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Pathoma: Cardiac Pathology – Questions & Answers
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Pathoma: Cardiac Pathology – Questions & Answers
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Pathoma: Cardiac Pathology – Questions & AnswersIschemic Heart Disease (IHD) Right Ans - Group of syndromes *related to
myocardial ischemia*, which is an imbalance between cardiac blood supply
(perfusion) and myocardial oxygen and nutritional requirements.
IHD is the *leading cause of death in the US.*
Usually *due to atherosclerosis* of *coronary arteries* →* decreases blood
flow* to *myocardium*
Risk factors for IHD are similar to those of atherosclerosis; incidence
increases
with age.
Stable Angina Right Ans - *chest pain that arises with exertion* or*
emotional stress*.
1. Due to *atherosclerosis of coronary arteries* with *> 70% stenosis*;
↓*blood flow* is *not able to meet the metabolic demands* of the
*myocardium* during exertion.
2. Represents *reversible injury to myocytes* (*no necrosis*)
3. Presents as * mid-substernal chest pain (lasting < 20 minutes)* that
*radiates to the left arm or jaw*, *diaphoresis*, and SOB.
4. *EKG shows ST-segment depression* due to *subendocardial ischemia*.
5. Relieved by rest or *nitroglycerin*
,Unstable Angina Right Ans - chest pain that *occurs at rest* or *minimal
exertion*.
1. Usually due to *rupture of an atherosclerotic plaque* with *thrombosis and
*incomplete occlusion* of a *coronary artery*.
2. Represents *reversible injury to myocytes* (no necrosis)
3. *EKG shows ST-segment depression* due to *subendocardial ischemia*.
4. Relieved by *nitroglycerin*
5. High risk of progression to myocardial infarction
*Clinical relevance*: *Any change in anginal pattern in the last 2-6 weeks* can
be considered *unstable angina*.
Prinzmetal angina Right Ans - *episodic chest pain unrelated to exertion*.
1. Due to *coronary artery vasospasm*
2. Represents *reversible injury to myocytes* (no necrosis)
3. *EKG shows ST-segment elevation* due to *transmural ischemia*.
4. Relieved by *nitroglycerin* or *calcium channel blockers*
Myocardial Infarction Right Ans - *NECROSIS of cardiac myocytes* Usually
due to *rupture* of an *atherosclerotic plaque* with *thrombosis* and
*COMPLETE OCCLUSION OF CORONARY ARTERY*. Other causes include
, *coronary artery vasospasm* (due to *Prinzmetal angina* or *cocaine* use),
emboli, and* vasculitis *(e.g., *Kawasaki disease*).
Clinical features include *severe*, *crushing chest pain* (lasting *> 20
minutes*) that
*radiates to the left arm or jaw*, *diaphoresis*, and *dyspnea*; symptoms are
*NOT relieved by nitroglycerin*.
Infarction usually involves the *left ventricle (LV)*; right ventricle (RV) and
both atria are generally spared.
Initial phase of infarction leads to *subendocardial necrosis* involving < 50%
of the myocardial thickness (*subendocardial infarction*. *EKG shows ST-
segment depression*, *NSTEMI*
Continued or severe ischemia leads to *transmural necrosis* involving most of
the
myocardial wall (*transmural infarction*); *EKG shows ST-segment
elevation*, *STEMI*.
Coronary vessels most commonly involved in Myocardial Infarction Right
Ans - 1. Occlusion of *left anterior descending artery* (*LAD*) leads to
*infarction of the anterior wall* and *anterior septum of the LV*; MOST
COMMON ARTERY (45% of cases).
2. Occlusion of *right coronary artery (RCA)* leads to *infarction of the
posterior wall*, *posterior septum*, and *papillary muscles of the LV*; RCA is
the 2nd most commonly involved artery in MI.
3. Occlusion of *left circumflex artery* leads to *infarction of lateral wall* of
the *LV*.
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