade
-papillary muscle rupture
-mitral insufficiency
-IV septum defect = Shunt

Question 18

Granulation tissue with plump fibrosis blood vessels seen in ?

Answer 18

1-3 weeks
red border emerge

Question 19

After months complications ?

Answer 19

1. White scar
2. Fibrosis
3. Mural thrombus
4. Dressler syndrome

Question 20

Dressler syndrome?

Answer 20

AB against own pericardium | 74

Question 21

Cause of sudden cardiac death ?

Answer 21

1. Fatal ventricular arrhythmia 2. Mitral valve prolapse 3. Cardiomyopathy 4. Cocaine abuse

Question 22

Chronic ischemic heart disease progression ?

Answer 22

CHF

Question 23

CHRONIC ischemic damage +/- ischemia = ????

Answer 23

CIHD

Question 24

Irreversible cell injury typical sign ? | UWorld

Answer 24

Mitochondrial Vacuolization ## Footnote UW

Question 25

Leads of ST elevation and Q waves indication ?? | Left circulflex artery = Lateral wall of LV = Infraction = ## Footnote UW

Answer 25

I aVL | UW

Question 26

Free wall rupture results in -- | UW

Answer 26

1. Cardiac temponade 2. Hypotension 3. Shock 4. Cardiac arrest

Question 26

Autpsy of MI ???? | UW

Answer 26

Slitlike tear at the site of infarction in the LV wall | uW

Question 27

Inferior wall lead in ECG ? | UW

Answer 27

II III aVF

Question 27

Which chamber is relatively protected from MI ? | UW

Answer 27

RV

Question 27

Devastating but uncommon complications of transmural MI ? | UWorld

Answer 27

LV free wall rupture | UW

Question 28

Which factors protect RV from MI ? | UW

Answer 28

1. Small muscle mass with high capacity to increase O2 extraction 2. Perfusion throughout the cardiac cycle 3. Heightened ischemic preconditioning

Question 29

same shit revise >>>> | UW

Answer 29

ST-elevation myocardial infarction involves transmural (full-thickness) infarction of the myocardial wall, and usually results from acute atherosclerotic plaque rupture with the development of overlying thrombus that fully occludes the coronary artery lumen. It classically presents with sudden-onset substernal chest pain that is not relieved by rest or short-acting nitrates. ECG demonstrates ST elevation in the affected leads with subsequent development of Q waves. [37]

Question 30

After the onset of severe ischemia leading to myocardial infarction (MI), early signs of coagulative necrosis do not become apparent when ?? | UWorld

Answer 30

Light microscopy untill 4 hours after the onset of MI | UWorld

Question 31

cellular and mitochondrial swelling that is observed histologically why ? | UW

Answer 31

=Ion pump failure =ATP deficiency during ischemia =Intracellular accumulation of Na & Ca =Draw free water into the cell =Cellular swelling | UWorld

Question 32

Why papillary muscle rupture in MI ? | UW

Answer 32

Papillary muscle = Supplied solely by Pst Decending Artery Its susceptible to ischemic rupture

Question 32

How fibrosis after MI occur ?? | UW

Answer 32

Transforming growth factor-Beta = Reduce inflmmation = Promote tissue remodelling = Fibroblast proliferation = collagen deposition | UWorld

Question 33

Life threatening complication of MI that occurs 3-5 days after ?? | UW

Answer 33

Papillary muscle rupture