Heart - Ischemic heart disease

13 important questions on Heart - Ischemic heart disease

What are ischemic heart diseases (IHD)

Syndromes that are caused by myocardial ischemia, which is an impalance between cardiac blood supply (perfusion) and myocardial oxygen and nutritional requirements

In most cacses, IHD is a consequence of artherosclerosis. What are factors that may result in cardiac ischemia?

  • Increased demand (increased HR or hypertension)
  • diminished blood volume
  • diminished oxygenation
  • diminished oxygen-carrying capacity

IHD is a direct consequence of insufficient blood supply to the heart and may include the following clinical presentation of cardiac syndromes:

  • Angina pectoris
  • myocardial infarction
  • Chronic IHD with CFH (chronic heart failure)
  • Sudden cardiac death (SCD)
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Describe the term acute coronary syndrome

Abrupt plaque changes followed by thrombosis which can cause unstable angina, infarction, and sudden cardiac death

In a lot of cases of MI, patients are not stenotic or symptomatic. Explain this

Because anginal symptoms typically occur in lesions with greater than 70% occlusion. Studies show that ruptured plaques are less than or equal to 50% occlusion

What is the most frequent cause of MI?

acute thrombosis within coronary arteries

What is typical for Transmural infarctions

ST segment elevations on the electrocardiogram (and can have negative Q waves with loss of R wave amplitude)

What factors contribute to reperfusion injury

  1. Mitochondrial dysfunction. release of mitochondrial contents promotes apoptosis
  2. Myocyte hypercontracture. Ischemia raises the calcium level which causes uncontrolled contraction of myofibrils after reperfusion
  3. Free radicals. Produced within minutes of reperfusion
  4. Platelet and complement activation
  5. Leukocyte aggregation

What is a clinical feature of MI?

severe, crushing substernal chest pain (or pressure) that can radiate to the neck, jaw, epigastrium, or left arm. This lasts several minutes to hours, unlike angina pectoris

What are Electrocardiographic abnormalities in MI

Q waves, ST segment changes, and T wave inversions

Besides electrocardiographic changes, there is another way that MI is diagnosed. What measurment is this?

measurement of serum biomarkers such as cardiac-specific troponins

On what measurement is the laboratory evaluation of MI is based on?

measuring blood levels of macromolecules that leak out of injured myocardial cells through damaged cell membranes

Name the complications that patiens may experience after acute MI

  1. Contractile dysfunction. MIs affect left ventricular pump function in proportion to the volume of damage
  2. Papillary muscle dysfunction.
  3. Right ventricular infarction
  4. Myocardial rupture.
  5. Arrhythmias
  6. Pericarditis
  7. Chamber dilation
  8. Mural thrombus
  9. Ventricular aneurysm
  10. Progressive heart failure

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