Coronary Disease and Myocardial Ischemia

Introduction

Atherosclerotic narrowing of the coronary arteries leads to:

MI (50%)
Angina pectoris (coronary artery spasm)
Ischemic cariomyopathy (slowly developing lesion within the myocardium – replaced by fibrous tissue

Stenosis of coronaries Þ ß perfusion Þ Ý accumulation of metabolites Þ reversible damage to myocardium

Thrombus formation

Replaced viable myocardium by a healing response: acute inflammationÞ chronic granulation Þ tissue fibrosis

Histological changes

Demarcation: viable tissue to nonviable tissue

Hallmarks of Granulation tissue

Complications of MI

rupture of papillary muscles of mitral valve – mitrla insufficiency

thickened interventricular septum

dysfunctional myocardium – compromised contractility (thrombus on surface; mural thrombus)

Pericarditis

aneurysm - caused by MI which healed

stroke

kidney

spleen

pleural effusion

Treatment

CABG (coronary artery bypass graft), balloon angioplasty, stint – not a cure-all!!

Fibroblast Growth Factor – external elastic lamina is ruptured

Vasovasorum – deep media will have a really bad inflammatory response

If the MI is only restricted to the intima

1.0-1.1mm