coronary artery disease (overview) Flashcards

1
Q

when does myocardial ischaemia occur

A

when there is an imbalance between the supply of oxygen and the myocardial demand

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2
Q

why can coronary blood flow be reduced

A
  • atheroma
  • thrombosis
  • spasm
  • embolus
  • coronary ostial stenosis
  • coronary arteritis
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3
Q

what can cause a decrease in flow of oxygenated blood to the myocardium

A
  • anaemia
  • carboxyhaemoglobulinaemia
  • hypotension
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4
Q

what can an increased demand for oxygen cause

A
  • increased cardiac output (thyrotoxicosis)

- myocardial hypertrophy

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5
Q

what is most common cause of coronary artery disease

A

myocardial ischaemia

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6
Q

what is coronary atherosclerosis characterised by

A

accumulation of lipid, macrophages and smooth muscle cells in intimal plaques

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7
Q

what plays a critical role in maintaining vascular integrity and homeostasis

A

vascular endothelium

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8
Q

what happens to an accumulation of oxidised lipoproteins

A

taken up by macrophages at focal sites within the endothelium to produce lipid-laden foam cells

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9
Q

what do the foam cells look like macroscopically

A

flat, yellow dots or lines on the endothelium of the artery

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10
Q

what are foam cells known as

A

fatty streaks

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11
Q

what promotes further accumulation of macrophages

A

release of cytokines, such as platelet-derived growth factor and transforming growth factor beta by monocytes, macrophages

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12
Q

what does the smooth muscle produce in larger quantities due to plaques

A

collagen

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13
Q

what are 2 mechanisms of thrombosis

A
  • superficial endothelial injury

- deep endothelial fissuring

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14
Q

what does superficial injury involve

A

a strip of the endothelial covering over the plaque

sub-endocardial connective tissue matrix is then exposed and platelet adhesion occurs because of collagen reaction

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15
Q

what does deep endothelial injury fissuring involve

A

an advanced plaque with a lipid core

the plaque cap tears (ulcerates, ruptures) allowing blood from the lumen to enter inside the plaque

the core surfaces and tissue factors from macrophages along with exposed collagen - highly thrombogenic

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16
Q

where does thrombus form in deep endothelial injury

A

within the plaque, expanding its volume and distorting its shape

17
Q

what do the thrombus cause

A

50% reduction in luminal diameter

18
Q

what does an increase in myocardial oxygen demand cause in the narrowed lumen

A

ischaemia

19
Q

what does coronary artery disease include

A
  • stable angina
  • unstable angina
  • myocardial infarction
20
Q

risk factors

A
  • age
  • gender (male)
  • race
  • family history
  • serum cholesterol
  • smoking
  • diabets
  • hypertension
  • gout
  • lack of exercise
21
Q

what lifestyle modifications should be made

A
  • reduce fat intake
  • replace saturated fats with monounsaturated and polyunsatured fats
  • reduce sugar intake
  • more vegetables and fish
  • increase exercise
  • reduce alcohol
  • stop smoking
22
Q

what drug is recommended for primary prevention

A

atorvastatin