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Adult Coronary Artery Pathology > Adult Coronary Artery Pathology > Flashcards

Adult Coronary Artery Pathology Flashcards

1
Q

what did Alexis Carrel recognize in the 1910s?

A

first to understand and recognize how angina and stenosis were related in canine models

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2
Q

who is Claude Beck and what did he develop?

A

developed methods to perfuse animal hearts by attaching adjacent tissues to form collateral blood flow to ischemic myocardium

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3
Q

what did Arther Vineberg discover?

A

implanting the internal mammary artery, through a tunnel in the myocardium, in animals, that shoed communication developed b/w the IMA and the coronaries

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4
Q

who is the “Father of Open Heart”

A

C. Walton Lillehei

first surgeon to correct a variety of congenital heart defects that were previously considered untreatable

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5
Q

what happened when the first use of IMA as a direct graft?

A

during a procedure, a right coronary artery was too damaged, and in desperation, William longhair placed an IMA as a direct graft to restore the flow

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6
Q

what did Sones and Shirey demonstrate?

A

feasibility of selective coronary arteriography by using a catheter to inject contrast solution into the coronary Ostia

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7
Q

what is coronary circulation?

A

the nourishment of the heart tissues via the heart’s own vessels

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8
Q

what are the two main coronary arteries that branch off of the aorta and have many sub branches that supply oxygenated blood to the heart?

A

right coronary artery

left main coronary artery

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9
Q

what is coronary dominance?

A

refers to which coronary artery feeds the PDA that supplies the inferior wall of the heart

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10
Q

what does it mean to be considered right coronary dominant?

A

one’s RCA feeds the PDA

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11
Q

ischemia results from

A

an imbalance in oxygen supply or demand

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12
Q

what is angina pectoris

A

clinical manifestation of ischemic myocardial tissue that is temporally, or permanently injured

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13
Q

what are typical anginas symptoms

A

mild discomfort
severe chest pain
pain radiating to the arms, shoulders, neck, jaw or back

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14
Q

what triggers stable angina

A

physical activity , which increases the myocardial oxygen demand

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15
Q

variant angina occurs when?

A

occurs mostly exclusively at rest and is not precipitated ny exertion

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16
Q

what is predominantly a disease of the left ventricle?

A

Acute MI

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17
Q

what does acute MI result in?

A

necrotic myocardial tissues that is permanently injured

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18
Q

what is the difference between unstable angina and acute MI in the lumen?

A

unstable angina has partial lumen obstruction

complete lumen obstruction will cause acute MI

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19
Q

what might occur any time after myocardial infarction, especially if left atrium is enlarged

A

arterial fibrilation

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20
Q

what is the most common complication of myocardial infarctions?

A

arrhythmias

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21
Q

what are other complications of acute MI

A 
ventricular fibrillation (VF) 
ventricular tachycardia (VT)
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22
Q

what is ventricular fibrillation?

A

essentially no blood is being pumped to the heart

usually seen in sudden cardiac death

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23
Q

what is ventricular tachycardia

A

significantly decrease the amount of blood pumped through the heart and increases oxygen demand

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24
Q

what is extreme LV failure called?

A

cariogenic shock

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25
Q

heart failure after an acute MI occurs predominantly as

A

left ventricular failure, caused by impaired LV function from infarcted left wall tissue

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26
Q

although less common, what are other causes of cardiac failure?

A

papillary muscle dysfunction or rupture
ventricular septal rupture
free wall rupture

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27
Q

what is a ventricular aneurysm

A

outpouching of scar tissue from a wide base in the ventricular wall

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28
Q

what are the characteristics of a true aneurysm?

A
  1. wide base
  2. walls composed of myocardium
  3. low risk of rupture
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29
Q

what is a risk of ventricular aneurysms?

A

have a low risk of rupture, but they can impair cardiac function causing heart failure

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30
Q

what is a pseudo aneurysm

A

an incomplete rupture of the free wall and is characterized by a narrow base with a saclike aneurysm extending from the wall

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31
Q

characteristics of pseudo aneurysm

A
  1. narrow base
  2. walls composed of thrombus and pericardium
  3. high risk of rupture
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32
Q

what is Dressler’s syndrome?

A

inflammatory response to injured tissue that develops in a few patients about 1-8 weeks after an acute MI

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33
Q

what does Dressler’s syndrome present as?

A

pericarditis
fever
joint pain
pericardial effusion

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34
Q

what is a recommended therapy for use after an acute MI when there is some form of LV dysfunction?

A

ACE inhibitors

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35
Q

what are used for hyperlipidemia and plaque stabilization

A

statins

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36
Q

ACS with non-ST segment myocardial infarction should not be given ____ if urgent surgery is considered likely

A

plavix

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37
Q

use for lipid-regulating drugs

A

treatment of hyperlipidemia

38
Q

effects of nitrates (4)

A
  • dilate arterial and venous systems
  • increase blood flow through coronary arteries
  • decrease cardiac workload
  • reduce myocardial oxygen demand
39
Q

effects of beta blockers

A
  • decrease heart rate, bp, and contractility of the heart
  • reduce myocardial oxygen demand
  • reduce incidence of arrhythmias
40
Q

calcium channel blockers effects

A
  • dilate arterial system (including coronary arteries)
  • decrease bp and contractility
  • reduce cardial oxygen demand
  • reduce incidence of arrhythmias
41
Q

ACE inhibitors effects

A

dilate arterial and venous systems

decrease bp

42
Q

anticoagulants effects

A

inhibit and prevent further clot formation

43
Q

antiplatelets effects

A

inhibit thrombus formation by decreasing platelet aggregation

44
Q

what is CABG (ACB)

A

performed to restore or increase blood flow to the myocardium

45
Q

indications for ACB

A
  • LM coronary artery stenosis
  • LM equivalent disease, significant stenosis (70%) of the proximal LAD and CIRC
  • multivessel disease, especially with high LAD stenosis or LV dysfunction
46
Q

what is the primary vessel of importance and why?

A

LAD artery since it supplies a major portion of the myocardium, especially the left ventricle

47
Q

the LAD must be grafted with the conduit that has the best latency rate. What does the latest research indicate this is?

A

the LIMA

48
Q

what are other potential graft sites?

A

the RCA
PDA of the RC
marginal branch off the RCA

49
Q

at 10 years, what is the LIMA and RIMA patency rate?

A

LIMA >95%

RIMA 80-90%

50
Q

what is a free IMA bypass graft?

A

a IMA graft that is anastomosed to the aorta for blood supply

51
Q

what are possible bypass graft conduits?

A

the IMA
SVG
radial artery
gastroepiploic artery

52
Q

what is the leading indication for reoperation

A

vein graft atherosclerosis, which is buildup of fats, cholesterol and other substances in and on your artery walls (plaque), which can restrict blood flow

53
Q

overall mortality with a first time elective CABG surgery is about

A

2%

54
Q

what is the average length of stay after CABG

A

5-7 days

55
Q

what does anti platelet therapy help in patients after an ACB

A

inhibits platelet adhesion in the new bypass grafts, especially in SVG grafts

56
Q

main preoperative risk factor for develops of complications in surgery are

A

reoperation
lung disease
emergency surgery
renal dysfunction

57
Q

plunged CPB time is an indication for

A

preoperative MI
bleeding
respiratory complication
cerebrovascular accident

58
Q

coronary artery disease results from

A

progressive blockage of the coronary arteries by atherosclerosis

59
Q

risk factors of CAD

A 
hyperlipidemia 
hypercholesterolemia
cigarette smoking
hypertension
diabetes 
obesity 
physical inactivity
60
Q

non modifiable risk factor for CAD

A

family history of disease, age > 65, gender (time as high in men as women)

61
Q

class I classification of CAD

A

no limitation of physical activity

ordinary physical activity does not cause undue breathlessness, fatigue, or palpitations

62
Q

class II classification of CAD

A

slight limitation of physical activity

comfortable at rest but ordinary physical activity results in undue breathlessness, fatigue, or palpitations

63
Q

class III classifications of CAD

A

marked limitation of physical activity

comfortable at rest but less than ordinary physical activity results in breathlessness, fatigue, and palpitations

64
Q

class IV classification of CAD

A

unable to carry on any physical activity w/o discomfort
symptoms at rest can be present
if any physical activity is undertaken, discomfort is increased

65
Q

left ventricular aneurysm ( LVA) results from

A

the occlusion of major coronary artery that produces an extensive transmural infarction

66
Q

what are the two most common presentations of left ventricular aneurysm?

A

ischemic syndromes and CHF

67
Q

surgical procedures for LVA

A

standard aneurysmectomy

endoaneurysmorraphy

68
Q

what is ventricular septal defect (VSD)

A

extensive myocardial damage subsequent to occlusion of a major coronary vessel may result in septal necrosis and rupture

69
Q

when does VSD occur?

A

usually in the first week of an infarction

70
Q

the presence of a VSD is suggested by

A

a loud holosystolic murmur that reflects the left to right shunting across the ruptured septum

71
Q

surgery is indicated on an emergency basis for nearly all post infarction VSDs to prevent

A

the development of progressive multi system organ failure

72
Q

aortic stenosis results from

A

thickening, calcification, and or fusion of the aortic valve leaflets which produce an obstruction to LV outflow

73
Q

development of aortic stenosis in younger patients is from

A

AS usually develops on congenitally bicuspid valves

74
Q

development of AS in order patients

A

AS is degenerative change in trileaflet valves

75
Q

what layer is the collagen and elastic fibers?

A

tunica externa or adventitia

76
Q

what layer is the smooth muscle of the cell

A

tunica media

77
Q

what layer is the internal elastic membrane, connective tissue, endothelial cells and lumen

A

tunica intima

78
Q

vasoconstriction is due to

A

high blood pressure

79
Q

vasodilation is due to

A

low blood pressure

80
Q

do arteries or veins have more smooth muscle in their walls?

A

arteries have more smooth muscle in their walls than veins

81
Q

what comes off the LCA

A

LAD
circumflex
diagonal
marginal

82
Q

what comes off the RCA

A

PDA

marginal

83
Q

if the blood supply to the heart muscle is cut off entirely, what happens

A

a heart attack or MI may occur

84
Q

stable angina

A

triggered by physical or mental exertion

resolves with rest or meds

85
Q

variant angina

A

occurs spontaneously
vasospasm
responds to meds

86
Q

unstable angina

A 
unpredictable 
may be caused by thrombus 
may happen at rest 
rest and meds do not help, may progress 
acute coronary syndrome that can lead to MI
87
Q

ischemia

A
  • reversible
  • t wave changes
  • coronary artery cannot supply enough oxygen rich blood to meet the heart’s needs to cells resume contraction
88
Q

injury

A
  • reversible
  • ST abnormalities
  • coronary artery cannot supply enough oxygen rich blood to meet the heart’s needs
  • becomes stunned and recovery is delayed
89
Q

infarction

A
  • irreversible cell death
  • pathological Q wave
  • coronary artery cannot supply enough oxygen rich blood to meet the heart’s needs, complete depletion occurs, necrosis of cells results
90
Q

MI tends to affect what ventricle more

A

left

91
Q

NSTEMI

A

occluding thrombus sufficient to cause tissue damage and mild myocardial necrosis

  • elevated cardiac enzymes
  • ST depression
92
Q

STEMI

A
  • complete thrombus occlusion
  • more severe symptoms
  • elevated cardiac enzymes
  • ST elevations on ECG or new LBBB

Adult Coronary Artery Pathology (1 decks)

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