Coronary Artery Disease (CAD)

Question 1

Coronary artery disease

Answer 1

• mostly due to atherosclerosis
• cardiac disease due to impaired cardiac perfusion
• coronary arteries (supplying heart tissue with blood) narrowing & occlusion causes impaired coronary blood flow

Question 2

Angina =

Answer 2

chest pain

Question 3

Types

Answer 3

Chronic ischemic heart disease: 
-stable angina 
-microvascular angina (induced by exercise, angiogram shows normal)
-variant angina 
-silent myocardial ischemia (ischemia without pain "silent")
Acute Coronary Syndromes (ACS): 
-unstable angina 
-MI

Question 4

Ischemia

Answer 4

an inadequate blood supply to an organ or part of the body, especially the heart muscles

Question 5

Angina pectoris

Answer 5

• pain is not a disease it’s a manifestation–angina pectoris is a manifestation of CAD
• inadequate perfusion to meet cardiac metabolic demand

Question 6

Angina pectoris etiology

Answer 6

• mostly due to atherosclerosis
• also due to vasospasm (=acute constriction of blood vessel, stays constricted for awhile)
• thrombosis

Question 7

Patho of Angina pectoris

Answer 7

• coronary arteries need to dilate on demand–atherosclerosis prevents dilation because unable to dilate because already dilated fully or cannot dilate
• inadequate perfusion – Ischemia –chest pain

Question 8

Mnfts of angina pectoris

Answer 8

chest pain

Question 9

Stable angina

Answer 9

lesion is a fixed plaque within wall

Question 10

Stable angina is triggered by

Answer 10

• exertion (needs extra perfusion)
• cold (cold causes vasoconstriction, decrease size of lumen blood unable to move through causing ischemia and then angina
• stress (increase in HR, pumps more blood, unable to pump blood)

Question 11

stable angina ______ at rest and

Answer 11

doesn’t present with pain at rest, but an increase in activity causes ischemic pain

Question 12

stable angina is brief ____ chest pain

Answer 12

transient (not permanent)

Question 13

stable angina is relived by

Answer 13

rest

Question 14

variant angina also called

Answer 14

vasospastic or prinzmetals angina

Question 15

variant/vasospastic/prinzmetals angina

Answer 15

• due to spasm of coronary artery
• nocturnal, at rest
• ECG changes during episode

Question 16

variant/vasospastic/prinzmetals angina________ etiology

Answer 16

unclear etiology

• endothelial?
• Ca?
• Sympathetic nervous system?
• Nitric oxide?

Question 17

suspected etiology for variant/vasospastic/prinzmetals angina

Answer 17

endothelial: drugs that might impact endothelial may cause vasospasm of vessel

Ca+: calcium enters muscle cells in order to contract –inappropriate Ca+ — causing vasospasm

Sympathetic nervous system: parts become hyperactive–triggers vasospasm

nitric oxide: (various fx in body 2 are: triggers vasodilation + acts as mediator for vs fx) May cause inappropriate trigger of vasodilation cause spasm

Question 18

Unstable angina

Answer 18

• UNSTABLE PLAQUE
• thrombosis & agglutination of platelets
• if disrupted, will cause platelet aggregation (thrombosis)
• when platelets aggregate they degranulate
  - prostoglandin (local hormone) release causing vessel spasm
• platelets, plaque & prostaglandins restricting vessel (triple whammy)
• plaque collects platelets, fibrin, cellular debris
• the more angina experinced the greater the chance of having MI

Question 19

mnfts of angina in general

Answer 19

• transient, mild to moderate chest pain
• squeezing, burning (heartburn/indigestion)–
• usually radiates to left shoulder & upper arm

Question 20

treatment of angina in general

Answer 20

• cease activity (avoid trigger)
• nitro-glycerin (a vasodilator) causing systemic vasodilation
• prevention in order to decrease risk of MI

Question 21

Degranulation

Answer 21

is a cellular process that releases antimicrobial cytotoxic or other molecules from secretory vesicles called granules found inside some cells. It is used by several different cells involved in the immune system, including granulocytes (neutrophils, basophils, and eosinophils) and mast cells

Question 22

what is the pain like with unstable angina

Answer 22

severe, longer, at rest and nocturnal