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Pathology Of Cardiopulmonary Systems > Coronary Artery Disease > Flashcards

Coronary Artery Disease Flashcards

1
Q

What are the 2 Coronary Arterial Circulation Problems?

A
  1. Coronary Artery Disease (CAD)

2. Acute Coronary Syndrome. (ACS)

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2
Q

Smooth muscle within an artery allows for…

A

Vasodilation and Vasoconstriction

Regulating blood flow

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3
Q

What layer of the artery becomes breeched allowing for plaque to build up in the artery?

A

Endothelium

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4
Q

The endothelium becomes breached and cholesterol (lipids) build up between the ______________ and ________________ of the arterial blood supply

A

Endothelium

Smooth Muscle Layer

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5
Q

What section of a blood vessel is reduced in its radius due to plaque buildup in the arterial walls?

A

Lumen

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6
Q

Chronic plaque build up in the arteries may lead to __________ of the blood vessel

A

Calcification

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7
Q

What are the 5 pathophysiological changes that occur with Coronary artery disease

A
  1. Damaged Endothelium
  2. Smooth Muscle Cell Hypertrophy
  3. Macrophages transformed into foam cells
  4. Lipids, calcium, and cellular debris buildup
  5. Fibrous cap (may become calcified).
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8
Q

This is when the artery becomes smaller

A

Vasospasm

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9
Q

This is the narrowing of the artery’s lumen

A

Fixed Stenosis

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10
Q

This is when a blood clot reduces blood flow

A

Thrombosis

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11
Q

What are 3 things that can reduce coronary blood flow?

A
  1. Vasospasm: Artery becoming smaller
  2. Fixed Stenosis: narrowing of the artery’s lumen
  3. Thrombosis: Blood clots reducing blood flow
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12
Q

If there is a decrease in oxygen supply, what happens to the coronary flow of blood?

A

Reduced

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13
Q

If the demand of O2 increase, what 3 things occur to the heart?

A
  1. Heart rate increases
  2. Heart contractions are stronger
  3. Blood pressure increases
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14
Q

Decreased oxygen supply and increased demand of oxygen both lead to what condition for the heart?

A

Angina

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15
Q

If the supply to the myocardium is not sufficient, it cannot meet the _______________ of the heart

A

Metabolic Demands

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16
Q

When the metabolic demands of the heart are not met, what is the consequence?

A

Decreased coronary blood flow

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17
Q

What are the 2 mechanisms of myocardial ischemia?

A
  1. Atherosclerotic disease

2. Coronary Microcirculation

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18
Q

What are the 2 pathways for Atherosclerotic disease?

A

Stable plaque

Vulnerable Plaque

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19
Q

For epicardial coronary arteries with disease, what is the pathway for stable plaque?

A

Atherosclerotic disease

  • > Stable Plaque
  • ->Reduction in CFR (Coronary Flow Reserve)
  • –>Damaged Ischemia w/wo Angina
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20
Q

For Epicardial coronary arteries with atherosclerotic disease, describe the pathway for vulnerable plaque

A

Atherosclerotic disease

  • > Vulnerable Plaque
  • ->Plaque Rupture
  • –>Thrombosis
  • —>Acute Coronary Syndromes/Infarction
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21
Q

For Epicardial coronary arteries with vasopastic disease, what are the two possible outcomes?

A

Focal/Transient Vasospasm –> Prinzmetal Angina

Persistent Vasospasm –> Myocardial Infarction

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22
Q

Myocardial ischemia could occur due to Coronary Microcirculation. Describe this pathway.

A

Coronary Microcirculation

  • > Microvascular dysfunction
  • ->Impairs coronary physiology and myocardial blood flow in subjects with risk factors
  • –>Contributes to myocardial ischemia in CAD and CMP
  • –>Induces severe acute ischemia “Tokotsubo”
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23
Q 
Effects of changes in .....
Heart Rate
Aortic Pressure
Inotropic State
Stroke Volume 
... On myocardial oxygen consumption. Of the 4 listed, which has the least effect on increasing Myocardial VO2?
A

Stroke volume has a much smaller influence on MVO2 than changes in heart rate, inotropy, and/or aortic pressure

24
Q

Myocardial VO2 is equal to…

MVO2

A

CBF x (CaO2 - CvO2)

CBF = Coronary Artery Blood flow
CaO2 - CvO2 = Coronary artery arterio-venous O2 Difference

25
Q

At rest, the myocardium extracts ___% of the oxygen it receives though the coronary vessels.

A

75% Myocardium

26
Q

At rest, the systemic tissue extracts ____% of the oxygen it receives through the coronary vessels

A

25% Systemic Tissues

27
Q

What is the rate pressure product? Formula?

A

The Product of

Heart Rate x Systolic Blood Pressure

28
Q

The Rate Pressure Product is Highly correlated with….

A

Myocardial VO2

29
Q

In the context of “stable” angina, the Rate Pressure Product threshold is typically ________

A

Reproducible.

30
Q

Angina/Ischemia come on at a predictable ____________

A

Rate Pressure Product

31
Q 
Hemodynamic Response for Rate-Pressure Product
High
High-Intermediate
Intermediate
Low-Intermediate
Low
A 
High: more than 30,000
High/Intermediate: 25,000-19,999
Intermediate: 20,000-24,999
Low Intermediate: 15,000--19,999
Low: 10,000-14,999
32
Q

What are the known risk factors for CAD (Coronary Artery Disease) (6)

A
  1. Lipids
  2. Blood Pressure
  3. Blood Glucose
  4. Smoking
  5. Diet
  6. Body Habitus (Genetic predisposition)
33
Q

What is an independent predictor for cardiovascular morbidity/mortality?

A

Cardiorespiratory Fitness

34
Q

Over the age of 40, the Lifetime risk of developing CAD is ____ in men and ____ in women

A

49% in men

32% in women

35
Q

CAD Progression timeline

(6) What are they

A
  1. Initial Lesion
  2. Fatty Streaks
  3. Intermediate Lesion
  4. Atheroma
  5. Fibroatheroma
  6. Complicated Lesion
36
Q

What decade do the 6 CAD criteria occur?

A

First Decade: Initial Lesion and Fatty Streaks
Third Decade: Intermediate Lesion and Atheroma
Fourth Decade: Fibroatheroma and Complicated Lesion

37
Q

Acute events associated with Coronary artery disease CAD can occur…

A

Symptomatically or Asymptomatically

38
Q

Coronary Artery Disease (CAD) in men is often described as…

A

Pressure/Squeezing in chest and may extend to arms

Worsens with physical activity and resolves with rest.

39
Q

Coronary Artery Disease (CAD) in women is often described as…

A

Sharp/Burning chest pain
Pain in Jaw, Neck, Throat, Back, or Abdomen
More likely than men to have resting symptoms or during sleep

40
Q

Are men or women more like to experience Coronary Artery Disease Symptoms during rest/sleep?

A

Women

Men is increased with Physical activity and alleviated with rest.

41
Q

What is the most common symptom associated with Coronary Artery Disease?

A

Angina

42
Q

Mechanism of cardiac pain referral follows the _________ rule

A

Dermatomal Rule

43
Q

CAD Pain Referral
When pain is referred, it is usually to a structure that developed from the same embryonic segment or dermatome as the structure in which the pain originates. But…

A

the CNS may “misinterpret” origin of sensory information as coming from non-cardiac regions and organs

44
Q

In men, what is the Referral pattern for Angina?

A

Pain in the upper left segment of the chest
Left Neck
Left Upper Back
Medial Aspect of Left Arm

45
Q

Chronic/stable angina is predictable at certain level of …

A

Exertion or stress

46
Q

Unstable angina is ______ or a change in stable symptoms

A

Unexpected

47
Q

What triggers Chronic/Stable angina?

A

Emotional or extreme physical stress

48
Q

What triggers Unstable angina?

A

Happens at rest; accelerating during sleep

49
Q

What is true about the duration of chronic/stable angina?

A

It is short lived; relieved at rest

50
Q

What is true about the duration of Unstable angina?

A

Can last Longer than 30 minutes.

51
Q

These types of angina are less common, and result from spams of dysfunction in coronary artery or walls of blood vessels.

A

Variant (Vasospastic Angina)

Microvascular (Syndrome X)

52
Q

What are the triggers for Vasospastic Angina (Variant) and Microvascular Angina (Syndrome X)

A

No clear triggers

53
Q

This chart is useful in quantifying Anginal/ischemic thresholds

A

Rate-Pressure Product (RPP)

54
Q

What are the Associated symptoms with Coronary Artery Disease?

A
  1. Difficulty Breathing
  2. Shortness of Breath
  3. Light-headedness
  4. Dizziness
  5. Extreme Weakness
  6. Fatigue
  7. Rapid/Slow/Irregular Heart Rate
  8. Sweating
  9. Cold Sweat
  10. Fulness
  11. Indigestion
  12. Choking Feeling
  13. Nausea/Vomiting
55
Q

CAD Differential Diagnosis List

A
  1. Retrosternal
  2. Intrascapular
  3. Right Lower Anterior Chest
  4. Left Lower Anterior Chest
  5. Epigastric
  6. Arm
  7. Shoulder
56
Q

TIM VADETUCONE Differential Diagnosis List

A 
T: Trauma
I: Inflammation
M: Metabolic
Va: Vascular
De: Degenerative 
Tu: tumor 
Co: Congenital
Ne: Neurogenic/Psychogenic

Pathology Of Cardiopulmonary Systems (1 decks)

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