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Cardiovascular Physiology > Coronary Circulation > Flashcards

Coronary Circulation Flashcards

1
Q

What is ischemic preconditioning?

A

Demonstrates that single or multiple brief periods of ischemia can be protective against a subsequent prolonged ischemic insult.

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2
Q

Which angina is associated with vasospasm and is a supple ischemia.?

A

Printzmetal’s Variant Angina

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3
Q

Which ion pump/channels plays an important role in preconditioning?

A

K+ATP channel

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4
Q

Which coronary artery is associated with the anterolateral region of the heart?

A

Circumflex

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5
Q

How do you measure this pressure gradient?

A

DBP-LVEDP

or Driving force minus the force that must be overcome.

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6
Q

Three types of angina?

A

Printzmetals Variant Angina.
Chronic Stable Angina.
Unstable Angina.

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7
Q

MVO2 of cardiac muscle at rest vs heavy exercise?

A

At rest=8ml/100g/min

Heavy exercise=70ml/100g/min

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8
Q

Comparing skeletal and cardiac muscle; which has small diameter fibers, which has more capillaries per mm3?

A

Cardiac muscle is more dense with fibers so the fibers are smaller. Since the capillaries run in between the fibers, there are significantly more capillaries in cardiac muscle.

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9
Q

What does damage to endothelial cells eventually produce?

A

Vasoconstriction.
Vasospasm.
Thrombosis.

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10
Q

What does acetylcholine do to coronary vessels?

A

Healthy vessels=vasodilation.

Atherosclerosed vessels=vasoconstriction.

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11
Q

How is terminology different for arteries and veins of the heart?

A

“Cardiac” used for veins.

“Coronary” used for arteries.

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12
Q

What are the two substances related to neural control that are sympathetic?

A

Norepinephrine and epinephrine

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13
Q

What substance is related to neural control and is parasympathetic?

A

Acetylcholine.

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14
Q

What is the formula for coronary perfusion pressure?

A

Coronary perfusion pressure= DBP-LVEDP

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15
Q

In the presence of ischemia, what does excess Ca++ do?

A

The overload of Ca++ will not allow for good relaxation in between systole.

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16
Q

What will a patient with higher percentage of stenosis require to maintain flow?

A

Higher Coronary perfusion pressure and therefore a higher BP.

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17
Q

Which organ in the body extracts oxygen to the greatest extent?

A

The heart.

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18
Q

What is the name of the veins located inside the myocardium?

A

Thebesian veins

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19
Q

What happens when there is damage to endothelial cells?

A

Damage to endothelial cells will lead to decreased nitric oxide and prostacylin production, but an increaase in endothelin production.

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20
Q

What is perioperative medical therapy for CAD?

A 
Anesthetic preconditioning.
Beta blockers.
Statins.
Alpha 2 agonist
Calcium Channel blockers.
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21
Q

4 Factors that increase MVO2?

A
    1. Increased HR*
      1. Increased Inotropy.
      2. Increased Afterload.
      3. Increased preload.
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22
Q

What do 37% of people have in the left coronary artery?

A

A trifurcation into the ramus intermedius.

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23
Q

In what percent of individuals does the (LCA) left coronay artery supply the (PDA) posterior descending artery?

A

LCA dominance is only 15% of individuals.

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24
Q

Which vessels of the heart are responsible for most of the Coronary Vascular Resistance (CVR)?

A

Intramyocardial vessels (arterioles).

25
Q

What must be present in order for there to be flow through coronary arteries?

A

A pressure gradient.

26
Q

What coronary artery is associated with the posterior region of the heart?

A

Right Coronary Artery

27
Q

How long should a patient wait before doing elective surgery after PCI with bare-metal stents?

A

90 days

28
Q

What action does the normal myocardium do upon systole?

A

Thickens and shortens.

29
Q

Which angina is associated with a thrombus and is a supply angina?

A

Unstable angina

30
Q

What percent of individuals does the right coronary artery (RCA) supply blood to the posterior descending artery (PDA)?

A

RCA dominance is in 85% of individuals

31
Q

How long should a patient wait before doing elective surgery after PCI with drug-eluding stents?

A

1 year

32
Q

What is the normal PO2 value of the coronary sinus?

A

20-22mmHg

33
Q

How is diastolic heart failure evidence by without echocardiogram?

A

LVEDP elevation

34
Q

What other factor is involved in coronary blood flow?

A

Neural control.

35
Q

In the absence of CAD, maximal flow is how much greater than at rest flow?

A

4-5 times greater.

36
Q

What coronary artery is associated with the anteroseptal region of the heart?

A

Left Anterior Descending

37
Q

Define extravascular compression:

A

During systole, the flow through the coronary arteries (predominantly left) drops significantly due to the ventricular myocytes pushing and collapsing the arterial supple vessels.
Extravascular compression is why flow through the coronaries is typically much greater during diastole.

38
Q

What is really the only way to increase O2 delivery to the cardiac muscle?

A

Increase blood flow to it.

39
Q

How does the heart make up for differences in extravascular compressive forces?

A

The subendocardium receives greater flow by a ratio of 1.25:1.00

40
Q

Coronary blood flow is controlled predominantly by what three factors?

A
  1. Metabolic factors.
  2. Autoregulatory factors.
  3. Endothelial factors.
41
Q

Do extravascular compressive forces effect the RV or LV more?

A

LV

42
Q

What coronary artery is associated with the inferior region of the heart?

A

Right Coronary

43
Q

Which patients do we normally see microvascular disease?

A

Diabetics

44
Q

What is considered the Gold Standard tx for MI?

A

CABG

45
Q

What is autoregulation?

A

The ability for a vascular network to maintain constant blood flow even thought the arterial pressure changes.

46
Q

Why is RV less susceptible to extravascular compressive forces?

A

Lower pressure generated by thin right ventricle during systole.

47
Q

What percent of total cardiac output (CO) goes to normal coronary blood flow?

A

About 5% of blood flow.

48
Q

Basic treatment of patient with coronary artery disease (CAD) revolves around two main things:

A

Avoid tachycardia and prolong diastolic phase to better perfuse coronary arteries

49
Q

Which medication is important to be taken or administered before or during anesthesia for CAD patients?

A

Beta blockers

50
Q

What coronary artery is associated with the anteroapical region of the heart?

A

Left Anterior Descending (Distal).

51
Q

Which layer of the heart is most susceptible to ischemia?

A

endocardium.

52
Q

During systole, what happens to coronary blood flow?

A

Cardiac muscle compression significantly decreases coronary blood flow during systole.

53
Q

Alpha/Beta: Which constricts and which dilates coronary vessels?

A

Alpha constricts coronary vessels and Beta dilates coronary vessels.

54
Q

In which layer of the heart are extravascular compressive forces greater , subendocardium (inner) or subepicardiacl (outer)?

A

Subendocardium.

55
Q

What is coronary flow reserve and how is it measured?

A

Difference between baseline blood flow and maximal blood flow.
Usually measured pharmacologically.

56
Q

What is the resting O2 consumption of the cardiac muscle?

A

9.7ml/100g/min

57
Q

The left coronary artery bifurcates into what vessels?

A

Left Anterior Descending (LAD) and Left Circumflex (obtuse marginales).

58
Q

Which angina is associated with a fixed stenosis and is a demand ischemia?

A

Chronic Stable angina.

Cardiovascular Physiology (7 decks)

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