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Sem4-AcuteMI

Sem 4 - Path - Acute MI

QuestionAnswer
What are the three types of angina pectoris? Stable, variant and unstable.
What type of angina pectoris is caused by >70% lumen narrowing by uncomplicated AS plaque? Stable angina
Chest pain induced by physical exertion, emotional stress, exposure to cold, or overeating. Stable angina
What kind of angina: Chest pain not associated with precipitating factors and usually occurs at rest due to uncomplicated AS plaque w/ coronary artery spasm ? Variant angina
What kind of angina: ST depression or elevation during angina Variant angina
What is the cause of variant angina? Uncomplicated AS plaque with coronary a. spasm
What type of angina: Transient ST elevation during angina, ST depression, and/or T-wave changes Unstable angina
Chest pain due to destabilized AS plaque, that is increasing in severity, frequency, and duration. Unstable angina
What type of angina is caused by AS plaque destabilization leading to rupture, hemorrhage or thrombosis Unstable angina
Angina upon exposure to cold? Stable angina
What is the leading cause of MI? Coronary AS. (other causes include coronary a. thromboembolism, coronary arteritis (ie PAN or kowasaki), dissectiving aortic aneurysm, and severe systemic htn
Describe the pathogenesis of AS-associated MI Plaque destabilization -> platelet aggregation --> thrombus formation --> ischemia --> necrosis.
What type of MI results from a complete obstruction of a single coronary artery? Transmural MI.
What is the cause of a circular subendocardial MI? severe systemic hypotension (ie collapse or shock)
What is the cause of a localized subendocardial MI? coronary a. obstruction with subsequent thrombolysis.
MI effecting only inner 1/3 ventricular wall? Subendocadial MI
What area if ventricular wall is most vulnerable to ischemia inner 1/3
Dark brown cardiac tissue following an MI indicates what? Reperfusion of the tissue
An obstruction of the LAD will affect what areas the heart? LV anterior wall near apex, Ant 2/3 of IV septum, and apex circumferentially
An obstruction of the RCA will affect what areas of the heart? Post wall of LV, Post 1/3 if IV septum, Post inferior free wall of RV
An obstruction of the LCX will affect what areas of the heart? LV lateral wall, except apex.
What is the duration of an MI with no associated findings on LM, and MC swelling and glycogen loss on EM. 0-1/2 hr (all reversible injuries)
What is the duration of an MI with findings of wavy myocardial fibers and staining defect with TTC on LM, along with Sacolemmal ruptures and MC amorphus densities on EM 1/2 - 4 hours
What is the duration of an MI with associated LM findings of coagulative necrosis(pyknosis, karyorrhexis), deeply eosinophilic cytoplasm, and PMN infiltrate. Necrotic debris found on EM study. 4-12 hours.
Pallor and matting on gross examination are indicative of an MI of what duration? Other expected LM and EM findings? 12-24hrs. LM findings of coag necrosis and EM findings of necrotic debris are expected.
At what duration MI does gross morphological changes begin to occur? 12-24 hrs
Staining defect with TTC dye occurs at what duration MI? 1/2-4hrs
Nuclear changes (pyknosis, karyorrhexis, etc) do not occur until what duration MI? 4-12 hours
At what time following onset of an MI does karyolysis occur? 24-48 hours (day 2-3)
Gross cardiac appearance of mottling with yellow tan center… time after MI? 2-3 days
Gross cardiac appearance of central yellow-tan softening with hyperemic borders… time after MI? 4-7 days
At what point after onset of an MI is macrophage infiltration found? 4-7 days (myocyte and PMN disintegration also occurs at this point)
At what point after onset of an MI does marginal phagocytosis and granulation tissue formation occur? 4-7 days!
How long after an MI would a gray white scar growing from border toward center be found? 2 – 8 weeks.
Histological finding of absence of nuclei in cardiac bx… how long ago did MI occur? appx 24 hours ago. (absence of nuclei is due to karyolysis)
Morphological findings of a cardiac reperfusion injury. Brown in color (hemorrhagic infarction), presence of accentuated contraction bands (***hypercontraction of sarcomeres with z line thickening due to massive Ca2+ influx***)
What is the most effective serum marker in dx of MI ? troponin I (elevates ***2-4 hours following MI****, peaks at 12h, and normalizes in 7-10 days)
What is the most common fatal complication of MI? v-fib.
How long after an MI is a cardiac tamponade most likely to occur? What is the cause? 4-7 days… caused by a free wall rupture due to action of PMN disintegration causing the release of lytic enzymes ‡ softens tissue. Connective tissue has not yet been synth’d, so tissue is weak.
In what situation is a mural thrombus actually beneficial? in the case of an acute MI, because it strengthens the ventricular wall.
Death within 1 hour of cardiac symptoms (may also occur without symptoms) in a person with no previously diagnosed fatal conditions. Sudden cardiac death.
What is the leading cause of death in 20-30 y/o men. sudden cardiac death.
What is the most common post-mortem finding of sudden cardiac death? Ischemic heart diasease: Healed MI (40-70%), destabilized plaque with acute coronary syndrome (20%)
What are 3 major causes of Chronic Ischemic Heart Disease (CIHD) ? IMPAIRED CONTRACTILITY DUE TO: 1) Healed MI (scars), 2)Ischemic cardiomyopathy: degeneration of cardiomyocytes without obvious MI (hibernating myocardium) and/or 3) Diffuse myocardial fibrosis.
What artery supplies the LV lateral wall, except the apex? LCX
What artery supplies the apex, circumferentially? LAD
Most common vessel implicated in an MI? LAD> RCA > LCX
What changes in cardiac enzymes are associated with angina pectoris? NO CHANGES! Cardiac enzymes are not elevated in angina pectoris.
Destabilized AS plaque causes what type of angina? Unstable angina. (angina increasing in frequency and severity)
Reduced stroke volume in a pt with severe coronary arteriosclerosis w/o EKG and troponin I level changes. Dx? CIHD
Reduced stroke volume in a pt with multiple minute myocardial scars... DX? CIHD
4 classifications of ischemic heart disease? Angina pectoris, acute MI, sudden cardiac death, and chronic ischedmic heart disease
Created by: rkirchoff