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Manifestations of ischemic heart disease
- Angina Pectoris
- Acute MI
- Sudden Cardiac death
- Chronic ischemic heart disease w/ congestive heart failure
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Angina pectoris
- intermittent chest pain caused by a transient, reversible myocardial ischemia
- Diffuse retrosternal pain (left), not localized-> may spread to inner surface of left arm, left neck, or left scapula (burning/squeezing pain)
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Typical/stable/exertional angina pectoris
Pain that develops after exertion, smoking, exposure to cold, or after a large meal
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Prinzmetal/variant angina
Due to spasms; response to strong emotions; may present as night pain
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Unstable/Crescendo angina
Pain w/o exertion, normally ends w/ MI aka pre-infarction angina (during sleep)
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Acute myocaridal infarct
- aka heart attack
- Indicates development of an area of myocaridal necrosis caused by local ischemia
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Sudden cardiac death
- Very common, due to coronary artery disease
- In 50% of ischemic heart disease cases, sudden cardiac death is the first manifestation
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Chronic ischemic heart disease with congestive heart failure
Lack of oxygen-> myofibrils die-> decrease contractility of heart-> congestive heart failure
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Congestive heart failure
Multisystem derangement that occurs when the heart is no longer able to eject blood returning from the venous system
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Left sided heart failure
- #1 cause is LV or LA
- #1 outcome is pulmonary edema
- MC causes include: systemic hypertension, mitral or aortic valve disease, ischemic heart disease, primary diseases of myocardium
- Blood builds up in the LA-> increased hydrostatic pressure-> accumulation of blood in lungs-> pulmonary/lung edema
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Heart failure cells
lung macrophages filled w/ heme/hemosiderin from ingested RBC, found in sputum
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Brown induration of the lung
overall brownish appearance of the lung due to increased blood
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Right sided heart failure
- MC causes: left sided HF or left ventricular failure, cor pulmonale leading to pulmonary vessel hypertension, lung emphysema
- 1st problem resulting from right sided HF is hepatomegaly from increased pressure in the RV-> hypertrophy-> RA-> increased pressure-> inferior vena cava-> portal veins
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Adaptive responses to congestive heart failure
- Increased sympathetic activity
- Hypertrophy (concentric v eccentric)
- Dilation
- Compensated HF- body can deal w/ the changes & there are no symptoms
- Decompensated HF- body cannot deal-> symptoms & death
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Concentric hypertrophy
Enlargement of heart muscle w/o enlargement of chambers (due to increase pressure)
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Eccentric hypertrophy
- Hypertrophy of heart muscle w/ increase of heart chamber (mitral stenosis)-> elongation of myofibrils in response to increase fluid in chambers
- Elongation of fibrils leads to increase contractility
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Symptoms of congestive heart failure
- Dyspnea (difficulty breathing): Exertional dyspnea, orthopnea, paroxysmal nocturnal dyspnea
- Muscle fatigue
- Enlarged heart
- Tachycardia
- Fine rales in the lungs bases
- High pitched systolic murmur
- Atrial fibrillation
- Distended neck veins
- Hepatomegaly
- Edema (feet, lower legs)
- Accumulation of fluid in the body cavities (R sided HF only)
- Cyanosis
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Orthopnea
Due to a change in position from standing to lying down; lack of gravity when lying down brings blood flowing back to a heart that is already congested
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Disorder of the lung that leads to isolated right sided heart failure
Lung emphysema- enlargement of lung alveoli & rupture of their walls
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Cor pulmonale
heart pathology due to lung pathology
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Interstitial lung diseases
- Replacement of lung tissue by connective tissue
- Blood vessels obliterated or torn
- Pneumoconiosis- dust in lungs- industry workers
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