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Pathology 2420A
Tom Haffie

Module 7 Ischemic Heart Disease1 Explain the pathogenesis of atherosclerosis Atherosclerosis Systemic disease affecting large and mediumsized arteriesCharacterized by formation of atheromas fibrofatty plaques which narrow stenose the artery lumen creating a reduction of blood flow ischemia and subsequent damage or necrosis to downstream organsComplications of atherosclerosis account for more than half of deaths in Western worldPathogenesisAtherosclerosis beings in early life but remains silent until it progresses to the point where it results in diseaseEarliest pathological lesion is called fatty streak can slowly progress and develop into mature atherosclerotic lesionfibrofatty plaqueResponse to injury hypothesis Plaque development is a chronic inflammatory response due to injury of the endothelial lining of the arteryDamage of endothelial lining endothelial dysfunction allowing platelets and monocytes macrophages to adhere to the liningPlatelets and monocytes release growth factors and cytokines causing recruitment and migration of smooth muscle cells and fibroblasts into the endotheliumCollagen is producedMacrophages engulf lipid and cholesterol derived from bloodEnd result raised plaque with both fibrous and fatty elements therefore narrowing the vessel lumen2 List risk factors for atherosclerosis Modifiable risk factors smoking hypertension elevated blood cholesterol and diabetes mellitus risk multiplied when 23 of the factors are presentedPotentially modifiable risk factors obesity lower socioeconomic class type A personalitystress and elevated blood homocysteine levelNonmodifiable risk factors age gender family history and ethnicityProtective factors reduced risk moderate alcohol consumption3 List and describe the major clinical manifestationssequelae of atherosclerosis in heart CAD angina MI and other organs Major sites of atherosclerotic ischemic injuryclinical disease can happen to 1Heart causing angina pectoris myocardial infarction chronic heart failure sudden cardiac deathBrian ischemic stroke Extremities claudication gangreneKidneys chronic kidney failureComplications in heartHeart receives blood supply from coronary arteries originating from aorta branches left anterior descendingleft circumflex branch supply anterior and lateral portions of left ventricle right coronary artery supplies posterior wall of left ventricleCoronary atherosclerosis beings in 20s and is slowly progressive flow reduction occurs when there is a 70 reduction in coronary artery lumenLeading cause in deathAngina Pectoris Chest pain in result of myocardial ischemiaCrushing tight and heavy painResults in actual death necrosis of heart muscleAngina is precipitated by events that increase myocardial blood flow demand ex exercisestressResolution restmedications nitroglycerin Myocardial InfarctionIf infarct involves full thickness of wall it is termed transmuralIf infarct involves only inner half of wall the furthest downstream muscle it is termed subendocardialInfarcts heal by process of scarring muscle DOES NOT REGENERATEHealing starts with removal of dead muscle requires digestive proteolytic and phagocytic action of neutrophils and macrophagesIngrowth of fibroblasts then help produce and lay down collagen which forms bulk of scar developed after 2 monthsSCAR not regeneration of heart muscleSudden deathHeart failure4 Appreciate the magnitude of the morbidity and mortality of ischemic heart disease IHD both in our society and worldwide Leading cause in death5 Explain the pathogenesis of myocardial infarction MIMyocardial InfarctionIf myocardium is ischemic for 3040 mins it begins to die and results in MIA formation of thrombus on luminal surface of coronary artery plaque causing completenear complete occlusion of vesselThrombolytic drugs clot busters reestablish coronary blood flowpreventreduce MILeft ventricle is more often site of infarction due to increased work 6 Explain how myocardial infarcts are diagnosed and treated Diagnosis of MI is made byClinical symptoms prolonged anginalike chest pain radiating to jawleft arm associated with nausea and sweating diaphoresis
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