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Block 2 PATH Exam -- Ischemic Heart Disease Lecture


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Men:Women risk ratio for MI
Ages 45-54 men 5x as likely as women
Ages 71-80 men 2x as likely as women

Younger than 50, women have 2x the mortality rate though
Non-thrombus causes of an MI
Segmental coronary spasm
Emboli, arteritis (Kawasaki's), cocaine, dissection
Infarct Distribution
Vast majority involve LV
Primary RV infarct is very rare
Arteries commonly involved in MIs
50% - LAD -- anterior LV, anterior 2/3 septum
30% - RCA -- posterior LV, posterior 1/3 septum
20% - LCCA -- lateral LV
Most common and most serious MI
Shows wave front phenomenon
Locations in arteries of significant arterial disease
Proximal first 2-4 cm of LAD and LCCA
Proximal and DISTAL thirds of RCA
(why causes posterior LV infarct)
Changes after 12 hours
Gross -- Nothing
Histo -- Wavy fibers, early coagulation necrosis
Changes atfer 2-5 days
Gross -- Tan/Yellow depressed central infarct, red margins
Histo -- Mummified center, granulomatous borders
Changes after 6-10 days
Gross -- Gray/Red borders, infiltrating central infarct
Histo -- Granulation throughout, COLLAGEN deposition
Changes after 2-8 weeks
Gross -- gelatinous scar, greater healing at border
Histo -- Collagen, prominent large CAPILLARIES
Infarct Extension
Increase in area necrotic muscle
Due to reduced oxygen supply after initial infarct
Clinical features of an MI
Severe ischemic pain
Biochemical markers -- Inc. CKMB, and troponin
Fever, Inc. PMN count
Inverted T wave, ST Elevation, Abnormal Q wave
Complications of an MI
Arrhythmias (greater than 70%)[mainly first few hours]
Heart block (common after posterior MI) (RCA)
BBB related to anteroseptal infarcts (LAD)
LV Failure (10%)
Pericarditis (first 2-3 days post-TRANSMURAL infarct)
Embolism from mural thrombus (15-50%)
Rupture (5%) [max. weakness is 5-7 days post]
Ventricular aneurysm (5%) [2 weeks - several months post]
Sudden Cardiac Death
Unexpected death from caridac causes
WITHIN 1 HOUR of acute symptoms
Smoking is a very high risk factor

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