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CVS Pathology > Pathology of Ischaemia and Infarction > Flashcards

Pathology of Ischaemia and Infarction Flashcards

(53 cards)

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1
Q

What does the heart need to function?

A

Oxygen

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2
Q

Definition of ischaemia

A

Relative lack of blood supply to tissue/organ leading to inadequate O2 supply to meet the needs of the tissue/organ - hypoxia

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3
Q

Types of hypoxia

A

Hypoxic
Anaemia
Stagnant
Cytotoxic

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4
Q

What is hypoxic hypoxia?

A

Low inspired O2 level
or
Normal inspired O2 but low PaO2

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5
Q

What is anaemic hypoxia?

A

Normal inspired O2 but blood abnormal

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6
Q

What is stagnant hypoxia?

A

Normal inspired O2 but abnormal delivery

  • local e.g. occlusion of vessel
  • systemic e.g. shock
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7
Q

What is cytotoxic hypoxia?

A

Normal inspired O2 but abnormal at tissue level

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8
Q

When does infarction occur?

A

When ischaemic necrosis within a tissue / organ in living body produced by occlusion of either the arterial supply or venous drainage

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9
Q

Definition of atheroma/atherosclerosis

A

Localised accumulation of lipid and fibrous tissue in intima of arteries

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10
Q

What does an established atheroma in coronary artery result in?

A

Stable angina

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11
Q

What does complicated atheroma in coronary artery result in?

A

Unstable angina

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12
Q

What does ulcerated / fissured plaques result in?

A

Thrombosis leading to ischaemia / infarction

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13
Q

What does atheroma in the aorta result in?

A

Aneurysm

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14
Q

What does stable angina result in?

A

Ischaemic pain in heart on exertion

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15
Q

What does unstable angina result in?

A

Ischaemia pain in heart on rest

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16
Q

A change in the vessel wall can lead to what?

A

Thrombosis

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17
Q

Effects of ischaemia

A

Blood/O2 supply fails to meet demand due to decreased supply
Anaerobic metabolism
- L lactate reversibly converted to pyruvate via LDH - which can be converted to acetyl CoA and CO2
Dysfunction, pain, physical damage

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18
Q

What type of cells are affected the most in ischaemia?

A

Specialised cells

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19
Q

Clinical consequences of ischaemia

A 
MI
TIA
Stroke
AAA
Peripheral vascular disease
Cardia failure
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20
Q

What is another name for stroke?

A

Cerebral infarction

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21
Q

Factors affecting O2 supply

A 
Inspired O2
Pulmonary function 
Blood constituents eg. haemoglobin 
Blood flow
Integrity of vasculature e.g. atheroma, embolis / tumour
Tissue mechanisms
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22
Q

Factors affecting oxygen demand

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A

Tissue - different ones have different O2 requirements

Activity of tissue above baseline value

23
Q

Supply issues in ischaemic heart disease

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A 
Coronary artery atheroma
Cardiac failure 
Pulmonary function, other disease or pulmonary oedema (LVF)
Anaemia
Previous MI
24
Q

Demand issues in ischaemic heart disease

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A

Heart has high intrinsic demand

Exertion/stress

25
Possible causes of infarction
Thrombosis Embolism Strangulation e.g. gut Trauma - cut/ruptured vessel
26
Scale of damage of ischaemia/infarction depends on…..
Time period Tissue / organ Pattern of blood supply Previous disease (decreased reserve)
27
What does anaerobic metabolism lead to?
Cell death which leads to liberation of enzymes which leads to breakdown of tissue
28
Types of necrosis
Coagulative e.g. heart, lung | Colliquitive e.g. brain
29
Which is the most common type of necrosis?
Coagulative
30
Pathology of myocardial ischaemia
1. Anaerobic metabolism - onset of ATP depletion (seconds) 2. Loss of myocardial contractility (leads to HF) - < 2 mins 3. Ultrastructural changes (few mins) - possibly reversible Severe ischaemia is in in 20 - 30 mins - this causes irreversible damage 4. Myocyte necrosis (20 - 40 mins) 5. Injury to the microvasculature > 1 hour
31
Appearance of infarct less than 24 hours
No change on visual inspection | A few hours to 12 hours post insult (swollen mitochrondia)
32
Appearance of infarct 24 - 48 hours
Pale - myocardium, solid tissues, spleen etc Red infarct - lung, liver etc Microscopically - acute inflammation initially at edge of infarct, loss of specialised cell features
33
Appearance of infarct at 72 hours onwards
Pale infarct - yellow / white in periphery Red infarct - little change Microscopically - chronic inflammation - macrophages remove debris - granulation tissue and new vessel formation - fibrosis - new tissue is laid down
34
End results of infarct
Scar replaces area of tissue damage
35
Shape of the scar after an infarct depends on what?
Territory of occluded vessel
36
What is the scar called after an infarct?
Reperfusion injury
37
Definition of transmural infarction
Ischaemic necrosis affects full thickness of the myocardium
38
Definition of subendocardial infarction
Ischaemic necrosis mostly limited to a zone of myocardium under the endocardial lining of the heart
39
What are acute infarcts classified according to?
Whether there is elevation of the ST segment on the ECG
40
What does it mean if there is no ST segment elevation but significantly elevated troponin level?
N-STEMI
41
Complications of MI
``` Sudden death Arrythmias Angina Cardiac failure Cardiac rupture - ventricular wall Septum Papillary muscle Reinfarction Pericarditis PE 2ndry to DVT Papillary muscle dysfunction - necrosis / rupture - mitral incompetence Mural thrombosis Ventricular aneurysm Dresslers syndrome ```
42
What is dresslers syndrome?
Immune system response after damage to heart tissue or to the pericardium
43
MI reparative process
``` Cell death Acute inflammation Macrophage phagocytosis of dead cells Granulation tissue Collagen deposition (fibrosis) Scar formation ```
44
MI 4 - 12 hours
Early coagulation necrosis Oedema Haemorrhage
45
MI 12 - 24 hours
Ongoing coagulation necrosis Myocyte changes Early neutrophilic infiltrate
46
MI 1 - 3 days
Coagulation necrosis Loss of nuclei and striations Brisk neutrophilic infiltrate
47
MI 3 - 7 days
Disintegration of dead myofibres Dying neutrophils Early phagocytosis
48
MI 7 - 10 days
Well developed phagocytosis | Granulation tissue at margins - red rim with pale infarct
49
MI 10 - 14 days
Well established granulation tissue with new blood vessels and collagen deposition
50
MI 2-8 weeks
Increased collagen deposition | Decreased cellularity
51
MI > 2 months
Dense collagenous scar
52
What does an ASD allow?
A paradoxical stroke - where an embolism from peripheral veins may bypass the pulmonary circulation
53
What murmur would be heard with an ASD?
Systolic Murmur Radiating through to the back Fixed S2 splitting

CVS Pathology (19 decks)

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