Term
| Why is a person having an MI hypotensive, tachycardic & tachypneic? |
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Definition
hypotensive: heart not working at full capacity
tachycardic: compensation for sm. stroke volume & to try to increase BP
tachypneic: due to decreased oxygen |
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Term
| Why does someone having an MI have cool & clammy skin? |
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Definition
| increased sympathetics to compenstate for decreased BP |
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Term
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Definition
| sound of turbulant blood flow |
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Term
| What does a femoral bruit most likely indicate? |
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Definition
| tubulant blood flow due to blockage of femoral a. |
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Term
| What lab values are most indicative of cardiomyocyte damage? |
|
Definition
primarily: increased troponin
increased creatine kinase |
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|
Term
| What does peripheral nerve look like microscopically? |
|
Definition
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|
Term
| What risk factors does a 52 yr old male with diabetes & a smoking history have for MI? |
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Definition
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Term
| Why would someone be given a regimen of aspirin, heparin, & t-PA post-MI? |
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Definition
| aspirin: inhibits COX1 => inhibits TXA2 => decreased platelet aggregation => decreased clotting
heparin: activated AT III => prevents thrombin (factor II) activation => decreased clotting
t-PA: thrombolytic activation of plasminogen to plasmin to break up clots |
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Term
| Microscopically, how do you distinguish between a post-mortem clot & a thrombus? |
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Definition
| thrombus has lines of Zhan |
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Term
| What are the possible complications of an atheromatous plaque? |
|
Definition
1) calcification
2) ulceration
3) thrombus
4) hemorrhage
5) aneurysmal dilation |
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Term
| What does calcification of an atherosclerotic plaque look like microscopically? |
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Definition
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|
Term
| Why is a pale infarct white? |
|
Definition
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|
Term
| What coronary artery is sucspected of occlusion when the anterior L ventricle & anterior interventricular septum are involved in an MI? |
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Definition
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|
Term
| What happens when a pale infarct becomes reperfused? |
|
Definition
| becomes a hemorrhagic infarct |
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|
Term
| How can reperfusion further damage cadiac myoctyes beyond initial injury? |
|
Definition
| formation of oxygen free radicals |
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|
Term
| What microscopic features are characteristic of coagulative necrosis of the cardiac muscle? |
|
Definition
remnants of myocardiocytes with no nucleus/pyknotic nuclei
very eosinophilic
contraction band necrosis |
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Term
| How can you distinguish a recent infarct <1 day old? |
|
Definition
some pyknotic nuclei
no neutrophils |
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Term
| What happens to the subendocardium in a recent infarct? |
|
Definition
become fibrotic & have hydropic degeneration (swelling).
it's reversible cell injury, as opposed to necrosis, because there is some diffusion from the lumen |
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|
Term
| What can cause a fever & increased WBC count in a MI recovering patient 3 days post-MI? |
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Definition
| state of chronic inflammation => proinflammatory state via cytokines |
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|
Term
| What cells predominate 3 days post MI? |
|
Definition
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|
Term
| How do PMNs get to the MI site 3 days post-MI? |
|
Definition
| chemotactic: C5a, leukotrienes, other neutrophils, platelet activating factors |
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|
Term
| Why is there so much clear space b/w muscle cells in area of infarction? |
|
Definition
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|
Term
| How do you tell how old an infarct it? |
|
Definition
< 24 hr: no neutrophils
1-3d: neutrophils
3-7d: macrophages
5-7d: granulation tissue formation
weeks: new scar fibrosis
years: fibrosis, little fibroblasts |
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|
Term
| Why do WBC count normalize 5d post-MI? |
|
Definition
| normalization due to decreased inflammatory response due to TGF-β & liopoxins |
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|
Term
| What do you expect to see microscopically 5d post-MI? |
|
Definition
| macrophages, little neutrophils, granulation tissue formation |
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|
Term
| What do the viable cariac myocytes look like 1 year post-MI? |
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Definition
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|
Term
| Why does fibrosis occur in subendothelial regions post-MI? |
|
Definition
| furthest area from coronary a. still perfused by them therefore less blood flow to them when occluded |
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|
Term
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Definition
| small clicking, bubbling, or rattling noises of the lungs |
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|
Term
| What can cause rales in a person with heart issues? |
|
Definition
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|
Term
| What causes pulmonary edema? |
|
Definition
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|
Term
| What is the process that causes pulmonary edema due to L ventricular failure? |
|
Definition
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|
Term
| What type of pulmonary edema is caused by L ventricular failure? |
|
Definition
| trsudate (little cells, little protein) |
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|
Term
|
Definition
| increased intravascular blood due to impaired venous outflow |
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|
Term
| Why would a person with previous heart failure have an enlarged liver & peripheral edema? |
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Definition
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|
Term
| Why would a person with R ventricular falure have an enlarged liver? |
|
Definition
| congestion on central v. due to decreased flow to IVC |
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|
Term
| What happens to the liver in acute congestion? |
|
Definition
| centrilobular sinusoids expanded with blood |
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|
Term
| What happens to the liver in chronic congestion? |
|
Definition
| centrilobular necrosis/atrophy, fibrosis & hemosiderin-laden macrophages |
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|
Term
| Why are the portal triads spared from congestion in R ventricular failure? |
|
Definition
| triads flow into the portal veins => IVC. The back up starts at the IVC & works it's way backwards. The triad is just far enough back to not be affected |
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|
Term
| What pigment in Kupffer cells indicates chronic liver congestion? |
|
Definition
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|
Term
| What causes the hemosiderin pigment accumulates in a chronically congested liver? |
|
Definition
| abundance of blood => increased [iron] at that site |
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Term
| What risk factors does a 52 yr old male with diabetes, a smoking history, and a previous MI have for thrombus formation? |
|
Definition
endothelial injury (atherosclerosis)
smoking
stasis of blood flow due to previous MI |
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|
Term
| What are the components of granulation tissue? |
|
Definition
neovascularication
fibroblasts
inflammatory cells (mostly macrophages) |
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|
Term
| Why would you see granulation tissue on scarred areas from old infarct? |
|
Definition
| New injury on old area of infarct |
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|
Term
| What produces the lines of Zhan |
|
Definition
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|
Term
| Are liens of Zhan more prominent in arteries or veins? |
|
Definition
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|
Term
| What are the possible complications of a mural thrombus? |
|
Definition
vascular obstruction
embolism |
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|
Term
| Why is a person with a thrombus likely to die from a stroke? |
|
Definition
| embolism to brain can cause stroke |
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