Ischemic Heart Disease I Flashcards
Atherosclerosis has a _______ asymptomatic period.
long
List the stages of coronary artery occlusion.
(1) normal; (2) fatty streak; (3) fibrous plaque; (4) occlusive plaque; and (5) rupture plaque
Smoking increases risk of coronary artery disease by _________.
50%
Describe the mechanisms by which hypertension leads to coronary artery disease.
It (1) increases shearing stress; (2) increases tension on vessel walls; (3) circulating hypertension hormones have negative effects on endothelial walls; and (4) causes hypertrophic cardiomyopathy.
What is the dyslipidemic triad?
High LDL, low HDL, and high triglycerides
Why is LDL deleterious?
When oxidized, it becomes pro-inflammatory and atherogenic
Why is HDL beneficial?
It prevents the oxidation of LDL and has anti-inflammatory and anti-thrombotic effects.
Lipid-laden macrophages are __________.
pro-inflammatory
Inflammation, cholesterol, HDL, and LDL are ____________.
independent predictors of CAD risk
What is stable angina?
A form of CAD in which the coronary arteries are only partially occluded, leading to angina upon exertion.
What are some metabolic differences between skeletal muscle and cardiac muscle?
Even at rest, a near-maximal amount of oxygen is extracted from the coronary arteries; thus, in response to increased demand, the heart has to increase flow of blood.
The drop in pressure across an occlusion is dependent on ______________.
the length of the plaque and the diameter of the occlusion
What is autoregulation?
The coronary arteries automatically dilate and constrict in response to changes in pressure such that flow stays constant.
What factors increase myocardial oxygen demand?
Heart rate, contractility, and wall tension
Myocardial infarction is distinguished from unstable angina by ___________ at rest.
severe, unremitting angina at rest
Deaths due to coronary heart disease have been decreasing since 1968 owing to better ___________.
anti-hypertensive medications and statins
What are three factors that have been shown to increase risk of ischemic heart disease?
Smoking, hypertension, and dyslipidemia
Even at rest, the myocardium extracts _______________.
a near-maximum amount of oxygen from the coronary arteries, so to increase oxygen the heart must increase flow
Autoregulation is controlled at the level of the ____________.
small arterioles
What are four pathophysiologies and treatment strategies for chronic stable angina due to decreased oxygen supply?
(1) for decreased perfusion pressure, treat the hypotension; (2) for decreased diastolic time, give ß-blockers; (3) for increased coronary resistance, give vasodilators; (4) for decreased oxygen content, treat the anemia or hypoxemia.
What are four pathophysiologies and treatment strategies for chronic stable angina due to increased oxygen demand?
(1) for increased systolic pressure, treat the hypertension; (2) for increased heart rate, give rate-controlling agents; (3) for increased wall tension, give agents to reduce ventricle dilation; (4) for increased inotropic states, give agents that inhibit contractility.
In terms of vessel occlusion, untable angina is defined as ___________.
near-complete occlusion of the vessel
Troponin is usually _________ is unstable angina.
normal
Nearly 100% of cells in the affected area will be dead at ______ minutes.
4.5
