Lecture 6- CAD Flashcards
widow maker
left anterior descending artery
what does the heart muscle rely on meet energy needs?
fatty acids and aerobic metabolism
where does the heart extract O2 from?
60-80% from coronary blood flow
25-30% from skeletal muscle
major determinant of coronary blood flow
metabolic activity
anti-thombogenic in coronary vessels
inhibit platelet aggregation
inhibit clot formation
via the release of NO (vasodilator)
facts that affect myocardial O2 balance
heart rate
contractility
wall tension - preload, afterload
when does myocardial ischemia occur?
when the hearts demands for O2 exceeds its supply from the coronary circulation
why does pain occur during heart disease?
secondary to the stimulation of the nerve ending due to abnormal stretching, build up of lactic acid, CO2 in ischemic tissue
2 types of atherosclerotic lesions
fixed or stable
unstable
chronic ischemic heart disease leads to
stable angina
variant angina
silent myocardial ischemia
acute coronary syndrome leads to
unstable angina
myocardial infarction
stable angina
pain is relatively constant and predictable
variant angina
cause in coronary spasm
occurs at rest with minimal exercise
associated with REM sleep
ST elevation or depression
silent myocardial ischemia
no anginal pain
common in diabetic patient
non pharmacological treatment
stop smoking
avoid stress/anxiety
sit or stand in order to reduce preload
pharmacological treatment
vasodilators
beta blocker
calcium channel blocker
aspirin
what is ACS
acute coronary syndrome is an umbrella term
includes unstable angina and MI
occurs when one or more coronary arteries are occluded
NSTEMI
no ST elevation
troponin elevated
STEMI
ST elevation
unstable angina and NSTEMI
associated with non-occlusive thrombus
pain is severe and prolonged
rest at minimum exertion lasting longer than 20 min
3 phases of UA and NSTEMI
1 a plaque ruptures or thrombus formation
2 acute ischemic event
3 long term risk of recurrent events
