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PATH: Ischemic Heart

keep it simple

cause of coronary ischemia 1) atherosclerosis 2) Platelet problems 3) Hemodynamic abnormalitites 4) coronary artery spasms 5) syphilis 6) Kawaski's (arteritis) 7) coronary artery embolism
what is the initiating even of an infarct rupture of a plaque (already 75% occluded) resulting in thrombis
what do EXPOSED platelets release to aggregate adenosine DIphosphate
what does the tissue release to encourage coagulation thromboplastin
what do activated platelets release thromboxan A2, serotonin, and platelet factor 3 and 4
Activated platelets (via tissue thromboxane favor? vasospasm and coagulation
besides thrombus how can an MI be initiated increased demand, decresed flow (sleep), cocain, syphilis, emboli, odd anatomy, arteritis
Most MIs involve? LV, Septum and conducting system
when do you see an infarct of the RV when there is a massive LV infarct
what is implied when you see an MI that is non-confluent (in a strange place Collaterals
LAD supplies? ant wall of LV and ant 2/3 of septum
what percent of MIs are LAD 50%
RCA supplies? posterior wall LV and post 1/3 of septum
LCCA supplies? Lateral wall LV
what percent of MIs are RCA in origin 30%
what percent of MIs are LCCA in origin 20%
what part of the myocardial wall is most vulnerable subendocardium (least well perfused) especially inner 1/3 of LV wall
where is clinically significant disease with the LCA poximal 2-4 cm
where is clinically significant disese with the LCCA proximal 2-4 cm
where is clinically significnt disease with the RCA proximal and distal 1/3s
what mediates vasospasms histomine and thromboxane
how long do you see prominant hemorrhage with reperfusion through day 3-5
you see mummified fibers and granulation what day is it post MI 6-10
when does collagen start to deposit post MI day 10-14 after mummified fibers with no reperfusion and day 3-5(early collagen) with reperfusion
do you get granulation tissue with reperfusion and without no only without
final appearance with reperfusion and without with you have white intermingled with red myocardium without you have gelatinous to greywhite scar and greater healing at the borders
when do you get a tan yellow with soft center with no reperfusion day 3-5
how do you diagnose MI 1) pain 2) increased CK, LDH, Troponin 3) systemic changes (acute phase) and fever and electrocardial changes
what electrocardial changes are seen with an MI inverted T, elevated ST, and abnormal Q
what percent of MIs have arrhythmias 70% within the first few hours
what type of ectopic arrhythimas are noted extopics (extra ventricular systole), vtach, and vfib
what are the arrythmias noted with MI 1. ectopics 2. heart block 3. autonomic stim
what artery supplies SA and AV nodes RCA
what supplies the bundle of his an LBB LAD
what is autonomic stim symp and parasymp
what happens when there is LV failure following and MI cardiogenic shock or severe pulmonary edema
what types of pericarditis can occur due to an MI hemorrhagic and fibrinous
when does pericarditis occur first 2-3 days
what are the top three complications of MI 1) arrythmia (70%) 2) Systemic Emboli (50%) 3) Pericarditis (30%)
systemic emboli from Mi is due most often to? mural thrombi
when is the maximum weakness of the heart 5-7 days after you can have a rupture
what can happen when there is a rupture 1) hemopericardium (tamponade) 2) intraventricular septal rupture (RV failure) 3) ruptured papillary muscle (mitral regurge)
when can you see a ventricular aneurysm 2 weeks to several months after
what EKG change is noted with stable angina ST depression maybe (subendothelial)
do enzymes elevate with angina no
what do you see on EKG of prinzmetal angina ST elevation (transmural)
sudden cardiac death occurs when? within 1 hour of symptoms
what is noted with chronic ischemic heart disease often post MI decompensation that results in a 4 chamber dilation with perivascular fibrosis
Created by: jmuame03