Term
| ischemic heart disease epidemology |
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Definition
prominant morbidity and mortality in western hemisphere
men>women until 80s
peak incidence 60-70yo
40% of all deaths
80% cause of heart disease |
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Term
| what is the other 20% of heart disease not caused by ischemic heart disease caused by |
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Definition
HTN
cor pulmonale
congenital
valvular: sterile, infective endocarditis, aortic stenosis, mitral valve, prolapse, rheumatic heart disease with valvular degeneration |
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Term
| define ischemic heart disease |
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Definition
| syndromes causing imbalance between myocardial O2 supply and demand |
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Term
| risk factors for ischemic heart disease |
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Definition
HTN
sedentary
DM
smoking
LDL
hyperTG |
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Term
| causes of ischemic heart disease |
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Definition
| closley associated with athlerosclerosis |
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Term
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Definition
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Term
| define acute plaque change |
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Definition
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Term
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Definition
plaque stress
activation of T cells
secretion of y interferon
activation of macrophages
secretion of metalloproteinases
degredation of fibrous cap
fissuring
erosion
ulceration
hemorrhage
thrombotic event |
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Term
| categories if ischemic heart disease |
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Definition
angina pectoris
unstable or preinfarctiona angina
prinzmetal or varient angina |
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Term
| stable/classic angina: signs, cause, location, tx |
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Definition
intermittent CP
represents reverse MI
75% in coronary artery
tx: nitroglycerin vasodilates and decreases cardiac work |
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Term
| unstable/preinfarction angina: signs, cause, effect |
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Definition
crescendo chest angina increasing in frequency with pregressivly less work
due to active plaque changes
associated with thrombosis, embolism, vasospasm |
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Term
| prinzemetal/varient angina: signs, cause, tx |
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Definition
substernal CP at rest
due to vasospasm w or w/o fixed athlerosclerotic lesion
tx: Ca channel blocker causes vasodilation |
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Term
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Definition
necrosis due to local ischemia which is promairly caused by thrombi
causes vasospasm or emboli |
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Term
| what are the most common locations for acute MI |
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Definition
left anterior descending coronary artery 40-50% (brings blood to most of LV wall)
right coronary artery 30-40%
left coronary artery 15-20% |
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Term
| what tissue is infarcted at 30 min after MI, why |
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Definition
| subendocardium (inner 1/3 of ventricle) it is least perfused region of myocardium |
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Term
| what tissue is infarcted at 3-6h after MI |
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Definition
| transmural (this is considered full size) complete wall of ventricle |
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Term
| when does MI treatment need to be done |
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Definition
| within 3 hours of transural approach to reduce morbidity and mortality |
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Term
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Definition
| restoration of flow to ischemic myocardium |
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Term
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Definition
thrombolysis
percutaneous transluminal coronary angioplasty
stent placement
coronary artery bypass graft (CABG) |
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Term
| complications of reperfusion |
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Definition
| myocytes irreversibly injured making contraction bands (hyperconnected sarcomere that is thick, irregular, eosinophilic) |
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Term
| labs used to help diagnose MI |
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Definition
myoglobin rises early
CK-MD 2-4h after MI (non-specific)
troponin: highly sensitive and specific to heart tissue necrosis. shows 4h afer MI, peak at 48h
CRP: less specific, higher puts at risk for storke and Mi |
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Term
| gross pathology of MI 12h |
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Definition
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Term
| gross pathology of MI 24h |
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Definition
| pallor/dark mottling on curt surface of ventricle |
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Term
| gross pathology of MI 3-5d |
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Definition
| necrotic, shoft, yellow, demarcated |
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Term
| gross pathology of MI weeks-years |
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Definition
| healed, white granulation itssue, fibrosis outside to in |
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Term
| microscopic path of MI 0-30 min |
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Definition
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Term
| microscopic path of MI 1-3h |
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Definition
non-contractile ischemic mocytes stretched with systolic tugs making wavy fibers
PMN attracted to necrosis |
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Term
| microscopic path of MI 4-12h |
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Definition
| earlynecrosis and neutrophils, hypereosinophilic myocytes due to coagulative necrosis |
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Term
| microscopic path of MI 18-24h |
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Definition
| contraction band necrosis, hypereosinophilic myocytes due to coagulative necrosis |
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Term
| microscopic path of MI 24-72h |
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Definition
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Term
| microscopic path of MI 4-7d |
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Definition
| macrophages, fibroblasts prolierate |
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Term
| microscopic path of MI 10d |
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Definition
| granulation tissue ingrowth of vessels |
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Term
| microscopic path of MI 7-8wks |
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Definition
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Term
| microscopic path of MI >2mo |
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Definition
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Term
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Definition
severe crushing substernal or percordal pain
can be epigastric burning, extend into jaw, or inside arm
SOB, sweating, nausea, vomiting |
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Term
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Definition
| fatigue, sleep disturbance, SOB, back pain, abd epigastric pain, nausea without vomiting |
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Term
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Definition
contractile dysfunction: pump failure
arrhythmia: can cause sudden death
mural thrombi
papillary muscle dysfunction/rupture
ventricular rupture
ibrinous pericarditis
ventricular aneurysm
sudden cardiac death |
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Term
| what is the most common complication with mortality in MI |
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Definition
contractile dysfunction (pump failure)
70% mortality with cardiogenic shock |
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Term
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Definition
| lack of motility of ventricular wall and thrombogenic nature of damaged myocytes |
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Term
| why is papillary muscle dysfunction/rupture associated with MI |
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Definition
| mitral regurgitation can occur at 3d because there is no protective granulation tissue yet (50% mortality) |
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Term
| ventricular rupture due to MI: when does it occur, where, effect |
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Definition
4-7d after
caues cardiac tamponade
1-3% in septum causing left to right shunt |
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Term
| fibrous pericarditis due to MI: when does it occur, why |
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Definition
| 2-4d after due to transmural neutrophilic infiltrate causing restrictive pathology |
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Term
| ventricular aneurysm due to MI: when does it occur, complications, why |
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Definition
late complication of large transmural infarct causing bloging in systole
often contains mural thrombi, can dysrupt pathways, area bubbling out into ventricles is weak |
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Term
| define sudden cardiac death |
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Definition
death within 24h of symptoms (usually whtin 1h)
usually related to ischemic heart disease (50%)
caused by electral irritability of myocardium |
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Term
| causes of sudden cardiac death |
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Definition
coronary artery disease
myocardial diseae
valvular disease
conduction abnormalities |
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Term
| how is coronary artery disease that causes sudden cardiac death caused 3 |
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Definition
coronary athlerosclerosis
developmental disorder
coronary artery embolism |
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Term
| how are myocardial diseases that cause sudden cardiac death caused 3 |
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Definition
cardiomyopathies
LV outflow obstruction
endocarditis |
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