Page 278 - Concise Pathology for Exam Preparation ( PDFDrive )

11 Disorders of the Heart 263

(f) Troponin levels remain elevated for 7–10 days permitting a late diagnosis/
evaluation of progression of infarct.
3. Lactate dehydrogenase (LDH)
(a) LDH1 is myocardium specific
(b) LDH1 1helps in diagnosis of acute MI I
LDH2
(c) Rises after 24 h, reaches a peak in 3–6 days and returns to normal in 14 days.
4. Myoglobin
(a) First cardiac marker to become elevated
(b) Lacks cardiac specificity
(c) Excreted rapidly in the urine
(d) Returns to normal within 24 h of the initiation of MI
• Other investigations
• Echocardiogram (to see abnormalities of regional wall motion)
• Radioisotopic studies (radionuclide scan)
• Perfusion scintigraphy (for regional perfusion)
• MRI (for structural characterization)

Q. Write briefly on Dressler syndrome.
Ans. Dressler syndrome (also called postmyocardial infarction syndrome):
• Thought to be an autoimmune reaction to necrotic muscle
• Occurs weeks or months after infarction
• Presents with fever, pericarditis and pleurisy
• Treated with aspirin and NSAIDs or corticosteroids
Q. Define sudden cardiac death.

Ans. Sudden cardiac death is defined as unexpected death from cardiac cause within one
hour of onset of symptoms. It may be a consequence of:
• IHD
• Congenital structural abnormality of heart and blood vessels (aortic valve stenosis/mitral
valve prolapse)
• Myocarditis
• Pulmonary hypertension
• Abnormality of cardiac conduction system
• Isolated hypertrophy/increased cardiac mass
Q. Define congenital heart disease (CHD). Write briefly on its
aetiopathogenesis.
Ans. CHD is defined as an abnormality of heart and blood vessels which is present since
birth and due to faulty embryogenesis during third to eighth gestational weeks (when
major cardiovascular structures develop). May result in:
• Severe anomalies, which are incompatible with life
May manifest soon after birth (at the time of change
• Less severe anomalies over from fetal to postnatal circulation)
May manifest in adulthood

Incidence
• 6–8/1000 live-born full-term infants
• Incidence higher in premature infants and stillborns

Aetiopathogenesis
Both genetic factors and maternal risks are implicated.

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