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patho 2 cad

What % of all death in western society is related to CAD 33%
resting coronary blood flow is 225ml/min->8 ml of O2/100g of tissue/min
what % of CO is going to the heart's circulation 4-5%
T or F Exercise can increase coronary BF up to 4X True
What is the O2 requirement to maintain the life of a cell? 1.3ml of O2/100g of tissue/min
T or F coronary BF is controlled by the nervous system False, it's controlled by local metabolism
The most important factor in local BF regulation O2 demand
Effects of the sympathetic NS ^HR+strength of contraction+^vasoconstrict
Effects of the parasymp NS decrease HR decrease strength of contraction..no effect on vessels
Cardiac muscle uses ______ 70% of the time, but in emergencies ________ is used fatty acids, glycolysis
The most frequent cause of decreased coronary BF Atherosclerosis
Death due to CAD is caused by 2 things Acute coronary occlusion or cardiac fibrillation
3 biological processes in the creation of atherosclerosis -proliferation of intimal smooth musc. cells(macroph.+Tlymph)-form. lg amts of connective tissue(collagen & elastin)-accum. of lipids(mostly chol)-
3 independant risk factors for the dev. of atherosclerosis plasma cholesterolsmokinghigh BP
Response to injury theory injury in the endothelium triggers eventsby changing the funct. act of the endoth. comb. w/ ^ chole.,smooth musc prolif., and platelet activity lead to plaque
monoclonal theory Each of the lesions is a benign neoplasm, resulting from a cell affected by a virus, chem, or mutation
Coronary insufficiency When the blood supply is lower than what is requiredfor normal cardiac metab.
Hypoxia decreased O2 supply to tissue despite adequate perfusion
Anoxia no O2 supply despit adequate perfusion
ischemia decreased O2 supply +insuff. removal of wastes as a result of decreased perf.
Angina Pectoris pain due to ischemia, begins when the load on the heart is too great in relation to coronary BF
Where is Angina felt and how does it feel beneath the upper sternum ext to L arm and shoulder, neck, side of face, opp arm, and shoulder. hot pressing, constricting
T or F there is myocardial necrosis in angina that's a BIG FAT NO!!!
Chronic or stable angina begins gradually reaching top intensity over a couple of minutes before dissipating,after sesation of the activity that caused it
Events that cause an episode of chronic or stable angina events causing an inc. in O2 demand-phys. activity, emotions, eating, tachy, fever, chills, etc..
Chronic/stable angina has ____O2 demand and ___O2 supply increased, fixed
Findings w/ chronic/stable angina HTN, non specific ST and T changes; LBBB
T wave inversion is usually indicative of ischemia
ST segment elevation is usually indicative of injury
Diagnosis of stable/chronic angina Exercise EKG, thallium stress test, myocardial perf imaging,exer. radionucleotide angiography, CXR, enzymes norm, ^chol., echo, cath
Definative diagnosis for chronic/stable angina coronary arteriography+LV Arteriography
How does myocardial perfusion imaging work? radionucleotide is injected at peak exercise and image obtained min.later with pt. at rest->pattern of perfusionduring exercise. defect areas are areas of stress induced ischemia or infarct.still shows defect in 2-3h=MI
Management of chronic/stable angina lifestyle changes, drugs, revascularization
methods of revascularization PTCA, CABG,laser angioplasty, athrectomy
Acute/unstable angina happens @___ rest
Acute angina has ____O2 demand and ____O2 supply fixed, decreased
T or F bed rest an nitro can eliminate the pain of acute angina completely or permanently False
Findings of acute angina on EKG transient deviations of ST segment and/or inv. T wave
Findings in acute angina in the cath lab show collat circ. less dev. than chronic and higher % of more than one vessel disease. inc incidence coronary thrombi.
Pt's w/ acute angina have a faster prog. of atheros due to inc. platelet aggreg., and thrombosis+coronary spasms
Diagnosis of acute angina exer. ekg, echo, thallium 201 test, cath and angiography
management of acute angina hospitilization,(tx fever, anemia, infections, arrythm, thyrotoxicosis), drugs(nitrates b-block anti coag, anti plate), thrombolytics, IABP, CABG, PTCA
If the whole thickness of the myocardial wall is infarcted what type of MI? Transmural
If the MI only involves the subendocardium, the intramural myocardium or both w/o extending to the epicardium what type of MI sub-endocardial
Acute coronary thrombosis is most common w/ what type of MI Transmural
When is a CABG contraindicated? pt's with uncomplicated transmural infarcts more than 6 hours after onset.
When is a CABG indicated? when PTCA was not successful, multi vessel CAD even in absence of an AMI. Should be w/in 4-6h, best in first 2h
Prinzmetal's angina occurs at rest, elev. of ST seg.,result of coronary artery spasm,
Diagnosis of Prinzmetal's angina dev. ST elevation w/pain, Ergonovine test(will cause chest pain & ST^
Treatment of Prinzmetal's angina nitrates and Ca antagonists
Created by: jenbirne69