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Spring 2020 - Physiology 1 > Coronary Circulation - Quiz 9 > Flashcards

Coronary Circulation - Quiz 9 Flashcards

1
Q

What are the Major Coronary Arteries?

A

Right Coronary Artery (RCA) - 85%

Left Main Coronary Artery (LM)

Left Anterior Descending (LAD)

Circumflex Artery (CX)

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2
Q

What is the Ramus Intermedius?

A

Additional Branch in people who have Trifurcation of the Left Main

37%

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3
Q

Do the Epicardial Arteries contribute significantly to Coronary Vascular Resistance?

A

No - Intramyocardial Vessels (Arterioles) contribute the most to resistance

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4
Q

What is Capillary Density and is it increased or decreased in the Myocardium?

A

Number of capillaries per unit cross sectional area.

Capillary Density is increased in the Heart

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5
Q

What are the major determinants of Myocardial Oxygen Demand

A

Metabolic Activity - HR, Contractility, Systolic Wall Tension

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6
Q

What are the major determinants of Myocardial Oxygen Supply?

A

Coronary Blood FLow

O2- Carrying Capacity

Vascular Resistance

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7
Q

Is O2 Consumption of the Heart at rest higher or lower than other organs?

A

Higher

Heart > Kidneys > Brain > Liver

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8
Q

Coronary Perfusion Pressure Formula?

A

CPP = DBP - LVEDP (or PCWP)

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9
Q

Is Oxygen highly extracted from blood flowing through the heart?

A

Yes, more than any other organ

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10
Q

What factors control Coronary Blood Flow?

A

Metabolic Control

Autoregulation

Endothelial Control of Tone

Extravascular Compression

Neural Control

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11
Q

Which stage of the heart cycle does the majority of coronary blood flow occur in the left ventricle?

A

Most blood flow during Distole b/c the muscles relax & no longer obstructs blood flow

During Systole, there’s strong compression of vessels by LV muscle

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12
Q

Which Layer of the Myocardium is at the greatest risk for ischemia?

A

Endocardium

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13
Q

What is Coronary Flow Reserve?

A

The Max increase of blood flow through Coronary Arteries above normal resting volume

4-5x more than at rest

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14
Q

Does Pressure Work or Volume Work cause more Heart O2 Consumption?

A

Pressure Work is much more costly

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15
Q

A significant decrease in flow happens at what degree of coronary vessel stenosis?

A

Critical Stenosis

60-75% Reduction

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16
Q

What is the final Intracellular Ion Disturbance that leads to impaired heart contraction & cell death?

A

Intracellular Calcium Overload

17
Q

How does Myocardial Ischemia affect Systolic Function?

A

Akinesis - No Movement

Dyskinesis - Systolic lengthening & Post-Systolic Shortening

18
Q

How does Myocardial Ischemia affect Diastolic Function?

A

↑LVEDP

Impaired Relaxation

↓Compliance

19
Q

What is Myocardia Stunning?

A

Prolonged Heart Dysfunction after episode of severe Ischemia with gradual return of activity

Stunning is Completely Reversible

20
Q

What is Myocardial Hibernation?

A

When heart function is depressed from chronic ishemia

Function can return to normal if blood blow is returned to normal in time

21
Q

What are some consequences of Myocardial Ischemia?

A
  • Systolic/Diastolic Dysfunction
  • Angina
  • CHF
  • Pulmonary Edema
  • MI
  • Ventricular Rupture/VSD
  • Cardiogenic Shock
  • Death
22
Q

What are some drugs used to treat cardiac ischemia?

A

Oxygen
B-Blockers
Calcium Channel Blockers
Nitrates
Antiplatelet/Anticoagulant
Analgesic

23
Q

What are some Interventions used to treat cardiac ischemia?

A
  • CABG
  • Percutaneous Coronary Intervention (PCI)
    • Balloon Angioplasty
    • Bare-Metal Stents
    • Drug-Eluting Stents
24
Q

How Logn should you wait before doing elective surgery for patients w/ Drug-Eluting Stents or Bare-Metal Stents?

A

Drug-Eluting: 1 Year

Bare-Metal: 90 days

25
Q

What are some Drugs used to reduce cardiac ischemic events during surgery?

A

Anesthetic Gas

B-Blockers

CC-Blockers

Statins

Alpha 2 Agonist

NTG

26
Q

Should Isoflurane be used for Cardiac Surgery?

A

Causes Coronary Steal

27
Q

What are Collateral Blood Vessels in the Heart?

A

New vessels that form in response to impaired coronary blood flow.

Form from pre-existing arterioles that branches b/t occluded & non-occluded arteries

28
Q

What is Ischemic Preconditioning in the Heart?

A

Brief periods of Ischemia can be protective against subsequent prolonged ischemic injury

Anesthetic Gas: Mimics IPC

K+ATP channels play important role

29
Q

What is the main way that the heart compensates for underperfusion?

A

Increase Coronary Blood Flow - cant extract much more Oxygen

30
Q

What is Cardiac Autoregulation?

A

Ability of vascular network to maintain constant blood flow

Tightly coupled to Demand and is location-dependent

31
Q

What serves as complimentary control of Coronary Blood Flow?

A

Neural Control

32
Q

What are the Direct effects of Neural Control of Coronary Blood Flow?

A

Sympathetic Stimulation - Release norepi & Epi

33
Q

What are the Indrect Effects of Neural Control of Coronary Blood Flow?

A

Increased metabolism activates local blood flow regulatory mechanisms to dilate vessels

34
Q

What is Parasympathetic control of Coronary Blood Flow?

A

Releases Acetylcholine

35
Q

Define Myocardial Oxygen Consumption

A

Volume of Oxygen consumed per minute

Spring 2020 - Physiology 1 (24 decks)

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