Week 3, Coronary heart disease Flashcards Preview

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Flashcards in Week 3, Coronary heart disease Deck (15)
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1
Q

What is the most frequent cause of death in developed countries?

A

Coronary heart disease

2
Q

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?

A

5% in large vessels 95% in small vessels

3
Q

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

A

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

4
Q

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

A

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.

5
Q

What is Angina Pectoralis? What are the types?

A

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.

6
Q

Describe classic angina

A

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

7
Q

Describe Prinzmetal angina

A

Occurs at rest or sleep

ST elevation

Not very responsive to nitrates

Caused by Coronary Spasm

8
Q

Describe Stable angina

A

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

9
Q

Describe unstable angina

A

Bad prognosis

Caused by a Ruptured Plaque

Unstable characteristics

occurs more frequently,

more painful

caused by lower levels of physical activity

10
Q

Describe Acute Coronary Syndrome

A

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)

11
Q

What are the effects of hypoxia in AMI?

A

ATP depletion

Decreased pump activity

Increased intracellular Na+

Increased intracellular Ca++

Edema

Altered membrane potential

Arrhythmia

Anaerobic glycolysis, lowered pH

Cell death

12
Q

Complications that can result from AMI

A

decreased contractility

  • stasis and thrombus generation
  • Cardiogenic shock

Arrhythmia

-vent fibrillation, death

Necrosis

  • 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
13
Q

How is ACS managed?

A

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:

14
Q

What are ways to prevent CHD?

A

Do not smoke

Physical exercise, avoiding sedentary lifestyle

Manage hypertension

Manage Diabetes

Manage hyperlipidemias

15
Q

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

A

Prophylactic anticoagulants, Aspirin

Monitor the CHD

Hospitalize if angina occurs, especially unstable angina

Surgery or angioplasty, stents if needed