Term
| what percent of deaths and heart disease is ischemic heart disease |
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Definition
70% of all deaths
80% of heart disease |
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Term
| if 80% of heart disease is ischemic, what is the other 2-% 7 |
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Definition
HTN
cor pulmonale
valvular: endocarditis, stenosis, prolapse, rheumatic |
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Term
| define ischemic heart disease |
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Definition
| syndromes causing imbalance between myocardial O2 supply and demand |
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Term
| what is stenosis critical and going to cause ischemic heart disease |
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Definition
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Term
| what are 8 risk factors for aschemic heart disease, which is most |
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Definition
HTN
50-75% athlerosclerosis
sedentary
DM
smoking
Age
LDL
hyperTG |
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Term
| how does athlerosclerosis cause ischemic heart disease |
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Definition
plaque stress activates T cells
secretes inFy which activates macrophages which secrete metalloproteinases which degrade fibrous cap which fissues, erodes, ulcerates, and hemorrhages causing thrombosis which can block the vessel or emboli and block a different one |
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Term
| symptoms of ischemic heart disease 6 |
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Definition
severe crushing substernal or precordal pain that extends into jaw or left arm
epigastric burning
sweating
vomiting
nausea
SOB |
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Term
| symptoms of ischemic heart disease in women 6 |
|
Definition
fatigue
sleep distrubance
SOB
back pain
abd/epigastric pain
nausea without vomiting |
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Term
| what labs are used to diagnosed ischemic heart disease 3, explain the timing and significance of each |
|
Definition
myoglobin (CK-MB): raises in 2-4h but falls fast, not specific to MI (can help diagnose re-infarction)
troponin I: MOST SPECIFIC TO HEART TISSUE, peaks in 24h, lasts 7-10d (not good in diagnosing re-infarction)
CPR: less specific, higher puts at risk for MI and stroke |
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Term
| unstable angina: aka, cause |
|
Definition
preinfarction angina
rupture of athlerosclerosis exposes epithelial collagen and allows for thrombosis |
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Term
| unstable angina: physical signs |
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Definition
crescendo chest angina increasing in frequency with progressivly less work
CP radiating to left arm and jaw for less than 20 min
high risk of progression to thrombosis or MI |
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Term
| unstable angina: changes in cardiac tissue |
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Definition
| reversible cell injury because it only progresses to subendocardial tissue |
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Term
| stable angina: aka, cause |
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Definition
classic angina
athlerosclerosis usually (75% fixed coronary artery lesions) is fine at rest but on exertion enough blood cant get to myocardium |
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Term
| stable angina: signs in tissue and clinically |
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Definition
reversible cell injury because it only progresses to subendocardial tissue
chest pain radiating to left arm and jae for <10 min |
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Term
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Definition
| nitroglycerin causes vasodilation and decreases cardiac work |
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|
Term
|
Definition
| vasoapasm of coronary artery cuts off blood to area of heart completely (with or without athlerosclerosis) |
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Term
| prinsmetal angina: effect on tissue and clinically |
|
Definition
substernal chest pain at rest radiating to left arm and jaw for <20 min
reversible myocyte injury because it only progresses to subendocardial tissue |
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Term
| prinsmetal angina: complications |
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Definition
| if it lasts more than 20 min it takes on effect of MI |
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Term
| what are the 3 most common sites of MI, what areas do they supply |
|
Definition
40-50% left anterior descending coronary artery: anterior LV and anterior septum
30-40% right coronary artery: posterior LV and posterior septum, papillary muscles
15-20% left coronary artery |
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Term
| explain the timeline of an infarction through the tissue layers and when it becomes critical |
|
Definition
30 min: subendocardium (inner 1/3)
3-6h: transmural (complete wall) treat within 3 h to reduce mortality |
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|
Term
| what changes can be seen in the heart between 0-30 min of infarction |
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Definition
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Term
| what changes are there in heart in 1-3h from infarction |
|
Definition
| non-contractile ischemic myocytes stretched with systolic tugs making wavy fibers |
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Term
| what complications from infarction can occur within the first 3h |
|
Definition
arrhythmia: can cause sudden death
cardiogenic shock: 70% mortality
CHF due to contractile dysfunction |
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Term
| what occurs in 4h-1d of infarction in the tissue |
|
Definition
4-12h: early necrosis
18-24h: contraction band necrosis, hypereosinophilic myocytes due to coagulative necrosis |
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|
Term
| what does the heart tissue look like between 4h and 1d of ifarction |
|
Definition
darkened
mottling on cut surface of ventricle |
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|
Term
| what complications occur 4h-1d from infarction |
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Definition
| arrhythmia: can cause sudden death |
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Term
| what occurs 1-3d from infarction in tissue, what does it look like |
|
Definition
neutrophil infiltration
inflammatory yellow exudate, necrotic, demarcated, soft |
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Term
| what complications occur 1-3d from infarction |
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Definition
| fibrinous pericarditis: exudate from neutrophils goes into heart wall causing CP and friction rub |
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Term
| what ocurrs 4-7d from infarction, what does it look like |
|
Definition
macrophage infiltration
inflammatory yellow exudate, necrotic, demarcated, soft |
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Term
| what are the complications 4-7d from infarction 3, why 1 |
|
Definition
macrophages eat the exudate making tissue weak
rupture of wall: causes tamponade
rupture of ventricular septum: causes shunt formation
rupture of papillary muscle: causes mitral insufficiency |
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Term
| what vessels is normal infarcted if in 4-7d from infarction there is papillary muscle rupture |
|
Definition
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Term
| what occurs in the dissue 1-3wk after infarction, what does it look like |
|
Definition
granulation
white granular tissue, fibroblasts, type I collagen, vessel angiogenesis causes RED BORDER |
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Term
| what occurs 7-8 wks from infarction, what does it look like |
|
Definition
fibrosis
occurs from inside out |
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Term
| what occurs >2mo after infarction |
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Definition
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Term
| what are the possible complications >2mo after infarction 2, why 1 |
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Definition
scar tissue is weaker than normal heart tissue
aneurysms of ventricle cause bloging in systole, can collect mural thrombi
stasis due to decreased movement and damaged myocyte exposure allows for formation or mural thrombi |
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Term
| 4 causes of reperfusion of an infarcted tissue |
|
Definition
thrombolysis
percutaneous transluminal coronary angioplasty
stint placement
coronary artery bypass graft |
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Term
| two complications from reperfusion, explain each |
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Definition
reperfusion injury: return of blood means return of O2 which makes ROS and further injurs cardiac tissue (continues to release diagnostic markers)
contraction band necrosis: return of blood means return of Ca and contraction of myocardium causing dense lines (thick, irregular, eosinophilic lines) |
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Term
| define sudden cardiac death, what is the most common cause |
|
Definition
death within 24h of symptoms (usually 1h) due to electrical irritability of myocardium (arrhythmia)
usually due to ischemic heart disease caused by athlerosclerosis |
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|
Term
| causes of sudden cardiac death 10 |
|
Definition
coronary artery disease: altherosclerosis, embolism, developmental disorder
myocardial disease: cardiomyopathy, myocarditis, RV dysplasia
valve disease: MV prolapse, LV outflow obstruction, endocarditis
conduction abnormalities |
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Term
| define chronic ischemic heart disease, what is a complication |
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Definition
poor myocardial function due to chronic ischemic damage with or without infarct present
can cause CHF |
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