Week 3, Coronary heart disease Flashcards Preview

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Flashcards in Week 3, Coronary heart disease Deck (15)
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What is the most frequent cause of death in developed countries?

Coronary heart disease


What is the approximate distribution of Resistance between large coronary vessels and their small vessel branches? How does this affect their ability to respond to a stenosis in the large vessel?

5% in large vessels 95% in small vessels


At what % of occlusion of a large coronary does its resting and maximal flow begin to decrease?

At 50% occlusion maximal flow begins to drop At 80% occlusion resting flow rate begins to drop.


What other factors are involved besides a stenosis to evoke CHD?

Dysfunction of the endothelial cells near the stenosis. -Inappropriate vasoconstriction or impaired vasodilation. Impaired NO or Adenosine release. -Loss of antithrombotic properties. Impaired NO or prostacyclin release.


What is Angina Pectoralis? What are the types?

Severe, dull/pressing pain in the chest, of limited duration. Often radiates, typically to left arm. Usually provoked by physical activity, cold, or a large meal. Classic and Prinzmetal angina, Stable and Unstable angina.


Describe classic angina

Stress induced, ST depression Alleviated by nitrates Caused by coronary occlusion Common type


Describe Prinzmetal angina

Occurs at rest or sleep

ST elevation

Not very responsive to nitrates

Caused by Coronary Spasm


Describe Stable angina

Has a good prognosis

Caused by a quiescent plaque

Has stable characteristics

Occurs at a predictable level of physical activity

Usual frequency and usual pain amount


Describe unstable angina

Bad prognosis

Caused by a Ruptured Plaque

Unstable characteristics

occurs more frequently, 

more painful

caused by lower levels of physical activity


Describe Acute Coronary Syndrome

May be from either AMI or Unstable Angina


Sypmtoms indicate ACS if:

1) it is the first angina-pain occurence

2) in a CHD patient, the angina is not relieved by nitrates or is unusually severe. 


May occur with ST elevation: ST-elevation Mycardial Infarct (STEMI) or Q-Wave Myocardial Infarct QMI


or without ST elevation: unstable angina, Non-ST-Elevated MI (NSTEMI), or Non-Q MI (NQMI)



What are the effects of hypoxia in AMI?

ATP depletion

Decreased pump activity

Increased intracellular Na+

Increased intracellular Ca++


Altered membrane potential


Anaerobic glycolysis, lowered pH

Cell death


Complications that can result from AMI

decreased contractility

   -stasis and thrombus generation 

   -Cardiogenic shock



   -vent fibrillation, death



   - Papillary muscle or valve defect --> regurgitation and congestive heart failure

   - subsequent decreased contractility --> congestive heart failure, 

   - pericarditis   -->pericardial effusion, cardiac tamponade

   - Ventricle rupture  --> cardiac tamponade


How is ACS managed?

Acute Coronary Syndrome:

ECG is performed --> Is there ST elevation?

Yes, ST elevation: STEMI, immediate percutaneous coronary intervention (PCI), also called coronary angioplasty, using a ballon catheter or stent.


No, Unstable Angina or Non-STEMI: Check if Troponin levels are elevated


Yes, troponin is elevated: 


What are ways to prevent CHD?

Do not smoke

Physical exercise, avoiding sedentary lifestyle

Manage hypertension

Manage Diabetes

Manage hyperlipidemias



In CHD patients, what precautions are taken to prevent AMI?

Prophylactic anticoagulants, Aspirin

Monitor the CHD

Hospitalize if angina occurs, especially unstable angina

Surgery or angioplasty, stents if needed