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ischemic heart disease - Lec 75 a & B
Terms in this set (43)
onset of ATP depletion in MI
onset of loss of contractility in MI
time until ATP reduced to 50% of normal in MI
time until ATP reduced to 10% of normal in MI
time to irrereversible cell injury in MI
time to microvascular injury in MI
where is the first place you see injury after MI?
what determines the dominance of a heart's vasculature?
whichever artery supplies the posterior septum is the dominant,
what is the most common dominance of the heart
RCA in 4/5 of individuals
what is the incidence of LAD infacrt?
incidence of LCX infart?
incidecnce of RCA infarct?
what do you see pathologically in the first 12 hours of MI?
<12 hours not apparent on gross exam, microvascular changes seen 4-12 hours
what do you see pathologically in 12-24 hours post MI?
gross - reddish blue discoloration caused by stagnated blood; micro- few inflammatory cells, intrafiber edema
what do you see pathologically in 1-3 days post MI?
gross: mottling with softening yellow-tan infarct center; micro - march of the polys lots of neutrophilic infiltrate
what do you see pathologically in 7-10 days post MI?
gross - maximally yellow tan and SOFT, depressed red-tan margins; micro - phagocytosis of dead cells, early formation of fibrous granulation
what do you see pathologically in 10-14 days post MI?
gross - redish gray infart borders; micro - granulation rim, early collagen deposition, polys gone, macrophages present
what do you see pathologically in 2-8 weeks post MI?
gross - gray-white scar progressive border toward core of infarct; micro - inc collagen, dec. cellularity
what do you see pathologically in greater than 2 months post MI?
gross - gray white scar; micro - dense collagenous scar
in what direction does damage to the heart heal in?
heals from the outside in
what is the timeline of myocardial rupture?
range 1-10 days, mean 4-5 days, usualy 3-7 days
what are the risk factors for myocardial rupture
>60, female, HTN
common sites and results from myocardial rupture
ventricular free wall - hemopericardium and cardiac tamponade, most common site is anterolateral wall - midventricular level; rupture of the ventricular septum - acute VSD and L-R shunt
most common site of myocardial rupture?
anterolateral wall - midventricular level
what is the most powerful independent risk factor for CVD?
Age; >55 for men, >65 for women
Another big risk factor with CVD?
What is the plaque like for stable angina
less than 70% obstruction,
what is the characterization of stable angina
predictable & reproducable, relieved with rest may last 5-20 minutes, assocaited with SOB, diaphoresis, N/V
what is the therapy for stable angina?
nitrates, beta blockers or calcium channel blockers
what do nitrates do that helps stable angina?
systemic vasodilation & coronary vasodilator
what do beta blockers and or calcium channel blockers do to help stable angina?
decrease HR & BP, dec. contractility
What are the three types of acute coronary syndrome (ACS) ?
unstable angina; non-STEMI; STEMI
what is a plaque like for unstable angina?
less than 50% obstruction,
what is the progression of the pathology of the plaque in ACS?
unstable plaque -> fibrous cap compromised -> lipid core exposed -> cascade -> balance between thrombosis and thrombolysis
What is the defining characterization of unstable angina?
ischemia but no infacrtion
what would tests show for unstable angina?
EKG - deep t wave inversion, ST depression, or normal; cardiac enzymes (CK-MB & troponins) both negative
What are the defining characteristics of non-STEMI
same EKG as unstable angina, but have positive troponins and or CK-MB
what are the defining characteristics of STEMI
EKG changes - ST elevation or LBBB, also has positive cardiac enzymes
what categories of ACS are defined by infarction
Non-STEMI & STEMI
What is the acute management for ACS?
O2, beta blockers, heparin, Aspirin or clopidogrel, IIB/IIIA agents; thrombolytics for STEMI, cath lab & or CABG
What are the discharge meds (secondary prevention) for CAD (stable angina & ACS)
aspirin, beta blockers, STATINS, Ace inhibitors, smoking cessation
Peripheral artery disease (PAD) - SX
intermittent claudication , presents with walking, relieved by rest, reproducible
walking program, statins
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