PATHOLOGY

ISCHEMIC HEART DISEASE HEART FAILURE

Definition: -group of closely related diseases -resulting from imbalance between -myocardial demand & oxygenated blood supply
Etiology: 1. Reduced coronary blood flow -atherosclerosis -coronary disease -embolism 2. Increased myocardial demand (hypertrophy) 3. Factors that aggravate ischemia (hypoxia)

CONSTITUTIONAL Age (44-45 yo) Sex M/F (4:1)

MAJOR Hyperlipidemia Diabetes mellitus Hypertension Cigarette smoking

MINOR Type A personality Physical inactivity

ANGINA PECTORIS

MYOCARDIAL INFARCTION

CHRONIC ISCHEMIC HEART DISEASE

SUDDEN CARDIAC DEATH

Definition: Presence of episodic pain in substernal area caused by transient myocardial ischemia and may radiate to the back or down the left arm 3 types:

1. Stable angina (typical) 2. Unstable angina (preinfarction) 3. Variant angina (Prinzmetal)

STABLE MOST COMMON

UNSTABLE SEVERE, FREQUENT, PROLONGED

VARIANT AT REST, AWAKEN PATIENT FROM SLEEP

PRECIPITATED BY: PHYSICAL ACTIVITY & STRESS

RELIEVED BY: VASODILATOR

PRECIPITATED BY: LESS EFFORT AND AT REST

-

UNRELATED TO PHYSICAL ACTIVITY

RELIEVED BY: VASODILATOR CALCIUM CHANNEL BLOCKER NORMAL TO SEVERE STENOSED CORONARY

75% NARROWING OF CORONARY

DISRUPTION OF PLAQUE-PLAQUEPREINFARCTION

ST SEGMENT SUPERADDED MURAL DEPRESSED (ISCHEMIA) THROMBI, VASOSPASM

NO NECROSIS FOCAL NECROSIS AND FIBROSIS

ST SEGMENT ELEVATED (INJURY)

NO NECROSIS

5 EASY THINGS TO REMEMBER!

1. 2. 3. 4.

DEFINITION VERY SIMPLE ONE! TYPES LOGIC MORPHOLOGY DIAGNOSIS CRUCIAL FOR A DOCTOR 5. COMPLICATIONS

1. Definition: Localized area of ischemic necrosis of myocardium caused by sudden complete occlusion of arterial supply with deficient collaterals. 2. Types: 1. Transmural infarction (full thickness) 2. Subendocardial infarction (inner 1/3 to half)

TRANSMURAL

SUBENDOCARDIAL OCCURS IN EVOLVING MYOCARD. INFARCT (IN CASE WE SUCCEED TO PREVENT TRANSMURAL INFARCTION) OCCURS IN DIFFUSE SEVERE ATHEROSCLEROTIC NARROWING

CAUSED BY 75% NARROWING OF CORONARY WITH ACUTE PLAQUE CHANGES 1. 2. 3. 4. FISSURING OF PLAQUE THROMBOSIS ENLARGED THROMBUS 20-40 MINS FOR ISCHEMIA TO CHANGE TO INFARCTION 5. NECROSIS IN SUBENDO. THEN EXTEND IN 3-6 HOURS 6. IF PATIENT SURVIVE, THROMBUS LYSES BY FIBRINOLYTIC AND BLOOD FLOW REESTABLISHED

TIME

GROSS

LIGHT MICROSCOPE

0-12 HRS
12-24 HRS

SLIGHT PALLOR

EARLY COAGULATIVE NECROSIS

1-3 DAYS

PALE INFARCT + HYPEREMIC MARGIN

LIQUEIFACTION & RED MARGIN RED PURPLE GRANULATION TISSUE GRAY WHITE INFARCT

-NUCLEAR LYSIS -NEUTROPHILS

-CAPILLARY DILATION
4-7 DAYS 7-14 DAYS -GRANULATION TISSUE -MACROPHAGE -NO NECROTIC TISSUE -FIBROSIS -GRANULATION SCAR, VASCULARITY, CONTRACTION

WEEKS-MONTHS

Clinical: -Severe pain, more than 30 mins, not relieved by vasodilators -Silent in diabetics and hypertensive -Nausea, sweating, vomitting ECG change: 1. Q wave (deep) 2. ST segment abnormalities ( in recent injury, in infarction) 3. T wave inversion 4. Arrythmia

Laboratory Investigation 1. 2. 3. 4. Troponin (1-4 hours) Myoglobin (1-4 hours) Creatinine kinase (CKMB: 2-4 hours) Lactate dehydrogenase (LDH-1:2-7days)

Echocardiography To visualize: -Ventricles, thrombi, rupture.

(MIN-HR) ARRHYTHMIA, CARDIOGENIC SHOCK, ACUTE LT. HEART FAILURE (FEW DAYS) THROMBOSIS, ACUTE PERICARDITIS (3-14 DAYS) RUPTURE OF INFARCTED AREA (WEEKS) DRESSLER SYD, VENTRICULAR ANEURYSM (ANYTIME) REPETITIVE INFARCTION

1. 2. 3.

4. 5. 6. 7.

8.
9. 10.

NAME 4 CLASS OF IHD GIVE DEFINITION OF ANGINA PECTORIS GIVE 2 CHARACTERISTICS FOR EACH 1. STABLE ANGINA 2. UNSTABLE ANGINA 3. VARIANT ANGINA STATE 6 STEPS ON HOW TRANSMURAL INFARCT DEVELOPS NAME AREAS INFARCTED IF ANT. DESC. BRANCH OF LT. CORONARY ARTERY IS OCCLUDED STATE THE MAJOR RISK FACTORS OF IHD HOW DO YOU DIAGNOSE MYOCARDIAL INFARCTION? STATE COMPLICATION OF MYOCARD. INFARCT THAT CAN OCCUR AT ANYTIME WHAT IS THE DIFFERENCE BTW SUBENDO AND TRANSMURAL INFARCTION? WHAT HAPPEN AT 4-7 DAYS AFTER MYOCARD. INFARCTION (GROSSLY)?