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Lecture 8
Ischemic Heart Disease
| Question | Answer |
|---|---|
| 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) |
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UVAPATH3
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