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Chronic Stable angina Flashcards

1
Q

what 4 processes occur in cellular injury

A
  1. decreased ATP
  2. membrane damage
  3. increased intracellular calcium
  4. increased oxygen derived free radicals
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2
Q

what does reduced ATP lead to?

A
  1. reduced action of Na-K-ATPase
  2. increased anaerobic glycolysis
  3. detachment of ribosomes
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3
Q

name 2 processes leading to membrane damage in cells

A

decreased ATP synthesis -> decreased phospholipid synthesis

raised intracellular Ca -> activates proteases and phospholipases

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4
Q

what does raised intracellular Ca lead to

A 
activation of enzymes:
ATPase
phospholipase
proteases
endonucleases
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5
Q

what is ischaemia repercussion injury?

A

some reversibly injured cells can die after blood is restored to the myocardium. possibly caused by:

  1. Oxygen free radicals
  2. mitochondrial permeability transition
  3. Inflammation associated injury
  4. Complement proteins
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6
Q

what is athersclerosis

A

the accumulation of lipid and fibrous tissue within the intimate or arteries called plaques.
Chronically it can affect the media and the whole structure of the artery

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7
Q

describe the structer of atheromatous plaques

A

core –> mainly cholesterol (also cellular debris, crystals, foam cells)
fibrous cap –> collagen, elastin, sm muscle, proteoglycan

Cellular area of T lymphocytes and macrophages

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8
Q

describe the structure of a stable plaque

A

concentric
rich in fibrous storm
rich in smooth muscle

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9
Q

describe the structure of an unstable plaque

A 
eccentric
rich in lipids
Macrophages ++
inflammation ++
endothelial cell injury
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10
Q

describe the consitutional risk factors for atherosclerosis

A

age
gender
FHx

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11
Q

describe some of the major risk factors for atherosclerosis

A

smoking
HTN
hyperlidiaemia
DM

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12
Q

describe some of the softer risk factors for atherosclerosis

A

Obesity
Personality/stress
Lack of exercise
infection

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13
Q

4 complications of coronary artery atheroma

A
  1. gradual narrowing of vessel
  2. ulceration of the plaque
  3. rupture and fissuring
  4. superimposed thrombosis
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14
Q

4 clinical features of atherosclerosis

A
  1. plaque rupture of coronary artery
  2. thrombosis
  3. occlusion of coronary artery
  4. MI
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15
Q

List some of the complications of MI

A 
sudden death
cardiac arrhythmias
LV failure
ventricular wall rupture
Papillary muscle fibrosis/rupture
Mural thrombosis
Ventricular aneurysm
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16
Q

what is Darcy’s law

A

Q= (P1-P2)/R

17
Q

what are autocoids

A

chemicals released from damaged tissue

histamine, bradykinin, 5ht, prostaglandins

18
Q

name a vasodilator endothelial factor

A

BO

19
Q

how does flow induced vasodilation occur

A

downstream vasodilation causes increased flow

this activates shear sensors in the endothelium and leads to vasodilation

20
Q

which mechanism altering the radius of resistance vessels is under extrinsic control?

A

human alerting response

nerves - sympathetic vasoconstrictor action are dependant on firing

hormone – adrenaline
angiotensin II

21
Q

which part of the aorta is the aortic root

A

runs between aortic valve and sinotubular junction

22
Q

what branches off the aortic root

A

RCA LCA

23
Q

which parts of the aorta are situated within the pericardial sac

A

the aortic root

the ascending aorta (up to 1cm pro to brachiocephalic trunk)

24
Q

what is the significance of parts of the aorta being situated within the pericardial sac

A

risk of tamponade if dissection occurs

25
Q

what are the major branches of the aortic arch

A
  1. the bracheocephalic trunk
  2. left common carotid
  3. left subclavian artery
26
Q

major branches of descending thoracic aorta

A
  1. bronchial
  2. oesophageal
  3. intercostal
  4. spinal
  5. pericardial
27
Q

define ischaemia

A

lack of blood supply from stenotic or occluded artery

this results in a lack of oxygen and essential metabolites

causes cell injury more rapidly than hypoxia

28
Q

define infarction

A

irreversible cell damage due to ischaemia and hypoxia

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