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Quiz yourself by thinking what should be in
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| 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
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| what is the initiating even of an infarct | rupture of a plaque (already 75% occluded) resulting in thrombis
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| what do EXPOSED platelets release to aggregate | adenosine DIphosphate
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| what does the tissue release to encourage coagulation | thromboplastin
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| what do activated platelets release | thromboxan A2, serotonin, and platelet factor 3 and 4
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| Activated platelets (via tissue thromboxane favor? | vasospasm and coagulation
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| besides thrombus how can an MI be initiated | increased demand, decresed flow (sleep), cocain, syphilis, emboli, odd anatomy, arteritis
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| Most MIs involve? | LV, Septum and conducting system
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| when do you see an infarct of the RV | when there is a massive LV infarct
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| what is implied when you see an MI that is non-confluent (in a strange place | Collaterals
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| LAD supplies? | ant wall of LV and ant 2/3 of septum
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| what percent of MIs are LAD | 50%
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| RCA supplies? | posterior wall LV and post 1/3 of septum
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| LCCA supplies? | Lateral wall LV
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| what percent of MIs are RCA in origin | 30%
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| what percent of MIs are LCCA in origin | 20%
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| what part of the myocardial wall is most vulnerable | subendocardium (least well perfused) especially inner 1/3 of LV wall
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| where is clinically significant disease with the LCA | poximal 2-4 cm
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| where is clinically significant disese with the LCCA | proximal 2-4 cm
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| where is clinically significnt disease with the RCA | proximal and distal 1/3s
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| what mediates vasospasms | histomine and thromboxane
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| how long do you see prominant hemorrhage with reperfusion | through day 3-5
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| you see mummified fibers and granulation what day is it post MI | 6-10
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| 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
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| do you get granulation tissue with reperfusion and without | no only without
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| 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
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| when do you get a tan yellow with soft center with no reperfusion | day 3-5
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| how do you diagnose MI | 1) pain 2) increased CK, LDH, Troponin 3) systemic changes (acute phase) and fever and electrocardial changes
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| what electrocardial changes are seen with an MI | inverted T, elevated ST, and abnormal Q
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| what percent of MIs have arrhythmias | 70% within the first few hours
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| what type of ectopic arrhythimas are noted | extopics (extra ventricular systole), vtach, and vfib
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| what are the arrythmias noted with MI | 1. ectopics 2. heart block 3. autonomic stim
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| what artery supplies SA and AV nodes | RCA
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| what supplies the bundle of his an LBB | LAD
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| what is autonomic stim | symp and parasymp
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| what happens when there is LV failure following and MI | cardiogenic shock or severe pulmonary edema
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| what types of pericarditis can occur due to an MI | hemorrhagic and fibrinous
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| when does pericarditis occur | first 2-3 days
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| what are the top three complications of MI | 1) arrythmia (70%) 2) Systemic Emboli (50%) 3) Pericarditis (30%)
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| systemic emboli from Mi is due most often to? | mural thrombi
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| when is the maximum weakness of the heart | 5-7 days after you can have a rupture
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| what can happen when there is a rupture | 1) hemopericardium (tamponade) 2) intraventricular septal rupture (RV failure) 3) ruptured papillary muscle (mitral regurge)
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| when can you see a ventricular aneurysm | 2 weeks to several months after
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| what EKG change is noted with stable angina | ST depression maybe (subendothelial)
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| do enzymes elevate with angina | no
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| what do you see on EKG of prinzmetal angina | ST elevation (transmural)
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| sudden cardiac death occurs when? | within 1 hour of symptoms
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| what is noted with chronic ischemic heart disease | often post MI decompensation that results in a 4 chamber dilation with perivascular fibrosis
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