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pathophysiology 3801 > coronary heart disease > Flashcards

coronary heart disease Flashcards

1
Q

this disease is caused by plaque buildup in the wall of the arteries that supply blood to the heart (called the coronary arteries).

A

coronary heart disease

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2
Q

a chronic complication of an acute disease

A

sequelae

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3
Q

what are common sequelae of coronary heart disease

A

-angina pectoris
-myocardial infarction (heart attack)
-dysrhythmias
-heart failure
-sudden cardiac death

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4
Q

alternate or “backup” blood vessels in your body that can take over when another artery or vein becomes damaged

A

collateral circulation

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5
Q

what are some common causes (etilogy) of coronary heart disease?

A

-known risk factors
-atherosclerosis with narrowing of the arterial lumen (thrombus formation)
-coronary vasospasm (temporary constriction of vessel bringing blood to heart)
-endothelial cell dysfunction
-left ventricular hypertrophy

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6
Q

what are some uncommon causes (etiology) of coronary heart disease

A

-emboli (a blood clot that moves through vessels until it reaches a vessel that its too small to travel through)
-respiratory failure
-anemia
-hypovalemia

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7
Q

what are some congenital causes (etiology) of coronary heart disease?

A

-LADCA (left arteriole descending coronary arteries) originating from the pulmonary artery

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8
Q

what lipoproteins are associated with a greater risk of atherosclerosis

A

LDL and VLDL

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9
Q

this lipoprotein transports cholesterol from peripheral tissue back to the liver, clearing any plaques

A

HDL

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10
Q

what is the desirable level of cholesterol?

A

<200mg/dl

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11
Q

at what level of cholesterol does an individual become at risk?

A

> 240mg/dl

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12
Q

what level of HDL cholesterol is low to desirable

A

<40mg/dl

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13
Q

what level of LDL cholesterol is desirable

A

<130mg/dl

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14
Q

which type of artery is atherosclerosis most likely to occur?

A

epicardial arteries

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15
Q

true/false: epicardial arteries are involved in microcirculation

A

false - involved in macrocirculation

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16
Q

what is the main stimulus for vasomotion in epicardial arteries?

A

flow

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17
Q

what is the main function of the epicardial arteries?

A

transport

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18
Q

do epicardial arteries have a relatively low or high resistance to blood flow

A

low

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19
Q

what is the main stimulus for vasomotion in small arteries?

A

pressure

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20
Q

what is the main function of small arteries?

A

regulation

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21
Q

do small arteries have a relatively low or high resistance to blood flow/

A

higher than epicardial arteries but lower than arterioles

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22
Q

what is the main stimulus for vasomotion in arterioles?

A

metabolites

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23
Q

what is the main function of arterioles

A

regulation

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24
Q

do arterioles have a relatively low or high resistance to blood flow?

A

high

25
Q

what is the main function of capillaries

A

exchange

26
Q

do capillaries have a relatively low or high resistance to blood flow

A

low

27
Q

risk factors, such as high LDL, hypertension, DM, and cigarette smoking, disrupt normal functions (e.g. local control of vascular tone, maintenance of antithrombin surface and control of inflammatory cell adhesion and diapedesis) of the vascular epithelium which causes _________

A

coronary atherosclerosis

28
Q

what do functional changes of the vascular endothelium cause?

A

a buildup of fat, smooth muscle cells, fibroblasts and intracellular matrix that make the atherosclerosis plaque.

29
Q

what does the loss of vascular endothelial defences cause?

A

-inappropriate constriction
-luminal thrombus formation
-abnormal interactions between blood cells and the activated vascular endothelium.

30
Q

Why does the velocity of blood flow decrease greatly in the capillaries and then increase in the veins?

A

blood flow is slowest in the capillaries to allow for exchange of nutrients.

31
Q

coronary _____ can be altered by:
-large, stable atherosclerotic plaque
-acute platelet aggregation and thrombosis
-vasospasm
-failure of auto regulation of the microcirculation by endothelial cell damage
-poor perfusion pressure (hypovalemia)

A

perfusion

32
Q

in coronary heart disease, is oxygen supply or demand increased?

A

demand

33
Q

what are clinical presentations of coronary heart disease?

A
  • angina pectoris
    -chest pain
    -sob
    -diaphoresis (sweating)
    -nausea and vomiting
  • physical exam
    -4th heart sound
    -congestive heart failure
    -shock
34
Q

chest pain is asymptomatic in 70-80% of people. when chest pain is present, what is it mediated by?

A

sympathetic afferent nerves

35
Q

________ may induce chest pain in at least two ways, either by direct stimulation of sensory afferents before actual ischemia occurs or secondary to ischemia.

A

adenosine

36
Q

this is an adenosine receptor blocker, therefore can be used to treat chest pain associated with coronary heart failure

A

aminophylline

37
Q

what is the pain pattern associated with coronary heart failure explained by?

A

convergence

38
Q

it is possible that plaques may rupture or become eroded. what are some characteristics of vulnerable plaques?

A

-large lipid core with thin cap
-fissured or ruptured cap
-active inflammation within the plaque
-epithelial denudation with platelet adherence

39
Q

this type of plaque has a thin fibrous cap, collagen-poor fibrous cap, large lipid core, many macrophages and fibrin-rich thrombus

A

ruptured plaque

40
Q

this type of plaque is protcoglycan and glycosaminoglycan rich, little or no lipid core, neutrophils and NETs, many smooth muscle cells and platelet rich thrombus

A

eroded plaque

41
Q

true/false: in acute coronary syndrome, chest pain is usually more severe and lasts longer than typical angina

A

true

42
Q

during plaque erosion or rupture, the occlusion/blockage is only partial

A

unstable angina (still have blood flow to keep myocardia alive)

43
Q

during plaque erosion or rupture, the occlusion/blockage is complete

A

MI

44
Q

in acute coronary syndrome, if the ___________________ are affected you will get severe cardiac failure – hypotension —- shock

A

left main coronary and left anterior descending arteries

45
Q

in acute coronary syndrome, if the ____________________ are affected you will see pericardial effusion —– tamponade (heart cannot contract thus, fluid in pericardial space) and mitral valve damage

A

circumflex coronary and left anterior descending arteries

46
Q

in acute coronary syndrome, if the ________ is affected you will see AV node affected —- bradycardia

A

posterior ventricular artery

47
Q

in acute coronary syndrome, if the _________ is affected (which it rarely is) you will see irrigation by the right and left sinuses

A

sinus node

48
Q

what are the immediate effects of acute coronary syndrome?

A

MI leads to a drop in cardiac output triggering activation of the sympathetic system - therefore an increase in HR, BP and contractility

49
Q

when an MI occurs and there is a decrease in stroke volume, what are the two ways we can get immediate time increase in stroke volume

A
  • baroreceptor activation and therefore activation of sympathetic NS
  • decrease in renin perfusion and RAAS activation
50
Q

what enzymes are increased when cells are totally ischemic

A

CK-MB, lactate dehydrogenase (LDH) and troponin

51
Q

is there ST changes on ECG for partial or total ischemic cells

A

partial

52
Q

are dysrhythmias associated with partial or total ischemic cells?

A

partial

53
Q

if a patient presents with signs and symptoms of cardiac ischemia, has ST elevation, + biomarkers, what is their diagnosis?

A

ST elevation MI (STEMI) -treated with a stent

54
Q

if a patient presents with signs and symptoms of cardiac ischemia, has no ST elevation, - biomarkers, what is their diagnosis?

A

unstable angina

55
Q

if a patient presents with signs and symptoms of cardiac ischemia, has no ST elevation, + biomarkers, what is their diagnosis?

A

no ST elevation MI (NSTEMI) - treated with meds

56
Q

will LDH levels be increased to decreased during a myocardial infarction

A

increased

57
Q

troponin serum levels rise ____ hours after the occurrence of cardiac symptoms in patients with acute MI

A

3-4

58
Q

________ are usually the primary cause of sudden cardiac (e.g. v-fib)

A

ventricular arrhythmias

pathophysiology 3801 (8 decks)

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