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28 Cards in this Set
- Front
- Back
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What causes Ischemic Heart Disease?
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- Atherosclerosis of coronary arteries (99% of AMIs)
- 75% stenosis of Coronary Arteries can produce symptoms of ischemia - Transmural MIs usually have cracked plaque & occlusive thrombus |
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Epidemiology of Ischemic Heart Disease
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Basically same as atherosclerosis
M:F::2-6:1 IMPORTANT: women do get CAD/IHD - Do NOT ignore obvious symptoms - Women have more variable presentations (fatigue, back pain, abdominal pain) |
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Are RV infarcts common?
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No. They usually occur as extensions of large posterior LV infarcts.
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What are complications of Myocardial Infarcts?
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- Rupture (free wall, septum, papillary muscle)
- Mural thrombus (cause of systemic embolus) - Congestive heart failure (CHF) - LV aneurysm - Dysrhythmia or arrhythmia - Pericarditis (if transmural involvement) - Pulmonary thromboembolism (venous congestion → thrombosed leg vein) |
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Early Acute
Morphology of Myocardial Infarcts |
Duration: 6-24 hours
Gross: Subtle: patchy pallow, slight hyperemia Micro: thin wavy fibers, eosinophilia, few PMNs |
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Acute
Morphology of Myocardial Infarcts |
Duration: 1-6 days
Gross: obvious pale, yellow Micro: necrotic myocytes, many PMNs |
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Organizing
Morphology of Myocardial Infarcts |
Duration: 1 wk- 3 wks
Gross: red-brown edge, around pale center Micro: granulation tissue, acute and/or chronic inflamation |
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Remote
Morphology of Myocardial Infarcts |
Duration: 3 months of longer
Gross: firm, white, scar, contracted, wall thinned Micro: collagen, thinning of wall |
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Pathogeneis of
Subendocardial MI |
Diffuse CAD & global perfusion made transiently critical by:
- Increased demand - Vasospasm - Hypotension Disrupted plaque w/ overlying thrombus that lyses thus limiting extent of myocardial injury |
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In absence of Sudden Cardiac Death, what are 2 ways that blood flow could be restored and the myocardium spared?
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1. thrombus may lyse
2. vasospasm may relax |
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Where do transmural MIs occur within the heart?
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Nearly all involve LV
15% LV + RV 1-3% RV alone |
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What is the time interval from myocardial ischemia → irreversible injury?
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20-40 minutes
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Pathogenesis of Transmural Myocardial Infarcts
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- 90% due to CA stenosis & disrupted plaques
- Significant plaques mainly in proximal CA - Initial event: acute plaque disruption of partially stenosing atheroma - Most vulnerable: soft lipid core w/ thin fibrous cap - Thrombosis follows acute plaque disruption Less common: vasospasm, Plt aggregation, emboli → MI w/o atherosclerosis |
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In which stage of MI repair does Rupture occur?
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Acute... Days 3-7
this is when there is maximal necrosis, but the fibroblasts have not come in yet |
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In which stage of MI repair does LV aneurysm occur?
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Organizing, (acute, remote)
1 week -3 weeks |
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In which stage of MI repair does CHFoccur?
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All stages
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In which stage of MI repair does dysrhythmia occur?
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most often within the first 24 hours .: early acute
possible at any of the stages |
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In which stage of MI repair does mural thrombus occur?
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Acute, Organizing, (Remote)
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In which stage of MI repair does pericarditis occur?
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organizing, acute
fibrosis occurs during remote staging |
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Fibrinous Pericarditis
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Follows AMI or Acute Renal Failure
- on the epicardial surface - hear a friction rub if they get a pericardial effusion... not a constrictive pericarditis |
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What happens if the Left Ventricle ruptures?
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hemopericadium... pericardial sac is full of clotted blood
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What is seen grossly on a CHF heart surface?
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- white patches on the epicardium
- enlarged dilated heart |
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How do the lungs of a patient with CHF appear?
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Rusty colored because of hemosiderin within parenchyma.
- on CXR, kerley B lines are present |
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What causes right-sided heart failure?
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Mainly due to LV failure
Pure RV failure due to intrinsic lung dz (cor pulmonale) or TV/PV dz |
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What are the major manifestations of right-sided heart failure?
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Portal, systemic & dependent peripheral congestion & edema (feet, ankles, sacrum) and effusions (pleural and peritoneal [ascites])
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Liver manifestations
Right Sided Heart Failure |
Hepatomegaly w/ Chronic Passive Congestion
- With severe hypoxia → centrilobular necrosis - Subsequent central fibrosis → cardiac sclerosis |
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Spleen manifestations
Right Sided Heart Failure |
Congestive splenomegaly
- Focal hemorrhages - Hemosiderin deposits |
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Kidney manifestations
Right Sided Heart Failure |
Renal congestion
- Acute Tubular Necrosis |
