Nov22 M3-Pathology - Coronary Artery Disease

Question 1

ischemic heart disease and causes

Answer 1

imbalance of supply demand to myocardium. 90% caused by CAD. also anemia, low flow states

Question 2

critical stenosis definition + why this occurs

Answer 2

70% stenosis, no symptoms below that

Question 3

90% stenosis what is the problem

Answer 3

symptoms of angina even at rest = unstable angina

Question 4

stable vs unstable angina

Answer 4

stable = pain occurs with exertion, at a predictable level of exercise
unstable = pain happening with less and less exertion

Question 5

acute MI def

Answer 5

cardiomyocyte death

Question 6

acute coronary syndrome includes what

Answer 6

unstable angina, acute MI, SCD (sudden cardiac death)

Question 7

subendocardial vs transmural infarct causes

Answer 7

subendocardial if partially occlusive thrombus (can also give unstable angina). transmural MI if completely occlusive thrombus

Question 8

angina phenomenon happening

Answer 8

ischemia

Question 9

why is the infarct initially subendocardial and then develops to transmural?
IMP

Answer 9

because receives most pressure (most compression on vessels) + furthest from coronaries. infarction progresses towards epicardium

Question 10

subendocardial infarct starts with _______

Answer 10

incomplete stenosis

Question 11

subendocardial vs transmural MI on ECG

Answer 11

subend: no Q wave, ST depression, T wave inversion, NSTEMI

transmural MI: STEMI. Q waves, St elevation

Question 12

LAD stenosis consequence

Answer 12

antero-septal subendocardial MI

Question 13

posterior descending stenosis conseq

Answer 13

postero-septal subendocardial MI

Question 14

RCA, LAD and LCX stenosis conseq

Answer 14

circumferential subendocardial MI

Question 15

LAD complete occlusion conseq

Answer 15

anteroseptal transmural MI

Question 16

RCA complete occlusion conseq

Answer 16

postero-septal transmural MI

Question 17

microscope findings after infarct 1 day

Answer 17

wavy fibers, eosinophilic

Question 18

microscope findings after infarct 2-3 days

Answer 18

PMNs infiltration

Question 19

microscope findings after infarct 7-10 days

Answer 19

macrophages clean (eat dead myocyte) + neutrophils gone

Question 20

microscope findings after infarct 14 days

Answer 20

new vessels, collagen (granulation tissue)

Question 21

microscope findings after infarct 7 weeks+

Answer 21

collagen scar

Question 22

main complications of MI

Answer 22

HF, cardiogenic shock, arrhythmias, vent rupture (tamponade), mural thrombus and embolism, septum shunt, valve dysfct (if pap muscle)

Question 23

unstable angina leads to ?

Answer 23

M.I

Question 24

what occurs in unstable angina?

Answer 24

disruption of plaque
plaque rupture
platelet aggregation
thrombus formation
vasoconstriction

increase in duration and tempo of angina at less exertion & rest

Question 25

how does stable angina occur

Answer 25

``` plaque vasoconstriction (by endothelial dysfunction) ```

Question 26

variant angina is what?

Answer 26

NO PLAQUE ischemia due to VASOSPASM occurs at REST

Question 27

what is unstable angina?

Answer 27

increase in tempo and duration of ischemia with LESS exertion and AT REST

Question 28

what are acute coronary syndromes?

Answer 28

MI and Unstable Angina

Question 29

when is the definition of stable angina?

Answer 29

predictable, transient chest discomfort during *exertion* or emotional stress

Question 30

types of ischemia

Answer 30

stable angina unstable angina variant angina silent angina

Question 31

variant angina is also known as?

Answer 31

printzmetal angina ONLY CAUSED BY VASOSPASM NO PLAQUE!!!

Question 32

silent ischemia is what?

Answer 32

asymptomatic ischemia | occurs in elderly, diabetes, women

Question 33

angina referred to as what?

Answer 33

``` tightness burning heaviness pressure discomfort elephant sitting on chest*** ``` lasts from few seconds to <5 minutes NOT PAIN

Question 34

Angina sign?

Answer 34

Levine sign!!! | hand clenched over sternum shows discomfort

Question 35

Angina where does it occur?

Answer 35

Diffuse | radiates to left sholders jaw back neck retrosternal inner arma

Question 36

Ischemic heart disease risk increases most with what risk factor?

Answer 36

higher cholesterol levels hypertension (higher in males than females)

Question 37

what factors favour occlusive thrombus?

Answer 37

procoagulant (tissue factor) | antifibrinolytic (PAI- plasminogen activator inhibitor)

Question 38

what factors resist thrombus accumulation?

Answer 38

anticoagulants (thrombomodulin, heparin) | profibrinolytic (tPA)

Question 39

describe vulnerable plaques

Answer 39

more inflammatory cells large lipid pool thin fibrous cap

Question 40

which cardiac biomarkers can tell you cardiovascular risk?

Answer 40

lipoprotein | C Reactive Protein (CRP)

Question 41

ATHEROSCLEROSIS CAUSES WHAT?!

Answer 41

ANEURYSMS

Question 42

atherosclerosis epidemiology

Answer 42

leading cause of mortality and morbidity

Question 43

what are the three determinants of myocardial oxygen demand?

Answer 43

wall stress heart rate contractility

Question 44

vasodilators from endothelium

Answer 44

prostacyclin NO EDHF

Question 45

vasoconstrictors from endiothelium (increase during endothelial dysfunction = injury = atherosclerotic plaque)

Answer 45

Endothelin -1

Question 46

stunned myocardium

Answer 46

after ischemia there is a prolonged systolic dysfunction delayed recovery bc Ca+ overload reversible NO NECROSIS

Question 47

hibernating myocardium

Answer 47

multivessel CAD --> VENTRICULAR CONTRACTILE dysfunction | NO NECROSIS

Question 48

examples of contractile dysfunction by ischemia where there is NECROSIS?

Answer 48

stable angina | unstable angina

Question 49

Angina accompanying symptoms? (3)

Answer 49

tachycardia diaphoresis nausea Also fatigue, weakness

Question 50

Angina is caused by what conditions

Answer 50

Exertion | conditions which increase O2 demand (wall stress, heart rate, contractility)

Question 51

risk factors for atherosclerosis --> CAD

Answer 51

cigs dyslipidemia HTN = MODIFIABLE -family history

Question 52

ischemia most common symptom?

Answer 52

angina pectoris =discomfort due to M.I.

Question 53

what is stable angina?

Answer 53

chronic pattern of transient angina pectoris by exertion or emotional upset ST depression