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19 Cards in this Set

  • Front
  • Back
What are the 3 general causes of Ischemic Heart Disease (IHD)?
coronary insufficiency, eg artherosclerosis

Increased myocardial demand

What are the 4 classical presentations of IHD, also known as the Acute coronary syndromes?
angina pectoris

myocardial infarction

sudden cardiac death

chronic congestive heart failure (chronic IHD)
What is sudden cardiac death syndrome (SCD)?
unexpected death by cardiac causes within one hour of symptom onset

typically involves a lethal arrhythmia, ususally ventricular afibrillation

may result from a conducting system anomaly, myocarditis, valvular disease, or most commonly ischemia

leads to an MI in 20-30% of cases
What types of arteries are most often involved in IHD?
epicardial arteries
Describe the most common cause of decreased myocardial flow?
Artherosclerotic coronary artery disease (CAD)

flow limiting stenosis usuallly occurs w/in first 5 cm of artery

chronic narrowing or complete occlusion = artherosclerotic plaque/ fixed stenosis

complications occur from acute lesions (thrombotic occlusion, plaque rupture)

collateral circulation increases during the disease process, may be newly formed vessels or modified flow
What are other causes of decreased coronary flow?
coronary spasm



coronary vasculitis

spasm is associated with variant (Prinzmetal's) angina
When does IHD occur?
when myocardial O2 demands meet supply
What would cause the myocardial O2 demand to meet supply?
Reduction in coronary flow

increased myocardial O2 demand b/c of tachycardia, hypertension, hypoxemia
How does coronary artery pathology correlate with the 4 clinical presentations of IHD?
most people who survive IHD have coronary artey artherosclerosis and an acute coronary lesion

fixed stenoses is associated with angina pectoris

plaque ruptures and non occlusive thrombi are associated with "crescendo angina"

Acute MI is associated with occlusive thrombi
What are the morphological patterns of Ishemic myocardium?
Transient Ischemia: contraction band, necrosis, often with hemorrhage; seen in reperfusion injury

Prolonged Ischemia: Myocardial infarction

Chronic and/or gradual Ischemia: myocytolysis and fibrosis, may include old infarcts, typical pathology of IHD (ischemic cardiomyopathy)
What are the funcxtional changes that occur in an ischemic myocardium?
arrythmia and cassation of conduction
How is diagnosis of MI made?

ECG findings

lab studies (serum markers)
What are general characteristics of Myocardial Infarction?
most important cause of morbidity from IHD

characterized by myocardial coagulative necrosis caused by coronary artery occlusion

marked by series of progressive gross and microscopic changes and release of myocardial nzms and protiens into bloodstream

cells involved include neutrophils, macrophages, and fibroblasts
What are the 2 distinct patterns of MI?
Transmural: myocardial necrosis that traversis the entire ventricualr wall from endocardium to epicardium
- us. associated with coronary occlusions

Subendocardial: myocardial necrosis that is limited to the interior one third of the wall of the left ventricle
circumfrential, usually result of reopened infarct related artery
What is a paradoxial infarct?
infarcts NOT in area supplied by occluded artery

occur b/c of loss of colateral circulation
What is the mechanism of muscle cell loss in MI?
What complications are assocaited with MI?
myocardial stunning; transiently non functional but viable myocardium, esp associated with reperfusion

arrythmia andcongestive failure - most common cause of death in first hours

Cardiogenic Shock - due to myocardial pump failure

pumonary embolism

myocardial rupture - usually occurs w/in 4-7 days may result in death from cardiac tamponade

mural and periphaeral thrombosis
Treatment of cardiac ischemia with reperfusion is often associated with distinctive pathologic anatomy. Give examples of this.
thrombolysis --> hemmorhagic infarction, contraction bands

PTCA --> Acute = plaque hemmorhage, dissection, thrombosis, rupture Subacute = restenosis

Coronary artery bypass graft -->graft artherosclerosis, fibrointimal hyperplasia

modulation of platelet function and reductions of risk factors --> ???
What serum markers are specific for MI?

contractile proteins: cardiac troponin troponin I

all rise approx 12 hours after MI but stay elevated for 4-7 days