Coronary Artery Disease

Question 1

Determinants of Coronary Artery Disease (14)

Answer 1

• increasing age
• males and postmenopausal women
• Maori, Pacific, Indian
• Socioeconomic deprivation
• Tobacco use
• sedentary
• depression
• isolation
• obesity
• diabetes
• hypertension
• dyslipidemia
• access to healthcare
• +ve family history

Question 2

Aetiology of Coronary Artery Disease

Answer 2

• build up of plaque in arteries –> reduces O2 supply to myocardium
• rupture of plaque in arteries –> O2 demand of myocardium is not being met

Question 3

Pathophysiology of Coronary Artery Disease

Answer 3

Atherosclerosis* –> plaque formation –> obstruction of blood flow –> less O2 supply to target organs

*Atherosclerosis - inflammatory, dysfunction of lining of blood vessels involved, cellular debris and lipid build up

Question 4

Pathophysiology of Chronic Progressive Coronary Artery Disease

Answer 4

Endothelium Dysfunction, initial fatty streaks and lesions in intima –> formation of plaque (fibrous cap narrows lumen of artery -stenosis) –> rupture of plaque and thrombus formation

Endothelium dysfunction - increase vasoconstriction, less resistance to thrombus formation, increase in permeability

Initial fatty streaks - due to too much cholesterol in blood

Lesions in intima (due to lipid deposit and other cells)

Thrombus consists of RBC’s, platelets and fibrin

Question 5

Clinical Features of Coronary Artery Disease (6)

Answer 5

Asymptomatic
Angina
Myocardial infarction
Cardiac arrest
Increased SOB on exertion
Decrease exercise tolerance

Question 6

Progression of Coronary Artery Disease (6)

Answer 6

• Atherosclerosis develops in vascular territories
• Altered mood status - depression, anxiety
• Decreased health related quality of life
• HF - acute left HF, chronic HF
• Increased SOB on minimal exertion (general deconditioning, decreased cardiac output, mild pulmonary oedema)
• Decreased exercise tolerance (decrease in cardiovascular fitness and peripheral muscle strength)

Question 7

Tests/investigations for Coronary Artery Disease (3)

-What do they show

Answer 7

Cardioangiogram - open (patency) artery

ECG - taken at rest or maximal exercise

• ST elevated = MI
• ST depressed = Angina

Blood tests - troponin levels

• Rise in troponin levels
• Peak around 12-24 hours after MI

Question 8

Pathophysiology of Pulmonary Oedema

Answer 8

increase in dysfunction (can’t maintain CO) + increase in pressure of LEFT side of heart –> increase in pressure of pulmonary veins and capillaries (more fluid in extravascular spaces that can be returned to capillaries) –> J receptors stimulated by the FLUID in interstitial lung and alveoli tissue –> increase Respiratory Rate + breathlessness

Question 9

Clinical features of Pulmonary Oedema

Answer 9

• Breathless
• Dry cough

Progresses to:

• Breathlessness at rest or lying down
• cough - pink frothy sputum