Chapter 5 - Coronary Artery Disease

the 2 valves that separate the atria from the ventricles on both sides of the heart - right: tricuspid valve & left: mitral valve.

atrioventricular valves

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phase of the cardiac cycle during which the heart muscle contracts and pumps blood from the chambers into the arteries.

systole

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phase of the cardiac cycle during which there is a period of relaxation of the heart muscle, accompanied by the filling of the chambers with blood.

diastole

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a valve in the right side of the heart, separating the right atrium and right ventricle, which allows deoxygenated blood to flow from the right atrium to the right ventricle.

tricuspid valve

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a valve in the left side of the heart, separating the left atrium and left ventricle, which allows oxygenated blood to flow from the left atrium to the left ventricle.

mitral valve

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a valve in right side of the heart that allows deoxygenated blood to flow from the right ventricle to the lungs through the pulmonary artery.

pulmonic valve

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a valve in left side of the heart that allows oxygenated blood to flow from the left ventricle to the body through the aorta.

aortic valve

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an artery that branches from the left main coronary artery, running down the front of the heart to its apex and supplies blood to the anterior wall, anterolateral wall and septum of the heart.

left anterior descending (LAD) artery

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an artery that branches from the left main coronary artery, running towards the back of the heart and supplies blood to the lateral wall of the heart.

circumflex artery (LCX)

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an artery that branches from the aorta, running towards the right side and back of the heart, supplying blood to the right ventricle.

right coronary artery (RCA)

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an artery that branches from the right coronary artery (RCA) that is responsible for supplying the inferior and posterior walls of the left ventricle.

posterior descending artery (PDA)

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a systemic degenerative process that involves the gradual accumulation of a fatty-fibrous material on the inside walls of large and medium-sized arteries, eventually compromising blood flow.

atherosclerosis

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a lack of blood supply to an organ or part of the body, especially the heart muscles.

ischemia

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an accumulation of smooth muscle cells and lipids in the intima or inner layer of the blood vessel in response to some injury.

fatty streak

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pain caused that occurs whenever myocardial oxygen demand exceeds oxygen supply (reduction of blood flow to the myocardium (i.e., chest pain)).

angina pectoris

(ch.5)

an abnormally high concentration of fats or lipids in the blood.

hyperlipidemia

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chest pain caused by spasm of the blood vessel with no presence of atherosclerosis.

Prinzmetal's angina

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chest pain described as a squeezing or pressure in the middle of the chest, of a relatively short duration (1 to 15 minutes), with or without radiation to the neck or arms, and usually precipitated by exertion or stress.

typical angina

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chest discomfort that occurs predictably and reproducibly at a certain level of exertion and is relieved with rest or nitroglycerin.

stable angina

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chest discomfort that occurs unpredictably, occurs more easily or at rest and carries a worse prognosis.

unstable angina

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coronary artery disease that is totally asymptomatic but can be diagnosed by cardiac testing.

silent ischemia

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injury and death of the heart muscle caused by prolonged total occlusion of a coronary artery.

myocardial infarction (MI)

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a chronic condition where the heart can't pump enough blood to meet the body's needs, usually caused when fluid accumulates in the lungs or other body tissues.

congestive heart failure

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a recording/tracing of the electrical activity of the heart obtained by placing electrodes (i.e., electrical sensors) on various positions of the body.

electrocardiogram (ECG or EKG)

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a cardiac test done to measure the heart's response to exercise during which individuals are asked to exercise, usually by walking on a treadmill, through various workloads as determined by a standardized protocol while their EKG and blood pressure are monitored. It is helpful in the diagnosis and prognosis of CAD.

exercise electrocardiogram (exercise tolerance test, ETT)

(ch.5)

a unit of measurement for assessing exercise capacity on an exercise electrocardiogram, determined by the duration of exercise and protocol used.

metabolic equivalents (METs)

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a measure of the pumping ability of the heart shown as the percentage of blood in the ventricle delivered to the body with each heartbeat.

left ventricular ejection fraction (LVEF)

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an area devoid of radioisotope tracer (i.e. thallium, technetium) as shown on a myocardial perfusion scan.

defect

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a type of defect on a myocardial perfusion scan that is visualized with exercise, but not at rest, generally indicating an area of hypo-perfused but viable myocardium.

reversible defect

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a type of defect on a myocardial perfusion scan that is present both with exercise and at rest, indicating a prior myocardial infarction.

fixed defect

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an invasive, radiographic test where dye is injected directly into the coronary arteries to determine the site, extent, and the percentage of the coronary obstruction.

coronary angiography

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scans are used to detect deposits of calcium in the arterial walls. Coronary calcium scores are calculated that reflect the individual's extent of atherosclerotic disease. Also called ultrafast CT.

Electron Beam Computed Tomography (EBCT)

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a hormone produced by the heart in response to the stretching of myocardial cells due to volume and/or pressure overload. BNP has been found to be useful clinically in the diagnosis, prognosis, and treatment of congestive heart failure (CHF).

brain natriuretic peptide (BNP)

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medications (e.g. nitroglycerin) that prompt the coronary arteries to dilate, which improves blood flow and thereby relieves angina.

nitrates

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medications (e.g. propranolol, metoprolol, and atenolol) that prevent angina by slowing the heart rate and decreasing the force of contraction, which decreases the need for myocardial oxygen.

beta-blockers

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medications used to treat heart conditions, some of which increase coronary artery blood flow (e.g., nifedipine) and some of which decrease oxygen demand (e.g., verapamil).

calcium channel blockers

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an invasive procedure performed to treat coronary artery disease by inserting a balloon-tipped catheter into a peripheral artery and threaded through the aorta to the coronary arteries. This procedure is used to dilate arteries and/or place stents in the arteries.

Percutaneous Transluminal Coronary Angioplasty (PTCA)

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a procedure in which plaque is removed from the inside of an artery either by shaving or cutting it away.

atherectomy

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an invasive procedure in which a new connection is made from the aorta to the coronary artery by use of a graft, a portion of an artery or vein that creates a detour for blood flow to the myocardium by bypassing the problematic blockage.

Coronary artery bypass graft surgery (CABG)

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a measure of the amount of the left ventricle subject to further damage and is determined by the number, severity, and location of the coronary artery lesions.

myocardium at risk

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