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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
At rest, the myocardium extracts ___% of the oxygen it receives though the coronary vessels.
75% Myocardium
26
At rest, the systemic tissue extracts ____% of the oxygen it receives through the coronary vessels
25% Systemic Tissues
27
What is the rate pressure product? Formula?
The Product of Heart Rate x Systolic Blood Pressure
28
The Rate Pressure Product is Highly correlated with....
Myocardial VO2
29
In the context of "stable" angina, the Rate Pressure Product threshold is typically ________
Reproducible.
30
Angina/Ischemia come on at a predictable ____________
Rate Pressure Product
31
``` Hemodynamic Response for Rate-Pressure Product High High-Intermediate Intermediate Low-Intermediate Low ```
``` 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
What are the known risk factors for CAD (Coronary Artery Disease) (6)
1. Lipids 2. Blood Pressure 3. Blood Glucose 4. Smoking 5. Diet 6. Body Habitus (Genetic predisposition)
33
What is an independent predictor for cardiovascular morbidity/mortality?
Cardiorespiratory Fitness
34
Over the age of 40, the Lifetime risk of developing CAD is ____ in men and ____ in women
49% in men 32% in women
35
CAD Progression timeline | (6) What are they
1. Initial Lesion 2. Fatty Streaks 3. Intermediate Lesion 4. Atheroma 5. Fibroatheroma 6. Complicated Lesion
36
What decade do the 6 CAD criteria occur?
First Decade: Initial Lesion and Fatty Streaks Third Decade: Intermediate Lesion and Atheroma Fourth Decade: Fibroatheroma and Complicated Lesion
37
Acute events associated with Coronary artery disease CAD can occur...
Symptomatically or Asymptomatically
38
Coronary Artery Disease (CAD) in men is often described as...
Pressure/Squeezing in chest and may extend to arms | Worsens with physical activity and resolves with rest.
39
Coronary Artery Disease (CAD) in women is often described as...
Sharp/Burning chest pain Pain in Jaw, Neck, Throat, Back, or Abdomen More likely than men to have resting symptoms or during sleep
40
Are men or women more like to experience Coronary Artery Disease Symptoms during rest/sleep?
Women Men is increased with Physical activity and alleviated with rest.
41
What is the most common symptom associated with Coronary Artery Disease?
Angina
42
Mechanism of cardiac pain referral follows the _________ rule
Dermatomal Rule
43
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...
the CNS may "misinterpret" origin of sensory information as coming from non-cardiac regions and organs
44
In men, what is the Referral pattern for Angina?
Pain in the upper left segment of the chest Left Neck Left Upper Back Medial Aspect of Left Arm
45
Chronic/stable angina is predictable at certain level of ...
Exertion or stress
46
Unstable angina is ______ or a change in stable symptoms
Unexpected
47
What triggers Chronic/Stable angina?
Emotional or extreme physical stress
48
What triggers Unstable angina?
Happens at rest; accelerating during sleep
49
What is true about the duration of chronic/stable angina?
It is short lived; relieved at rest
50
What is true about the duration of Unstable angina?
Can last Longer than 30 minutes.
51
These types of angina are less common, and result from spams of dysfunction in coronary artery or walls of blood vessels.
Variant (Vasospastic Angina) Microvascular (Syndrome X)
52
What are the triggers for Vasospastic Angina (Variant) and Microvascular Angina (Syndrome X)
No clear triggers
53
This chart is useful in quantifying Anginal/ischemic thresholds
Rate-Pressure Product (RPP)
54
What are the Associated symptoms with Coronary Artery Disease?
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
CAD Differential Diagnosis List
1. Retrosternal 2. Intrascapular 3. Right Lower Anterior Chest 4. Left Lower Anterior Chest 5. Epigastric 6. Arm 7. Shoulder
56
TIM VADETUCONE Differential Diagnosis List
``` 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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