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Lecture 8

Ischemic Heart Disease

What is "critical stenosis" when the coronary flow is decreased by >75% and there is decreased coronary flow at rest
What is Prinzmetal angina Angina due to coronary artery spasm
What are the four ischemic syndromes of ischemic heart disease Myocardial Infarction, Angina, Sudden Cardiac Death, Chronic Ischemic Heart Disease
The acute event of a myocardial infarction is due to ? in 80-90% of cases a fresh thrombus overlying an ulcerated or fissured atherosclerotic plaque
What is more common a RV or LV infarction LV (a RV infaction may occur as part of a massive LV infarct but rare as an isolated primary event)
What Coronary is most likely affected LCCA, RCA or LAD? LAD
What part of the heart is affected when there is a lesion in the LAD Ant wall LV, Ant. 2/3 of the septum
What part of the heart is affected when there is a lesion in the RCA Post. Wall LV, post 1/3 septum
What part of the heart is affected when there is a lesion in the LCCA Lateral wall LV
Gross findings 12 hours after Occlusion No change/pallor
Gross findings 24-48 hours after occlusion pallor-tan yellow
what gross changes are noted 3-5 days after occlusion tan yellow soft center, hyperemic borders
what gross changes are noted in the heart 6-10 days after occlusion tan yellow depressed central infarct, tan-red margins
what gross changes are noted 10-14 days after occlusion grey-red borders infiltrating central tan-yellow infarct if large
what gross changes are noted 2-8 weeks after occlusion gelatinous to grey white scar greater healing at border zone
what does granulation tissue form following a MI 10-14 days
when do PMNs show up at the borders of the infarcted area following an MI 24-48 hours
when does collagen deposition start following an MI 2-8 weeks
what biochemical changes can be looked for with markers during an MI increased Ck-MB, LDH-1, and cardiac troponin
what are some ECG changes noted during an MI Inverted T wave, Elevated ST segment, and abnormal Q waves
What cardiac arrythmia results in a large number of deaths in MI patients Vfib
AV node block is common after what type of MI posterior MI (RCA supplies SA and AV nodes)
Ischemia/necrosis of anterioseptal infarcts (LAD) can result in what type of heart block Bundle Branch Block (especially the bundle of His and LBB)
When would you typically see Pericarditis following an MI? within the first 2-3 days of a transmural infarct
when is the maximum cardiac wall weakness following an MI (concern for rupture) maximum weakness is 5-7 days following the MI
when do you worry about ventricular aneurysms following an MI 2 weeks to several months
how is unstable angina defined progression or increased frequency and intesity of angina pain or occuring at rest
What is the cause of an angina that occurs at rest with ST elevation and negative enzymes coronary artery spasm (prinzmetal angina)
Created by: UVAPATH3



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