Unit 2 Day 1 (Tuesday 4/7) Flashcards

1
Q

Coronary Atherosclerosis Risk Factors

A

-risk factors: smoking, hypertension, dyslipidemia, diabetes, obesity, inflammation, stress, sedentary lifestyle, male gender, age, high LDL, low HDL

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2
Q

Autoregulation

A
  • an adaptive mechanism to maintain perfusion in face of altered perfusion pressure
  • an epicardial coronary stenosis may cause autoregulation to be exhausted and lead to ischemia
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3
Q

Treatment for Stable Coronary Heart Disease: Inc O2 Supply

A
  • perfusion pressure: prevent hypotension
  • diastolic time: rate-slowing drugs (e.g. beta blockers)
  • coronary resistance: vasodilator drugs (e.g., nitrates, calcium channel blockers); coronary angioplasty or bypass surgery
  • oxygen content: treat anemia and hypoxemia
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4
Q

Treatment of Unstable Coronary Disease: Reducing O2 Demand

A
  • systolic pressure: Antihypertensive drugs
  • heart rate: Rate-slowing drugs (beta blockers, calcium channel blockers)
  • wall tension: Limit LV cavity size by limiting excessive preload (diuretics, nitrates)
  • inotropic state: negative inotropes (beta blockers and Ca channel blockers)
  • revascularization: coronary angioplasty, coronary artery bypass surgery
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5
Q

Pathophys of Unstable Coronary Artery Disease

A
  • Inflammation in arterial wall
  • Weakening of fibromuscular cap
  • Abrupt plaque fissure or rupture
  • Thrombogenic components (lipids, tissue factor) exposed to blood
  • Thrombosis with partial or complete vessel occlusion
  • Myocardial injury and/or necrosis (serum markers)
  • Cardiac dysfunction, risk of arrhythmias, death
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6
Q

Dx of CAD with ECG

A

• Resting ECG:
– ST segment changes (usually depression) – T wave inversion
– Q-waves (indicate prior infarction)
• Exercise ECG (stress testing): – dynamic ST segment changes

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7
Q

Angiography

A
  • diagnostic tool
  • underestimates pathologic extent of CAD
  • underestimates severity of CAD
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8
Q

Angioplasty

A
  • reduces risk of recurrent ischemic events in unstable angina
  • balloon dilation to expand vessel wall
  • sometimes vessel restenoses
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9
Q

Tx for MI with ST Elevation

A
  • Immediate aspirin, nitroglycerin, ± beta blocker

* Reperfusion therapy ASAP: Usually coronary angioplasty, if unavailable thrombolytic therapy

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10
Q

Coronary Bypass Grafting

A

-using other arteries to reperfuse heart
– Internal mammary artery
– Saphenous vein
– Prosthetic materials have not proven successful as coronary grafts

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