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Common Congenital Heart Lesions - page 37 / 126

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37 / 126

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Lists taken from Dr. Smith’s lecture…

  • Subendocardial

    • Inner 1/3 to 1/2 of LV wall is occluded

    • Multifocal, patchy (distributed throughout the LV)

    • Circumferential

    • Coronary thrombosis rare

    • Often result of shock

    • No epicarditis

    • Do not form aneurysms

  • Transmural

    • Full thickness of the wall is occluded

    • Unifocal, solid

    • Coronary artery distribution

    • Coronary thrombosis common

    • Often cause of shock

    • Epicarditis common since it’s a full thickness infarct

    • May result in aneurysm

    • Volume of collateral flow is the main factor in transmural infarct progression

  • Infarctions represent the progression from potentially reversible ischemiaÆirreversible myocardial necrosis

  • Tissues supplied directly by the infracted artery die first, then surrounding tissues if the imbalance b/t myocardial O2 supply & demand isn’t fixed

  • Infarcts involving the LV are more common & more extensive than the RV since the myocardium is thicker and thus harder to perfuse.

  • The magnitude of the infarction depends on:

  • Amount of myocardium supplied by the occluded vessel

  • Magnitude & duration of obstruction

  • Oxygen demand of the affected region

  • Ability of collateral blood flow to supply the affected region

  • Degree of tissue response to modify the ischemia

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