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PHA222 > CHD > Flashcards

CHD Flashcards

1
Q

What is tissue ischaemia?

A

Reduced blood flow to an organ/tissue

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2
Q

Tissue ischaemia leads to a lack of what?

A
  • O2
  • nutrients
  • washout of metabolic wastes
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3
Q

What determines the extent of tissue damage due to tissue ischaemia?

A
  • organ

- duration

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4
Q

Longer reduction of blood flow to tissues is more likely to be reversible/irreversible damage

A

irreversible

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5
Q

What is myocardial ischaemia?

A

Reduced blood flow to the heart

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6
Q

What is ischaemia?

A

Imbalance between myocardial O2 supply and demand

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7
Q

When does exertional demand ischaemia occur?

A

During activity/stress

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8
Q

Why does exertional demand ischaemia occur?

A

O2 demand increases & more ATP and nutrients required due to increased HR

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9
Q

When does non-exertional supply ischaemia occur?

A

At rest

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10
Q

Why does non-exertional supply ischaemia occur?

A

When there is insufficient O2

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11
Q

Describe the 2 possible conditions of the coronary arteries during non-exertional supply ischaemia?

A
  • Plaque closes the artery

- Plaque ruptures -> clot forms -> artery closes -> heart attack

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12
Q

Define coronary heart disease

A

Reduced blood flow to heart due to obstructive/constrictive disease of coronary arteries

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13
Q

Describe the disease process of CHD

A

-> coronary artery obstruction/constriction
-> reduced blood flow to heart
-> O2 & nutrient deprivation, accumulation of toxic wastes
Leading to:
Metabolic dysfunction
Contractile dysfunction
Electrical instability
Myocardial cell death

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14
Q

What are the clinical manifestations of CHD?

A

Angina (stable/variant/microvascular)
ACS (unstable angina/MI NSTEMI/STEMI)
Sudden cardiac death

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15
Q

List the 4 pathological diseases of CHD

A

Atherosclerosis
Coronary thrombosis
Coronary artery spasm
Coronary microvascular dysfunction

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16
Q

Define atherosclerosis

A

Degenerative, progressive arterial disease characterised by asymmetric deposition of lipids and fibrous tissue on artery walls

17
Q

What is the most common cause of CHD?

A

Atherosclerosis

18
Q

What type of process is atherosclerosis?

A

Inflammatory

19
Q

Give 3 medical risk factors of CHD

A

Hypercholesterolaemia
Diabetes
HPT

20
Q

Give 4 modifiable risk factors of CHD

A

Diet
Obesity
Smoking
Physical Activity

21
Q

Describe the disease process of atherosclerosis whereby an atheroma/fibrous plaque is formed

A
  • > LDL deposition in sub-endothelial space
  • > LDL oxidation & monocyte recruitment
  • > Uptake of oxidised LDL & macrophage differentiation
  • > Foam cell formation
  • > SMC migration, proliferation & de-differentiation
22
Q

List the 3 possible consequences of atherosclerosis

A

Stable angina - partial coronary occlusion
Coronary artery spasm - endothelial/vascular dysfunction
Coronary thrombosis - ulceration/rupture

23
Q

Define Coronary thrombosis

A

Unwanted formation of a haemostatic plug within coronary arteries

24
Q

Describe the disease process of coronary thrombosis

A
  • > Rupture/ulceration of atherosclerotic plaque
  • > Contact of blood elements with collagen & TF
  • > Platelet adhesion & activation leads to platelet aggregation
  • > Activation of the coagulation cascade
  • > Fibrin formation & deposition
  • > Clot
25
Q

List the possible consequences of coronary thrombosis

A

ACS - complete & permanent OR intermittent occlusion of artery
Thromboembolism in distal artery

26
Q

Define coronary artery spasm

A

Transient & spontaneous coronary vasoconstriction

27
Q

Coronary artery spasm is the underlying cause of which type of angina?

A

variant angina

28
Q

Describe the 3 disease mechanisms of coronary artery spasm

A
  • local endothelial injury -> increased reactivity to vasoconstrictors
  • abnormal release of vasoconstrictors & constrictors
  • smooth muscle cell hyper-contraction
29
Q

Describe the impact on coronary function due to coronary artery spasm

A

Intermittent OR complete occlusion of coronary artery

30
Q

Define coronary microvascular dysfunction

A

Inner wall damage of small coronary blood vessels of heart leading to microvascular spasms, decreased blood flow to the heart muscle & decreased coronary flow reserve

31
Q

Coronary microvascular dysfunction is the underlying cause of which type of angina?

A

microvascular angina

32
Q

State the result of structural & functional damage due to coronary microvascular dysfunction

A

structural -> microvascular remodelling

functional -> endothelial dysfunction

33
Q

State the 3 disease mechanisms of coronary microvascular dysfunction

A

microvascular remodelling
endothelial dysfunction
functional abnormalities

34
Q

Describe microvascular remodelling

A

Luminal narrowing of intramural arterioles & capillaries -> microvascular obstruction

35
Q

Describe endothelial dysfunction

A

Impaired vasodilator response & reduced coronary blood during exercise/stress

36
Q

Describe the effect of functional abnormalities of smooth muscle cells

A

Regulates arterial tone

37
Q

Describe the impact on coronary function due to coronary microvascular dysfunction

A

Decreased coronary flow reserve
Increased risk of myocardial ischaemia
INOCA/MINOCA

PHA222 (7 decks)

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