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29 Cards in this Set
- Front
- Back
ischemic hrt disease
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imbalance of tissue perfusion and oxygen requirement
decreased coronary blood flow |
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exercise induced ischemia
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50-75% narrowing of coronary cross section, adequate at rest
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critical stenosis
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>75% narrowing of coronary flow, problem at rest
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4 ischemic syndromes
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MI
Angina Pectoris Sudden Cardiac Death Chronic ischemic Heart Disease |
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12 hrs after MI
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Gross: no change
micro: wavy fibers, coagulation necrosis, edema |
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24-48 hrs after MI
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gross: yellow
micro: hypereosinophilic, PMNs at border |
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3-5 days after MI
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gross: tan yellow soft center, hyperemic borders
micro:lots of PMS, coag necr, loss of nuclei |
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Changes of serum in MI
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increased creatine kinase MB CK2
lactic acid dehydrogenase (LDH-1) cardiac troponin contractile proteins released from injured muscle |
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What are the major coronary events leading to MI
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1)abrupt change or rupture in a stenosing atheroma (already more than 75% reduction)
2) platelets aggregate, activate, release ADP which further builds up aggreg 3) tissue thromboplastin is released activating extrinsic coag 4) platelets relase TXA2, serotonin, PF 3 and 4 causing coag and vasospasm 5) thrombus may become occlusive causing transmural AMI |
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6-10 days after MI
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gross: yellow, depressed central, tan red margins
micro: GRANULATION TISSUE AT BORDER, mummified in center, MO at border |
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10-14 days after MI
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gross: grey red borders, central tan yellow
micro: GRANULATION EVERYWHERE, collagen dep |
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What are the factors that determine the location and size of MI,
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CA involvement (LAD, RCA, LCCA), existance of vascular collaterals, underlying coronary disease
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Complications
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Arrhythmias, within first few hours,
heart block, AV nodal PostMI, BBB LAS LV Failure Progressive infarct Pericarditis within 2-3 days, pain, rub Embolism from mural thrombis when endocardium is involved Rupture (5%) ventricular Aneurysm |
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Why is a primary right ventricular infarct rare
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because it is thin walled and can be perfused directly from cahmber
when it happens is part of massive LV infarct |
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Difference between mural and subendocardial infarct
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Mural full thickness is most common, wave front phen
subendocardial most vulnerable least well perfuse, inner third of LV wall, multifocal or circumferential depending on coronary involvement |
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LAD infarct
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50%
anterior wall LV; anterior 2/3 septum |
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RCA infarct
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30%
posterior wall LV; post 1/3 of septum |
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LCCA
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20%
lateral wall LV |
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coronary abnormalities
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>75% reduction of cross sectional area of one major
typically wihin first 2-4 cm of LAD and LCCA, and proximal distal thirds of RCA |
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Systemic Changes after Mi
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fever
PMN up fibrinogen and hepoglobin up (Acute phase reactants) |
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Electrocardial Changes after Mi
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inverted T
elevated ST segment abnormal Q |
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When does pericarditis occur
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after 2-3 days
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when can you rupture
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5-7 day is the weakest
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when is ventricular aneurysm risk high
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2weeks to several months
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Hemopericardium
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cardiac tamponade
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interventrculare septal rupture
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L to R shunt, Acute RV failure
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rupture of papillary muscles
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acute mitral incompetence
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what is prinztmetals angina
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angina at rest, due to coronary spasm often ST elevated
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Sudden cardiac death
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dfined as unexpected death within an hour of onset of acute symptoms
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