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3 PHARM SELF > 40 Coronary Regulation > Flashcards

40 Coronary Regulation Flashcards

1
Q

What are the 3 main conduit coronary arteries? Do they contribute to coronary vascular resistance? Are they susceptible to atheroscclerosis?

A
  1. LAD, LCFlex, RC
  2. very little
  3. They are the site of atherosclerosis
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2
Q

What vessels regulates coronary vascular resistance?

A

resistance vessels- intramural arteries <100micrometers in diameter

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3
Q

What develops in response to epicardial stenosis? What are the main stimulus?

A
  1. collateral vessels

2. VEGF, bFGF, PDGF

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4
Q

What are veins and venues role in coronary regulation or dysregulation?

A

They have no role

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5
Q

What are the 3 most important factors of regulation for coronary blood flow?

A
  1. metabolic factors
  2. Autoregulation
  3. Wall tension

[neural regulation, humoral regulation, myogenic tone]

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6
Q

Myocardial oxygen consumption/metabolism overrides any other stimulus. What are the 3 major determinants?

A

contractility, HR, Wall tension [preload and after load]

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7
Q

What are the 2 determinants of O2 supply to the heart?

A

coronary flow

oxygen extraction

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8
Q

What is unique about oxygen extraction in the heart?

A

max at rest and exercise…you must change coronary flow then

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9
Q

Where is wall stress greatest? Where is blood flow greatest at rest?

A
  1. greater in endocardium

2. greater in endocardium than epicardium

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10
Q

What is auto regulation?

A

maintaining constant flow with changing perfusion pressure= range in the heart = 40 to 120

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11
Q

What is myogenic regulation?

A

stretch on blood vessel wall produces an increase in smooth muscle contraction—occurs over minutes

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12
Q

What does a1 stimulation and a2 stimulation direct effects?

A

a1=increase epicardial and resistance vessel tone

a2=increase release of NO

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13
Q

What are the adrenergic stimulation indirect effects?

A
  1. increase in arterial pressure

2. reflex decrease in HR

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14
Q

What is the net effect of alpha adrenergic stimulation? beta?

A

modest decrease in flow

increase in flow

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15
Q

What are direct effects of beta 2? indirect effects of beta 1?

A
  1. decrease epicardial and resistance vessel tone

2. up HR, up contractility, increase MVO2 and vasodilation

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16
Q

What are the direct effects of paraSNA? Indirect effects?

A
  1. decrease epicardial and resistance vessel tone

2. down HR, down arterial BP, down MVO2 and vasoconstrict

17
Q

What is the overall paraSNA effect on blood flow?

A

decrease flow

18
Q

What are ROS effects in cardiovascular disease?

A

O2- and NO combine to form ONOO- , the decreased NO decreases cGMP which leads to less relaxation

19
Q

What are ROS increased by in regards to vascular dysfunction? 5

A 
atherosclerosis
diabetes
hypertension
AngII
Inflammation
20
Q

What antioxidants may be beneficial?

A

E and C vitamins NO!!!

SOD/Catalase–maybe but not available

21
Q

How is Rho kinase involved in CV disease?

A

it is increased, which it inhibits MLC phosphatase, which leads to increased phosphorylation of Myosin light chain which is the contractile state

22
Q

What is angina?

A

When the O2 supply does not meet the MVO2 demand

[Can happen from a decrease in supply or an increase in demand]

23
Q

CHD, CVD, IHD and angina are all the same and have reduced myocardial perfusion. What are the 3 main causes?

A
  1. coronary artery narrowing with atherosclerosis or plaque
  2. Vasospasm (with or without thrombus)
  3. Plaque rupture
24
Q

When does maximal flow start diminishing in stenotic patients?

A

past 50%, but resting flow maintains normal until past 75%

25
Q

What is chronic stable angina?

A

exertional or typical, fixed atherosclerotic lesions

26
Q

What is variant angina?

A

vasospasms

27
Q

What is acute coronary syndrome?

A
  1. unstable angina/severe atherosclerosis

2. MI

28
Q

About how many people have silent ischemia?

A

50%–women more often

29
Q

Average time to seek MI care? Why?

A
  1. 2 hours

2. mismatch of expectations and symptoms

30
Q

What is the approach to CHD treatment?

A
  • increase supply and decr. demand
  • decrease work of the heart
  • inhibit platelet agg.
  • prevent vasospasm
  • mechanical interventions

3 PHARM SELF (13 decks)

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