Coronary Artery Disease and Myocardial Ischemia

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Questions and Answers

What percentage of patients typically survive the acute event when admitted to a hospital?

90% or more (correct)

Approximately 75%

Less than 50%

Only about 40%

What is the main complication that can occur three hours after an acute event?

Infarcts impair the right ventricular function (correct)

Infarcts lead to increased myocardial oxygen supply

Contractile dysfunction positively affects the left ventricular pump function

Contractile dysfunction impacts systemic circulation

What is an essential factor that relates to contractile dysfunction following an acute event?

The volume of damaged myocardium (correct)

The total volume of blood in circulation

The speed of the initial response treatment

The age of the myocardial tissue

What is the likely timeframe in which complications begin to manifest after the acute event?

After three hours Signup and view all the answers

In patients with compromised ventricular function, which of the following is a likely consequence?

Reduced myocardial contraction efficiency Signup and view all the answers

What condition is described when the right ventricular function is compromised due to an acute event?

Described as contractile dysfunction Signup and view all the answers

Which of the following is NOT a characteristic of senile calcific aortic stenosis?

Increased elastin Signup and view all the answers

What is the primary mechanism of valve dysfunction in rheumatic heart disease?

Inflammation and fibrosis of the valve leaflets Signup and view all the answers

Which of the following conditions is characterized by calcification of the mitral ring?

Rheumatic heart disease Signup and view all the answers

Which of the following is NOT a potential consequence of the altered extracellular matrix in heart valve disease?

Increased valve leaflet elasticity Signup and view all the answers

What is the difference between the pathological changes in rheumatic heart disease and senile calcific aortic stenosis?

Rheumatic heart disease involves inflammation and fibrosis, while senile calcific aortic stenosis involves calcification. Signup and view all the answers

Which of the following is a common feature shared by both rheumatic heart disease and senile calcific aortic stenosis?

Degeneration of the valve leaflets Signup and view all the answers

What often causes degenerative changes in cardiac valves?

Mechanical stresses Signup and view all the answers

Which of the following is a condition associated with mitral valve disease?

Mitral stenosis Signup and view all the answers

What type of calcifications are most commonly associated with the aortic valve?

Cuspal calcifications Signup and view all the answers

Postinflammatory scarring can occur in which valve type associated with degenerative disease?

Mitral valve Signup and view all the answers

What is the most common degenerative change in aortic valves?

Aortic stenosis Signup and view all the answers

Which term describes the degenerative change resulting in narrowing of the mitral valve opening?

Mitral stenosis Signup and view all the answers

What pathological feature is associated with the degeneration of heart valves?

Postinflammatory scarring Signup and view all the answers

Which of the following conditions is NOT typically related to degenerative heart valve disease?

Vasospasm Signup and view all the answers

Which biomarker is considered particularly sensitive and specific for myocardial injury?

Troponin I Signup and view all the answers

What is the approximate mortality rate within the first year following a myocardial infarction?

30% Signup and view all the answers

Which complication is NOT associated with myocardial infarction?

Chronic kidney disease Signup and view all the answers

What does an increase in troponin I levels indicate?

Myocardial injury Signup and view all the answers

Which enzyme is often measured alongside troponins following a myocardial infarction?

Creatine kinase (CK-MB) Signup and view all the answers

Which of the following is NOT a type of myocardial rupture discussed?

Posterior wall rupture Signup and view all the answers

What type of surface change is observed in fibrinous pericarditis following a myocardial infarction?

Hemorrhagic and roughened surface Signup and view all the answers

How do increases in CK-MB relate to the severity of coronary artery disease?

They correlate with severity Signup and view all the answers

What is the primary cause of death in 80% to 90% of myocardial infarction cases?

Ventricular fibrillation Signup and view all the answers

Which condition is said to cause disturbances in electrical conducance within the heart?

Coronary plaque disruption Signup and view all the answers

What is a common feature of the morphology observed in myocardial infarction?

It evolves over time based on the severity of ischemia Signup and view all the answers

What risk factor is associated with increasing the likelihood of arrhythmias during myocardial ischemia?

Severity of electrical disturbances Signup and view all the answers

Which statement accurately describes thrombus in relation to myocardial infarction?

Thrombus contributes to increased myocardial necrosis Signup and view all the answers

What percentage of myocardial infarction cases can lead to pump failure?

80% to 90% Signup and view all the answers

In the context of chronic ischemic heart disease, which aspect is emphasized regarding myocardial ischemia?

It leads to structural changes in the myocardium over time Signup and view all the answers

What is the relationship between ischemia and myocardial infarction in terms of death outcomes?

Ischemia can lead to myocardial infarction, which may result in death Signup and view all the answers

Suc"s"en" fractals are extremely rare in older patients and myocardial infarcts.

False Signup and view all the answers

Morphological features of a myocardial infarct depend on the size and location of the infarct only.

False Signup and view all the answers

The rate of development of pain is directly proportional to the severity of the infarct.

False Signup and view all the answers

Non-transmural infarcts only affect the subendocardial region.

False Signup and view all the answers

Global hypotension can cause a permanent occlusion of the left anterior descending branch.

True Signup and view all the answers

Small intramural vessel occlusions always lead to large infarcts.

False Signup and view all the answers

Restoration of flow is only possible in non-transmural infarcts.

False Signup and view all the answers

Permanently occluded vessels can never be restored.

False Signup and view all the answers

RV dysfunction is always a consequence of LV dysfunction.

False Signup and view all the answers

Microinfarcts are only seen in the context of chronic ischemic heart disease.

False Signup and view all the answers

The annual mortality rate for patients who have suffered a myocardial infarction is 1% to 2%.

False Signup and view all the answers

Severe, progressive heart failure punctuated by new episodes of angina is a common feature of chronic ischemic heart disease.

True Signup and view all the answers

Arrhythmia, heart failure, and recurrent myocardial infarction account for most of the associated morbidity and mortality.

True Signup and view all the answers

Chronic ischemic heart disease is characterized by a low risk of recurrent myocardial infarction.

False Signup and view all the answers

The majority of patients with chronic ischemic heart disease experience a sudden death due to arrhythmia.

True Signup and view all the answers

The primary mechanism of valve dysfunction in chronic ischemic heart disease is related to contractile dysfunction.

False Signup and view all the answers

Chronic ischemic heart disease is typically associated with a low risk of heart failure.

False Signup and view all the answers

The majority of patients with chronic ischemic heart disease experience a slow and gradual progression of the disease.

True Signup and view all the answers

Sudden cardiac death is the leading cause of mortality in patients with pulmonary artery hypertension.

True Signup and view all the answers

Increased pulmonary vascular resistance can lead to right ventricular failure.

True Signup and view all the answers

Ventricular dysfunction is a rare complication of pulmonary artery hypertension.

False Signup and view all the answers

Pulmonary artery hypertension can lead to acute cor pulmonale.

True Signup and view all the answers

Chronic thromboembolic pulmonary hypertension is a rare cause of pulmonary artery hypertension.

False Signup and view all the answers

Pulmonary artery hypertension can lead to increased cardiac output.

False Signup and view all the answers

Right ventricular hyperrophy is a rare finding in patients with pulmonary artery hypertension.

False Signup and view all the answers

Pulmonary artery hypertension is a rare condition that affects fewer than 100,000 people in the United States.

False Signup and view all the answers

Restoration of blood flow to ischemic muscle may paradoxically cause the death of viable myocardium.

True Signup and view all the answers

Increased risk for let-sided thrombosis is associated with the contraction of the coronary arteries.

False Signup and view all the answers

Myocardial injury can lead to the paradoxical version of ventricular function called 'a/risk' myocardium.

False Signup and view all the answers

The term 'decompensated heart failure' is often used interchangeably with the severe manifestations of myocardial ischemia.

False Signup and view all the answers

Reperfusion injury primarily occurs due to oxidative stress and inflammation upon restoration of blood flow.

True Signup and view all the answers

Sustained increased blood pressure during ischemic conditions can lead to a reduction in myocardial oxygen demand.

False Signup and view all the answers

The accumulation of lipoproteins can cause inflammation in the heart valves.

True Signup and view all the answers

An increase in the size of the left ventricle is a risk factor for rupture of the chordae tendineae.

True Signup and view all the answers

Fen-phen, a drug combination, has been linked to a decreased risk of valve calcification.

False Signup and view all the answers

Calcification of the mitral ring is a common cause of left ventricular enlargement.

False Signup and view all the answers

The risk of valve calcification is significantly higher in females compared to males.

False Signup and view all the answers

Abnormal heart valve function can be caused by inflammation, but not by calcification.

False Signup and view all the answers

The rupture of the chordae tendineae is a rare complication of left ventricular enlargement.

False Signup and view all the answers

The presence of bicuspid valve, a heart valve with two leaflets instead of three, can exacerbate inflammation within the heart.

True Signup and view all the answers

What is the primary factor that influences the morphological features of a myocardial infarct?

Size and location of the infarct Signup and view all the answers

What is the relationship between the rate of development of pain and the severity of the infarct?

The rate of development of pain is not directly proportional to the severity of the infarct. Signup and view all the answers

What type of infarcts can affect regions other than the subendocardial region?

Non-transmural infarcts Signup and view all the answers

What is the consequence of global hypotension on the left anterior descending branch?

Temporary or partial obstruction Signup and view all the answers

What is the relationship between the size of infarcts and small intramural vessel occlusions?

Small intramural vessel occlusions do not always lead to large infarcts. Signup and view all the answers

In what type of infarcts is restoration of flow possible?

Both transmural and non-transmural infarcts Signup and view all the answers

What can happen to permanently occluded vessels?

They can be restored with reperfusion Signup and view all the answers

What is the relationship between RV dysfunction and LV dysfunction?

RV dysfunction is not always a consequence of LV dysfunction Signup and view all the answers

In what context are microinfarcts typically seen?

Not only in chronic ischemic heart disease Signup and view all the answers

What is the annual mortality rate for patients who have suffered a myocardial infarction?

Higher than 1% to 2% Signup and view all the answers

What is the typical color change associated with necrotic myocardium during an infarction?

Red-blue discoloration caused by trapped blood. Signup and view all the answers

What is the peak timeframe for acute inflammation following an infarction?

1 to 3 days after the infarction occurs. Signup and view all the answers

What type of cells are primarily involved in the removal of necrotic myocytes following an infarction?

Macrophages. Signup and view all the answers

How long is necrotic myocardium typically present before the acute inflammatory response is most pronounced?

5 to 10 days post-infarction. Signup and view all the answers

What are the consequences of acute coronary syndromes related to myocardial infarction?

They can lead to necrosis and sudden death. Signup and view all the answers

What do the terms 'infarction' and 'sudden death' signify in the context of acute coronary syndromes?

They indicate critical conditions often resulting from disrupted blood supply. Signup and view all the answers

In the sequential progression of coronary artery lesions, what major pathological process occurs?

Influx of macrophages and removal of necrotic fragments. Signup and view all the answers

What role do necrotic myocytes play in the development of acute coronary syndromes?

They contribute to the inflammatory response and further tissue damage. Signup and view all the answers

What condition describes a heart valve anomaly that includes two functional cusps instead of three?

Bicuspid aortic valve Signup and view all the answers

Which condition associated with aortic dilation can be a result of genetic factors such as Marfan syndrome?

Degenerative aortic dilation Signup and view all the answers

Identify a risk factor that notably increases the incidence of mitral valve prolapse with age.

Age over 70 years Signup and view all the answers

What autoimmune condition is associated with papillary muscle dysfunction leading to valve issues?

Rheumatoid arthritis Signup and view all the answers

What impact does aortic stenosis typically have on the lifespan of patients with a congenitally abnormal aortic valve?

It generally leads to shortened lifespan due to complications. Signup and view all the answers

In patients with degenerative aortic dilation, what is a common timeframe for the development of aortic stenosis?

1 to 2 decades earlier than in trileaflet valves Signup and view all the answers

Which type of aortic condition can result from syphilitic aortitis?

Aortic dilation Signup and view all the answers

What degenerative change is particularly associated with the development of calcification in aortic valve disease?

Fibrosis Signup and view all the answers

What condition can predispose the mitral valve to calcification?

Injury related to Fen-phen (Fenfluramine-phentermine) can predispose the mitral valve to calcification. Signup and view all the answers

Identify two important risk factors for aortic valve degeneration.

Hypertension and smoking are two important risk factors for aortic valve degeneration. Signup and view all the answers

What anatomical structures experience abnormalities related to the rupture of chordae tendineae?

Abnormalities occur in the left ventricular cavity and/or annulus. Signup and view all the answers

What pathological condition is associated with the accumulation of lipoproteins in the heart?

Myocarditis is associated with the accumulation of lipoproteins in the heart. Signup and view all the answers

Which abnormality might be exacerbated by low-density lipoprotein accumulation?

Low-density lipoprotein accumulation might exacerbate valve calcification. Signup and view all the answers

What is a common sex-related predisposition seen in patients with aortic valve degenerative changes?

Male sex is commonly associated with aortic valve degenerative changes. Signup and view all the answers

How does left ventricular enlargement relate to aortic valve disease?

Left ventricular enlargement is often a consequence of aortic valve disease. Signup and view all the answers

What type of mitral valve defect is associated with hypertension?

Bicuspid mitral valve is a defect associated with hypertension. Signup and view all the answers

Based on the provided text, what are the most common types of heart disorders and why are they prevalent?

The most common types of heart disorders are those affecting coronary arteries, pulmonary parenchyma, pulmonary vessels, chest movement, and pulmonary vascular constriction. Their prevalence is attributed to coronary artery disease being responsible for 80% to 90% of cases, while other factors like chronic obstructive pulmonary disease and pulmonary embolism also contribute. Signup and view all the answers

Describe the difference in the causes of heart disease in younger vs. older patients, as presented in the text.

In younger patients, non-atherosclerotic causes like congenital abnormalities, valve defects, and inflammatory conditions are more common. In older patients, coronary artery disease, due to atherosclerosis, is the primary cause of heart disorders. Signup and view all the answers

What are some examples of conditions affecting chest movement, and what is their relevance to heart health?

Conditions affecting chest movement include kyphoscoliosis and obesity. These conditions can hinder proper breathing and lung function, indirectly impacting the heart's ability to efficiently pump blood. Signup and view all the answers

What are two potential causes of myocardial hypertrophy, and how does this impact the heart's function?

Myocardial hypertrophy, an increase in heart muscle mass, can be caused by hypertension and hypertrophic cardiomyopathy. This can lead to a stiffening of the heart muscle, affecting its ability to relax and fill with blood effectively. Signup and view all the answers

Based on the text, what are some examples of diseases that can affect the pulmonary vessels, and how do they impact the heart?

Diseases affecting pulmonary vessels include recurrent thromboembolism, pulmonary hypertension, and congenital vascular abnormalities. These conditions can lead to increased pressure in the pulmonary arteries, making it harder for the right ventricle to pump blood to the lungs, ultimately impacting the heart's overall efficiency. Signup and view all the answers

Explain the difference between primary and secondary pulmonary hypertension, as mentioned in the text.

Primary pulmonary hypertension has no known underlying cause, while secondary pulmonary hypertension arises as a consequence of other conditions like heart disease, lung disease, or blood clots. Signup and view all the answers

What are some examples of conditions that can lead to pulmonary vascular constriction, and how do they affect the heart?

Conditions that can lead to pulmonary vascular constriction include obstructive lung diseases like asthma and chronic obstructive pulmonary disease. This constriction reduces blood flow to the lungs, increasing the workload on the heart, making it pump harder to deliver oxygen to the body. Signup and view all the answers

The text mentions various factors contributing to heart disorders. Name two factors that are not directly related to the heart itself, and explain their impact.

Two factors not directly related to the heart itself are kyphoscoliosis and obesity. Kyphoscoliosis, a curvature of the spine, can affect lung function and breathing, making it harder for the heart to work efficiently. Obesity can put extra strain on the heart due to increased blood volume and demand for oxygen. Signup and view all the answers

Based on the text, what is the primary cause of death in most cases of heart disease? Explain your answer.

The primary cause of death in most cases of heart disease is coronary artery disease. The text states that coronary artery disease is responsible for 80% to 90% of heart disease cases, indicating its significant role in mortality. Signup and view all the answers

The text briefly mentions 'other factors' contributing to heart disease. Based on the information provided, what are two potential examples of these factors?

Two potential examples of 'other factors' contributing to heart disease could be lifestyle choices like smoking and poor diet, as well as genetic predispositions to certain heart conditions. Signup and view all the answers

The _______________ barked

not found Signup and view all the answers

The coronary _______________ winder window of a certain size canessen the size of

artery Signup and view all the answers

Atherosclerosis is a condition in which the _______________ of the coronary artery becomes blocked

artery Signup and view all the answers

The _______________ is the innermost layer of the blood vessel

intima Signup and view all the answers

The _______________ is the middle layer of the blood vessel

media Signup and view all the answers

The _______________ is the outermost layer of the blood vessel

adventitia Signup and view all the answers

Coronary _______________ can lead to the death of myocardial cells across the full thickness of the myocardium

obstruction Signup and view all the answers

Lipids are deposited in the _______________ of the blood vessel, leading to the formation of atherosclerotic plaques

intima Signup and view all the answers

The dependence of myocardial infarction on the location and nature of the diminished perfusion is a key factor in understanding the ______ of the infarct.

severity Signup and view all the answers

Transmural infarction, resulting from major coronary artery occlusion, can involve the ______ ventricle in cases of right main coronary artery occlusion.

right Signup and view all the answers

Partial or transient occlusion can lead to patterns of infarction, as can global hypotension superimposed on fixed three-vessel disease or occlusion of ______ vessels.

small Signup and view all the answers

Serum levels of proteins released from injured myocardial cells are useful in ______.

diagnosis Signup and view all the answers

Cardiac troponins T and I have high specificity and sensitivity for ______ damage.

myocardial Signup and view all the answers

The morphology of a myocardial infarct depends on the ______ and location of the infarct.

size Signup and view all the answers

Non-transmural infarcts affect only the ______ region.

subendocardial Signup and view all the answers

Restoration of flow is possible in ______ infarcts.

non-transmural Signup and view all the answers

The precise ______ is uncertain.

mechanism Signup and view all the answers

Increased production of ______ species from cells.

reactive oxygen Signup and view all the answers

Increased uptake of ______ into cells.

calcium Signup and view all the answers

Damaged membranes and deferred ______ effects of inflammatory cells.

deletorious Signup and view all the answers

The long-term prognosis after myocardial ______ depends on many factors.

infarction Signup and view all the answers

The most important factor of which are yet ventricular ______ dysfunction.

function Signup and view all the answers

The text suggests that damaged mitochondria can lead to increased uptake of ______.

calcium Signup and view all the answers

Fibrous scar replaces the ______ in the myocardium.

myocardial tissue Signup and view all the answers

Reactive oxygen species can cause damage to ______ in cells.

mitochondria Signup and view all the answers

Antiplatelet agents, such as ______, are useful in the treatment of myocardial infarction.

aspirin Signup and view all the answers

Clinical features of myocardial infarction are characterized by ______ chest pain.

severe, crushing Signup and view all the answers

Loss of contractility occurs in the ______ due to myocardial ischemia.

myocardium Signup and view all the answers

Ischemia lasting ______ minutes causes irreversible damage to the heart.

40 Signup and view all the answers

Myocardial infarction may be asymptomatic in a minority of ______.

patients Signup and view all the answers

Reperfusion after an acute myocardial infarction is crucial to prevent ______ damage.

irreversible Signup and view all the answers

Accumulation of noxious metabolites like ______ occurs during myocardial ischemia.

lactic acid Signup and view all the answers

Invariably, there is moderate ______ and can manifest as rhythms that are too slow.

bradycardia Signup and view all the answers

Severe ______ of the coronary arteries can lead to compromised heart function.

atherosclerosis Signup and view all the answers

The endocardium may be too ______, which can cause ineffective cardiac pumping.

thick Signup and view all the answers

Microscopic findings include myocyte ______ and fibrosis.

hypertrophy Signup and view all the answers

Atrial myocytes become 'irritable' and ______ under certain conditions.

depolarize Signup and view all the answers

Signs are variably ______ through the atrioventricular node.

transmitted Signup and view all the answers

Thrombi may present as ______ in the cardiac anatomy.

mural Signup and view all the answers

Endocardial ______ can occur as a result of prior infarction.

fibrosis Signup and view all the answers

Match the following descriptions with their corresponding terms related to myocardial infarction (MI):

Non-ST-segment elevation MI (NSTEMI) = MI characterized by less severe blockage of coronary arteries, often with no ST-segment elevation on ECG Transmural MI = MI that affects the entire thickness of the heart wall, resulting in complete blockage of coronary artery Subendocardial MI = MI that affects only the inner layer of the heart wall, causing partial blockage of coronary artery Microinfarct = Small, localized areas of heart muscle damage, often occurring in chronic ischemic heart disease Signup and view all the answers

Match the following symptoms with their respective descriptions:

Red-blue discoloration = Caused by trapped blood during infarction Necrotic myocardium = Indicates severe myocardial injury Acute inflammation = Follows an infarction within days Macrophage influx = Helps remove necrotic myocardial tissue Signup and view all the answers

Match the terms related to acute coronary syndromes with their explanations:

Infarction = Tissue death due to lack of blood supply Sudden death = Unexpected loss of life caused by heart conditions Acute coronary syndrome = A spectrum of conditions due to reduced blood flow to the heart Myocardial necrosis = Death of heart muscle cells due to ischemia Signup and view all the answers

Match the timeframes with the associated events in acute coronary syndromes:

1 to 3 days = Peak of acute inflammation after infarction 5 to 10 days = Pronounced influx of macrophages 12 hours = Initial signs of myocardial injury develop 24 hours = Gross identification of infarction begins Signup and view all the answers

Match the terms with their pathological significance in myocardial infarction:

Acute coronary syndrome = Leads to diverse myocardial complications Fibrinous pericarditis = Surface change after heart injury Troponin I = Sensitive biomarker for myocardial injury CK-MB = Enzyme linked to severity of heart damage Signup and view all the answers

Match the complications of myocardial infarction with their descriptions:

Arrhythmias = Disturbances in heart electrical conduction Pump failure = Inability of the heart to generate sufficient output Cardiogenic shock = Critical condition due to inadequate blood circulation Myocardial rupture = Tear in heart muscle leading to severe complications Signup and view all the answers

Match the terms related to the healing process after an infarction with their roles:

Collagen deposition = Provides structural support during healing Scar formation = Replaces necrotic myocardial tissue Fibrosis = Increased connective tissue leading to stiffness Granulation tissue = Initial healing phase in damaged myocardium Signup and view all the answers

Match the types of ischemic heart disease with their characteristics:

Chronic ischemic heart disease = Often leads to recurrent myocardial infarctions Sudden cardiac death = Can occur due to arrhythmias during ischemia Stable angina = Predictable chest pain during exertion Unstable angina = Unpredictable chest pain, high risk of infarction Signup and view all the answers

Match the pathophysiological changes with their descriptions in the context of myocardial infarction:

Hypoxia = Oxygen deficiency in myocardial tissue Ischemia = Reduced blood flow to the heart muscle Apoptosis = Programmed cell death of myocardial cells Necrosis = Irreversible injury leading to cell death Signup and view all the answers

Match the following terms related to acute myocardial injury with their descriptions:

Acquired factors = Risks that contribute to the development of cardiac conditions Ischemia = Insufficient blood supply to the heart Ventricular hypertrophy = Thickening of the heart muscle often due to increased workload Myocarditis = Inflammation of the heart muscle Signup and view all the answers

Match the following clinical features with their associated conditions:

Hypertensive heart disease = Often asymptomatic and indicated by elevated blood pressure Coronary artery disease = Primary risk factor often leading to myocardial ischemia Cardiac amyloidosis = Deposition of abnormal proteins in the heart tissue Arrhythmias = Abnormal electrical conduction in the myocardium Signup and view all the answers

Match the following types of injuries with their potential consequences:

Myocardial infarction = Can lead to ventricular dysfunction and arrhythmias Cerebrovascular accident = Often results in loss of neurological function Myocardial ischemia = Can trigger chest pain and discomfort Renal damage = May result from poor perfusion and fluid overload Signup and view all the answers

Match the following conditions with their respective risk factors:

Cardiac failure = Often associated with longstanding hypertension and ischemia Sudden cardiac death = Can be linked to arrhythmias and significant heart disease Heart valve disease = Commonly due to degenerative changes and calcification Heart failure with preserved ejection fraction = Often occurs in a patient with hypertension Signup and view all the answers

Match the following types of heart rhythm disturbances with their triggers:

Atrial fibrillation = Can be triggered by chronic hypertension or ischemia Ventricular tachycardia = Often precipitated by acute ischemic events Supraventricular tachycardia = May occur in response to stress or stimulants Bradycardia = Can be induced by vagal stimulation or medication Signup and view all the answers

Match the following cardiac features with their definitions:

Contractile dysfunction = Impaired ability of the heart muscle to contract Ischemic injury = Damage caused by reduced blood flow to the heart Hypertrophy = Enlargement of cardiac muscle from increased workload Electrophysiological abnormalities = Irregularities in the heart's electrical conduction system Signup and view all the answers

Match the following cardiac events with their possible outcomes:

Ventricular rupture = Can occur after myocardial infarction Infarction = Leads to necrosis of cardiac muscle tissue Pericarditis = Inflammation of the protective covering of the heart Aortic dissection = Can present with acute chest pain and be life-threatening Signup and view all the answers

Match the following genetic factors related to cardiac health with their implications:

Cardiac channelopathies = Conditions caused by mutations in ion channel genes Hypertrophic cardiomyopathy = Increased risk of sudden cardiac death Dilated cardiomyopathy = Often results in heart failure due to muscle impairment Arrhythmogenic right ventricular cardiomyopathy = Typically leads to arrhythmias and syncope Signup and view all the answers

Match the following terms with their descriptions related to myocardial infarction:

Atherosclerotic plaque = Causes complete obstruction of a coronary vessel ST-segment elevation MI (STEMI) = Type of MI characterized by elevated ST segments on ECG Endocardial infarcts = Result in death of myocytes in the inner portion of the myocardium Platelet aggregation = The process that leads to formation of thrombi Signup and view all the answers

Match the following terms with their effects on the heart:

Suc"s"en" fractals = Extremely rare in older patients and myocardial infarcts Global hypotension = Can cause permanent occlusion of the left anterior descending branch Microinfarcts = Only seen in the context of chronic ischemic heart disease RV dysfunction = Always a consequence of LV dysfunction Signup and view all the answers

Match the following terms with their relationships to myocardial infarction:

Troponin I levels = Increase indicates myocardial injury CK-MB = Enzyme often measured alongside troponins following MI Thrombus = Forms in response to plaque rupture Arrhythmia = Risk factor associated with increasing likelihood during myocardial ischemia Signup and view all the answers

Match the following terms with their associations with chronic ischemic heart disease:

Severe, progressive heart failure = Common feature punctuated by new episodes of angina Annual mortality rate = 1% to 2% for patients who have suffered a myocardial infarction Recurrent myocardial infarction = Low risk in chronic ischemic heart disease Chronic ischemia = Emphasizes the aspect of myocardial adaptation Signup and view all the answers

Match the following terms with their characteristics related to myocardial infarction:

Non-transmural infarcts = Only affect the subendocardial region Permanently occluded vessels = Can never be restored Restoration of flow = Only possible in non-transmural infarcts Small intramural vessel occlusions = Always lead to large infarcts Signup and view all the answers

Match the following terms with their effects on the myocardium:

Endocardial infarcts = Result in death of myocytes in the inner portion of the myocardium Platelet aggregation = Leads to formation of thrombi Atherosclerotic plaque = Causes complete obstruction of a coronary vessel Global hypotension = Can cause permanent occlusion of the left anterior descending branch Signup and view all the answers

Match the following terms with their relationships to cardiac function:

RV dysfunction = Always a consequence of LV dysfunction Chronic ischemic heart disease = Characterized by a low risk of recurrent myocardial infarction Arrhythmia = Risk factor associated with increasing likelihood during myocardial ischemia Heart failure = Common feature of chronic ischemic heart disease Signup and view all the answers

Match the following terms with their effects on cardiac outcomes:

Troponin I levels = Increase indicates myocardial injury CK-MB = Enzyme often measured alongside troponins following MI Thrombus = Forms in response to plaque rupture Severe, progressive heart failure = Common feature punctuated by new episodes of angina Signup and view all the answers

Match the following heart valve diseases with their characteristics:

Mitral Regurgitation = Abnormalities of leaflets and commissures Aortic Regurgitation = Postinflammatory scarring Calcific Aortic Stenosis = Calcific degeneration is usually asymptomatic Infective Endocarditis = Can cause severe stenosis necessitating surgical intervention Signup and view all the answers

Match the following terms with their definitions related to heart valve diseases:

Calcium deposition = Common cause of aortic stenosis Intrinsic valvular disease = Causes severe valve dysfunction Postinflammatory scarring = Often a consequence of rheumatic heart disease Commissural fusion = Results in restricted valve motion Signup and view all the answers

Match the following conditions with their primary causes:

Mitral Regurgitation = Leaflet abnormalities Aortic Regurgitation = Intrinsic valvular disease Calcific Aortic Degeneration = Aging-related calcific changes Infective Endocarditis = Microbial infection Signup and view all the answers

Match the following descriptions with the corresponding valve conditions:

Calcific Aortic Degeneration = Most common cause of aortic stenosis Mitral Regurgitation = Causes backflow into the left atrium Aortic Regurgitation = Leads to volume overload of the left ventricle Infective Endocarditis = Characterized by vegetative growth on valves Signup and view all the answers

Match the following descriptions of valve conditions with their consequences:

Mitral Regurgitation = May lead to pulmonary congestion Aortic Regurgitation = Can cause left ventricular dilation Calcific Aortic Stenosis = Associated with exertional dyspnea Infective Endocarditis = Risk of embolic events Signup and view all the answers

Match the following types of valve abnormalities to their causes:

Calcific Degeneration = Asymptomatic in early stages Postinflammatory Scarring = Result of chronic infection Commissural Fusion = Seen in rheumatic heart disease Leaflet Elongation = Associated with mitral valve prolapse Signup and view all the answers

Match the following valve diseases with their surgical intervention requirements:

Mitral Regurgitation = May require repair or replacement Aortic Regurgitation = Often necessitates aortic valve replacement Calcific Aortic Stenosis = Surgical intervention necessary for severe cases Infective Endocarditis = Valve replacement may be required Signup and view all the answers

Match the following valve diseases with their diagnostic features:

Mitral Regurgitation = Holosystolic murmur Aortic Regurgitation = Diastolic murmur along the left sternal border Calcific Aortic Stenosis = Systolic ejection murmur Infective Endocarditis = Fever and embolic phenomena Signup and view all the answers

Study Notes

Plaque Disruption and Myocardial Ischemia

Severe fixed coronary obstruction leads to myocardial ischemia and can disturb electrical conductance in the heart.
Increased risk of arrhythmias results from chronic ischemic heart disease.
Myocardial ischemia and infarction can cause death due to pump failure, responsible for 80% to 90% of cases.
Ventricular fibrillation is a common cause of death in acute myocardial infarction.

Thrombus and Infarction

The morphology of myocardial infarction varies with the injury's age.
Over 90% of patients survive the acute event but may face complications within three hours.
Significant post-infarction complications include contractile dysfunction related to the volume of damaged myocardium.
Myocardium-derived markers like troponin I, CK-MB, and myoglobin elevate after myocardial infarction, offering insight into severity.

Post-Infarction Complications

The first-year mortality rate post-myocardial infarction is about 30%, with a notable fraction dying before hospital admission.
Complications include cardiac rupture (anterior free wall, ventricular septal, and papillary muscle ruptures) and fibrinous pericarditis.

Heart Valve Disease and Degenerative Changes

Degenerative changes in cardiac valves relate to repetitive mechanical stresses, leading to structural deformities.
Common degenerative conditions:
- Mitral Valve Disease includes mitral stenosis, often due to post-inflammatory scarring common in rheumatic heart disease.
- Aortic Valve Disease may also present with stenosis due to calcifications and post-inflammatory scarring.

Mitral and aortic stenosis can result from calcifications, which may be cuspal or annular.
Senile calcific aortic stenosis is characterized by age-related degenerative processes affecting valve integrity.
Calcifications may lead to increased fibrosis and scarring within the cardiac structures.

Ischemic Heart Disease

Location, size, and type of myocardial infarcts are often associated with older patients.
Morphological features of myocardial infarcts vary based on size and presence of diabetes, influenced by autonomic neuropathies affecting perception of involved vessel distribution.

Types of Myocardial Infarcts

Transmural Infarcts: Permanent occlusion, affecting full thickness of the heart muscle.
Non-Transmural Infarcts: Result from transient or partial obstruction, mostly subendocardial.

Reperfusion Injury

Restoration of blood flow to ischemic muscle can paradoxically lead to cell death in "at-risk" myocardium.

Annual Mortality Rates

Annual mortality for patients with myocardial infarcts ranges from 3% to 4%.
Associated with chronic ischemic heart disease and progressive heart failure, which can include episodes of angina or further infarctions.

Heart Failure and Arrhythmias

Chronic ischemic heart disease primarily causes significant morbidity and mortality due to myocardial infarction.
Arrhythmias may present as palpitations or rapid heart rates, indicating underlying cardiac dysfunction.

Risk Factors for Aortic Valve Degeneration

Major risk factors include male sex, aging, hypertension, and smoking.
Pathological changes often linked to atherosclerosis and accumulation of lipoproteins, which lead to local inflammation.

Structural Abnormalities

Abnormalities may include left ventricular enlargement and enlargement of the left ventricular cavity or annulus.
Certain conditions predispose the heart to structural changes, such as mitral ring calcification and endothelium dysfunction.

Decreased Cardiac Output

Inadequate cardiac output may result in increased pulmonary vascular resistance, potentially leading to pulmonary hypertension or cor pulmonale.
Sudden death in these conditions may arise from various complications, including rupture of chordae tendinae or ventricular hypertrophy.

Myocardial Infarction and Acute Coronary Syndromes

Infarction or sudden death typically observable through red-blue discoloration due to trapped blood 12 to 24 hours post-incident.
Necrotic myocardium initiates acute inflammation, peaking 1 to 3 days post-infarction.
The influx of macrophages aids in removing necrotic tissue, significantly noticeable 5 to 10 days after infarction.
Necrosis morphology and its features depend on infarct size and presence of diabetes, affecting autonomic responses.

Types of Infarcts

Transmural Infarcts: Result from permanent obstruction of blood flow, leading to large regions of dead tissue.
Non-Transmural Infarcts: Result from transient or partial occlusion, affecting regional or subendocardial areas, possibly leading to small, localized microinfarcts.

Causes of Myocardial Ischemia

Majorly attributed to coronary artery disease, present in 80% to 90% of cases.
Other causes may include pulmonary diseases (e.g., chronic obstructive pulmonary disease), congenital abnormalities, and inflammatory disorders.

Risk Factors and Patient Demographics

Risk increases with age; most patients present around 70 years.
Bicuspid aortic valve, a condition affecting 1% to 2% of the population, can lead to serious complications over time.
Conditions promoting vascular calcification, such as hypertension and smoking, also heighten risks.

Structural Heart Abnormalities

Mitral valve prolapse, aortic diseases, and inflammatory conditions (e.g., rheumatoid arthritis) can lead to valvular dysfunction.
Left ventricular abnormalities can arise due to various factors, including ischemic damage or myocardial disorders, affecting the heart's pumping ability and structure.

Common Heart Disorders

Aortic dilation and associated diseases, such as syphilitic aortitis and Marfan syndrome, significantly impact overall cardiovascular health.
Abnormalities in muscle function and structure can result in reduced cardiac effectiveness and predispose individuals to sudden cardiac events.

Management and Implications

Careful monitoring for diseases affecting pulmonary and vascular systems is critical for early intervention.
Regular assessments of structural and functional heart integrity are necessary, especially in older populations or those with predisposing conditions.

Overall Clinical Insight

Recognition and understanding of these conditions and their interrelationships are crucial for effective diagnosis and treatment strategies in cardiology.

Myocardial Infarction (MI)

Critical window for intervention can minimize the extent of myocardial infarction within "territory at risk."
Myocardial infarction patterns vary based on coronary artery obstruction location and severity.
Two primary patterns of myocardial infarction:
- Transmural infarcts result in myocyte necrosis across the full thickness of the myocardium.
- Fixed coronary obstruction manifests as numbness in the myocardial layer except for subendocardial myocytes which maintain some oxygen and nutrient supply from blood.
Myocyte death leads to compensatory fibrous scar tissue formation over weeks.

Clinical Features of Myocardial Infarction

Classic presentation: severe, crushing substernal chest pain, possibly radiating to neck, jaw, or arm.
Ischemic chest pain lasts over 20 minutes, unrelieved by nitroglycerin; after 40 minutes, irreversible damage occurs.
Some patients may experience asymptomatic myocardial infarction.
Serum protein levels (e.g., cardiac troponins T and I) peak during myocardial injury, providing diagnostic utility.

Pathophysiology of Myocardial Injury

Increased production of reactive oxygen species and calcium uptake in cells contributing to myocardial damage.
Mechanism of injury involves damaged mitochondria and inflammatory cell involvement.
Long-term prognosis after myocardial infarction relies heavily on various factors, predominantly left ventricular function.

Cardiac Rhythm and Function Post-MI

Myocardial infarction can lead to arrhythmias such as bradycardia or tachycardia, diminishing effective cardiac pumping ability.
Endocardium typically shows signs of patchiness, fibrous thickening, and mural thrombosis.
Microscopically, findings may include myocyte hypertrophy and fibrosis at sites of prior infarction.

Conclusion

The clinical management of myocardial infarction includes immediate intervention to restore blood flow and prevent further myocardial damage.
Understanding the pathology and clinical manifestations is essential for effective diagnosis and treatment strategy.

Myocardial Infarctions (MIs)

Caused typically by atherosclerotic plaques leading to complete obstruction of epicardial coronary vessels.
Often present as ST-segment elevations in electrocardiograms (ECGs), known as ST-segment elevation myocardial infarction (STEMI).
Non-ST-segment elevated MIs (NSTEMI) are characterized by common ECG findings without ST-segment elevation.

Endocardial Infarcts

Result from the death of myocytes in the inner portion of the myocardium.
May arise from obstruction of multiple distal coronary vessels or severe but incomplete obstructions.
Specifically vulnerable to damage due to exposure to high ventricular pressures and reduced blood supply.

Healing Process

Early stages after an infarction involve necrotic myocardium and acute inflammation, generally peaking between 1 to 3 days post-infarction.
Macrophages play a critical role in removing necrotic myocytes and debris, with pronounced effects observed from 5 to 10 days after an infarction.
Acquired factors like ischemia, inflammation, or scarring can disturb cardiac signaling.

Clinical Features of Acute Coronary Syndromes

Early hypertensive heart disease often asymptomatic, typically identified through elevated blood pressure readings.
Coronary artery disease is a significant risk factor, potentially leading to ischemic injury and subsequent ventricular hypertrophy.

Arrhythmias and Risk Factors

Arrhythmias can trigger ischemic heart disease, exacerbated by underlying conditions like coronary atherosclerosis.
Risk of complications increases significantly with poorly controlled hypertension and genetic predisposition.

Valvular Heart Diseases

Mitral and aortic regurgitation may arise from regurgitant flow due to structural abnormalities in heart valves.
Calcific aortic degeneration is a common cause of aortic stenosis, particularly in older populations.
Infective endocarditis can lead to severe valvular damage, necessitating surgical intervention for symptomatic stenosis or regurgitation.

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Description

This quiz covers the concepts of coronary artery disease, myocardial ischemia, and the effects of plaque disruption on blood flow and cardiac function.