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coronary circ pt 1
patho exam 2
| Question | Answer |
|---|---|
| Why is coronary circulation important? | because the heart is the first organ supplied |
| coronary artery disease | reduced supply of oxygen and nutrients |
| coronary heart disease (CHD) | atherosclerosis, angina pectoris, acute coronary syndrome, silent myocardial ischemia, myocardial infarction |
| cardiovascular disease | pathologic process causing disease of heart, and coronary and systemic circulation |
| examples of cardiovascular disease | stroke, transient ischemic attack (TIA), claudication, limb ischemia |
| ischemia | temporary deficiency of blood flow to tissue, myocardial ischemia |
| myocardial infarction (MI) | necrosis in myocardium due to obstructed blood flow |
| In coronary circulation disorders alteration in what are possible? | cognition, comfort, fluids and electrolytes, and oxygenation |
| common symptoms of impaired tissue perfusion | pain |
| In coronary circulation disorders auto regulation is possible where? | in the brain |
| What can inadequate fluid resuscitation lead to? | multiple organ failure and death |
| What is essential for gas exchange to occur? | ventilation, diffusion, and perfusion |
| Coronary artery disease epidemiology | more than one in three adults in United States have one or more types of CVDs |
| Coronary Artery Disease risk factors | modifiable, non modifiable (age, race, family history), inflammation, other medical conditions |
| what medical condition can lead to coronary artery disease | cancer, chemo can induce cardiotoxicity |
| When is most blood flow to myocardium delivered? | during ventricular diastole |
| What is coronary collateral circulation triggered by? | insufficient blood supply |
| Pathophysiology of CAD, endothelial cells | thrombus |
| Pathophysiology of CAD, smooth muscle cells | vasospasm |
| Pathophysiology of CAD, blood vessel wall | atherosclerosis (aneurysm, carotid artery disease, peripheral artery disease) |
| What is atherosclerosis induced by? | dysplipidemia- increased LDL, triglycerides, FFAs |
| What does increased LDLs activate? | macrophages |
| What happens on thrombus if patient takes aspirin? | no platelets accumulate |
| What does a narrowing of the artery cause? | increase in blood pressure (hypertension) |
| What does the foam cell do? | activates arachidonic acid cascade, cytokines come to this area |
| foam cell | macrophage that engulfs too many lipids |
| Diagnosis of CAD | presence of dysrhythmia (arrhythmia), stress test, blood tests, echocardiography, nuclear stress test (SPECT), coronary angiogram (coronary angiography or arteriography) |
| stress test | increase heart rate and look for any abnormalities in EKG |
| arrythmia | cardiac cycle faster or slower than normal |
| blood tests for diagnosis of CAD | lipid panel, c-reactive protein (CRP), lipoprotein (a), homocysteine |
| lipid panel | LDL, HDL, total cholesterol and triglycerides |
| C-Reactive protein (CRP) | a marker of inflammation in the body, main marker saying there is inflammation |
| lipoprotein (a) | a type of cholesterol that can build up in the arteries |
| homocysteine | an amino acid that can damage blood vessels, seen with protein breakdown due to any damage to heart |
| detection of heart attack | cardiac troponin test I and T |
| echocardiography | transducer emits ultrasound waves that bounce off the heart and return as echoes to create images of the heart |
| coronary angiogram (coronary angiography or arteriography) | invasive test, can see if there is any occlusion, any narrowing down in coronary vasculature |
| Treatment of CAD | lifestyle changes, hypertension management, lipid-lowering therapy, anxiety management |
| lipid-lowering therapy | statins |
| anxiety management | counseling, support |
| What does an increase in troponin indicate? | damage to the heart |
| Myocardial Ischemia and Infarction- cell and tissue features | atherosclerosis, disruption of coronary blood flow, reduced contractility of ischemic myocardial fibers, disruption in cardiac conduction system, ischemic cascade |
| Myocardial Ischemia and Infarction- atherosclerosis | narrowed coronary arteries, decreased blood flow, fracture in fibrous cap, superficial erosion of intima |
| What is the first step of coronary artery disease? | atherosclerosis |
| How does CAD start? | with accumulation of macrophages that breakdown lipids, when there are too many lipids macrophages phagocytize and lipids accumulate on walls, platelets accumulate on top and form thrombus |
| When the heart puts more pressure on the blood to overcome increased blood pressure what does it cause? | fracture in fibrous cap |
| What does a fracture in fibrous cap cause? | embolus |
| A fracture in fibrous cap induces what? | superficial erosion of intima, exposing the tunica media |
| Myocardial Ischemia and Infarction- disruption of coronary blood flow | imbalance among oxygen supply, demand, and consumption |
| When is coronary artery occlusion reversible? | If you restart blood flow within 20 minutes |
| How long can the myocardium live without O2? | 20 minutes |
| What happens to the myocardium when it has been without O2 for more than 20 minutes? | cardiac muscle starts to die due to necrosis and reaches point of no return, myocardium can't regenerate |
| What does the myocardium get replaced with once the muscle starts to die? | CT (fibrous tissue) called replacement tissue |
| What is the biggest problem with the myocardium being replaced with CT? | does not contract, heart is dysfunctional |
| Ischemic cascade | occlusion initiates steps, electrolyte balance, anaerobic metabolism, systolic and diastolic dysfunction, ECG abnormalities |
| Stable Angina | chronic form of ischemic heart disease (IHD) |
| When does stable angina occur? | with increased myocardial oxygen demand and reduced blood flow during exertion or emotional stress |
| Stable angina clinical manifestations | related to exertion, resolve with rest or short-acting nitroglycerin |
| nitroglycerin | very strong vasodilator, makes pain go away |
| What does it mean if the pain does not go away after administering nitroglycerin? | it is not stable angina |
| Stable angina diagnosis | resting ECG, stress test, CT angiography |
| Stable angina treatment | risk factor modification, anti-platelet medication, antihypertensives |
| What is silent ischemia thought to be related to? | defective anginal warning system |
| Silent ischemia clinical manifestations | Chest pain (not always present), ST-segment changes |
| Silent ischemia | similar to stable angina, usually develops without seeing symptoms |
| Silent ischemia diagnosis | ambulatory ECG, SPECT |
| SPECT | imaging test that will tell you which areas of the heart are not working properly, shows blood flow to the heart |
| Silent ischemia treatment | same medical therapies as for symptomatic ischemia, coronary angiography and revascularization |
| Coronary microvascular disease | damage to walls and of small coronary arteries |
| Cause of microvascular disease | not clearly understood |
| coronary microvascular disease clinical manifestations | angina in absence of myocardial ischemia |
| coronary microvascular disease diagnosis | transthoracic doppler echocardiography, SPECT scan, CMR myocardial perfusion imaging |
Created by:
camrynfoster