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Common Congenital Heart Lesions - page 36 / 126

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*Transient total occlusive thrombi are the result of spontaneous recanalization or vasospasm.

*REFER TO FIGURE 7.4 (p. 162) FOR A SCHEMATIC OF THIS!!!

Non-Atherosclerotic causes of ACS

  • Rarely mechanisms other than intracoronary thrombus formation can cause ACS

  • Suspect these in young children presenting with ischemic syndrome or in those without risk factors for CAD

  • Potential causes include:

    • Thromboemboli from mechanical or infected valves

    • ValvulitisÆcoronary occlusion

    • Intense transient vasospasms

    • Cocaine abuseÆblocks Uptake I of NEÆaccumulation of NEÆintense

vasospasms, increased HR, contractility, & BP

Pathology & Pathophysiology of MI

  • MIs (both STEMI & NSTEMI) result when there’s sufficient ischemia to cause necrosis

  • UA can also lead to necrosis if its underlying cause isn’t corrected

  • Defined by the extent of necrosis they produce in the myocardial wall:

    • Transmural: spans the entire wall thickness; results from complete or prolonged occlusion of an epicardial artery

    • Subendocardial: involves only the innermost layers of myocardium; subendocardium is the most vulnerable to ischemia because it’s:

  • Subjected to the highest ventricular pressures

  • Has few collateral vessels to help perfuse it

  • Perfused by vessels that must pass through the contracting wall

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