Coronary Artery Disease

Question 1

What is CAD?

Answer 1

Heart disease d/t impaired delivery of blood to the myocardium.

Results from atherosclerosis of coronary arteries.

AKA = ischemic heart disease

Question 3

What is Coronary Heart Disease?

Answer 3

Heart disease d/t impaired delivery of blood to the myocardium.

The result of atherosclerosis of coronary arteries.

Also called ischemic heart disease.

Question 4

What happens to intramyocardial arteries during systole?

Answer 4

During systole, these arteries are compressed = most coronary perfusion occurs during diastole.

Question 5

What factors influence coronary perfusion?

Answer 5

Perfusion pressure, coronary artery diameter/patency and the duration of diastole.

Question 6

What is collateral circulation?

Answer 6

Collateral circulation is new vasculature (angiogenisis) that forms around a slow atheroma growth in order to preserve blood flow.

Question 7

What factors contribute to collateral circulation?

Answer 7

• possible genetic predisposition for angiogenisis
• regular cardiovascular exercise stimulates collateral growth

NOTE: b/c of collateral growth, a patient may be unaware of a developing problem.

Question 8

Presentation of CAD is dependent on…?

Answer 8

Extent of occlusion (partial or complete)

Speed of ischemic development (acute or chronic)

Question 9

What is cardiogenic shock?

Answer 9

Heart is unable to pump enough blood and oxygen to the body’s vital organs. Can result from an MI.

Question 10

CAD presents in what 3 different ways?

Answer 10

1. Angina (stable (stable plaque) or unstable (transient thrombus on a plaque))
2. Acute MI
3. Heart failure (ischemic cardiomyopathy or cardiogenic shock))

Question 11

Define Angina Pectoris.

Answer 11

Chest pain or discomfort caused by insufficient O2 supply to meet myocardial O2 demands.

Question 12

What is the most common cause of Angina Pectoris?

Answer 12

Myocardial ischemia d/t CAD

Question 13

What are some reasons, other than CAD for decreased myocardial infusion?

Answer 13

• hypovolemia
• coronary vasospasm (e.g. cocaine overdose)
• coronary embolism
• heart failure

Question 14

What are some reasons for decreased oxygen in the blood?

Answer 14

-anemia
- hypoxemia d/t to chronic respiratory disease (e.g. COPD)
- acute gas exchange impairments (pneumonia)

Question 15

What are some causes of increased myocardial oxygen demand?

Answer 15

• ventricular hypertrophy (d/t HTN, aortic stenosis)
• large pulmonary embolism
• tachycardia
• hyperthyroidism
• hyperthermia, physical exertion, stress/anxiety

Question 16

How would someone experiencing angina describe their pain?

Answer 16

• substernal, sometimes epigrastic
• may be referred to inner arm, shoulder, neck, jaw or back
• described as pressure, tightness, heaviness, constricting, squeezing
• may come with associated symptoms: dyspnea, nausea or dizziness

Question 17

Provide a description, the pathophysiology, duration and outcome of stable angina.

Answer 17

Description - exertion or emotional stress. Chronic stable angina is predicable.

Patho - narrowing of the atherosclerotic coronary arteries means then cannot dilate to meet increased oxygen demands = myocardial ishcemia

Duration = 2-5 mins. Pain stops with rest or nitro.

Outcome = no significant permanent damage to myocardium.