Coronary Circulation Disorder

first

Coronary circulation is important because the heart is the ___ organ supplied

Coronary Artery Disease CAD

reduced supplies of oxygen and nutrients

Coronary heart disease CHD

• atherosclerosis

• angina pectoris (pain in chest)

• acute coronary syndrome (ACS)

• silent myocardial ischemia

• myocardial infarction (MI)

Ischemia

temporary deficiency of blood flow to tissue

Myocardial ___

Myocardial infarction MI

necrosis in myocardium due to obstructed blood flow

Cell and tissue features

• reduced contractility of ischemic myocardial fibers

• Disruption in cardiac conduction system

• Ischemic cascade

  • Occlusion initiates steps

  • Electrolyte balance

  • Anaerobic metabolism

  • Systolic and diastolic dyfunction

  • ECG abnormalities (changes depend on many factors)

CAD

Pathophysiology of _____

Most blood flow to myocardium delivered during ventricular diastole

Coronary collateral circulation

• triggered by insufficient blood supply

Endothelial cells EC

• thrombus

Smooth muscle cells SMC

• vasospasm (sudden, abnormal tightening or narrowing of an artery that reduces or blocks blood flow to tissues)

Blood vessel wall

• Atherosclerosis

  • aneurysm (bulging of BV that can rupture and cause blockage)

Atherosclerosis

cell and tissue features

• ____

  • narrowed coronary arterties

  • decreased blood flow

  • fracture in fibrous cap

  • superficial erosion of intima

Disruption of coronary blood flow

• imbalance among oxygen supply, demand, and consumption

commonly mixed with arterialscleorsis (overall thickness of the artery)

• this is a type of arteriosclerosis

Thrombus

Clot that blocks blood supply

Forms inside a blood vessel or the heart and stays attached to its site of origin

Dignosis

____ of CAD

lipid panel, CRP, lipoprotein a, homocysteine

detection of heart attack

Lipid panel

LDL, HDL, total cholesterol and triglycerides

C- Reactive Protein CRP

marker of inflammation in the body

Lipoprotein a

type of cholesterol that can build up in the arteries

Homocysteine

amino acid that can damage blood vessels

Detection of heart attack

Cardiac troponin test I and T (if you have these then it means you are lossing myocardium and damge to heart is being done)

Stable Angina

Chronic form of ischemic heart disease IHD

Occurs with increased myocardial oxygen demand and reduced blood flow during exertion or emotional stress

Clinical Manifestations

• related to exertion

• resolve with rest or short acting nitroglycerin (vasodilator medication used primarily to treat and prevent acute chest pain (angina) caused by coronary artery disease)

a predictable type of chest discomfort that occurs when your heart muscle does not get enough oxygen-rich blood during physical exertion or emotional stress

Silent Ischemia

thought to be related to defective anginal warning system

Clinical manifestations

• chest pain (not always present)

• ST-segment changes

DIgnosis

• ambulatory ECG

• SPECT (single photon emission computed tomogrpahy)

Treatment

• same medical therapies as for symptomatic ischemia

• coronary angiography and revascularization

CABG

Name this process. used to restore healthy blood flow to the heart muscle when coronary arteries become blocked or narrowed

Specific Acute Coronary Syndromes (ACS)

Types

• Non-ST segment elevation ____ NSTE-ACS) is an umbrella term for non-ST segment elevation myocardial infarction NSTEMI and unstable angina

• ST-segment elevation myocardial infarction STEMI

a group of life-threatening conditions caused by a sudden reduction or block of blood flow to the heart muscle

Plaque

Progression of ___

Non-ST segment elevation acute coronary syndrome

A heart attack caused by a partial blockage that damages the heart muscle, confirmed by elevated troponin levels without ST-elevation

NSTEMI vs unstable angina

1. Degree of ischemia that results

2. whether damage causes release of myocardial necrosis biomarkers (troponin, creatine, kinase-MB, myoglobin)

Pathogenesis

• atherosclerotic plaque rupture

• coronary artery vasoconstriction

• myocardial oxygen demand and supply imbalance

Risk Factors

• cigarette smoking (vasospastic angina)

Clinical Manifestations

• presentation of unstable angina and NSTEMI similar

• severe chest pain lasting more than 20min

Emergency medical services needed in cases of

• chest pain

• sever dyspnea

• Syncope (loss of consciousness or fainting) or presyncope episode (lightheadedness, nausea, and weakness)

• Palpitations

Dignosis

• ECG

• Serial cardiac tropnins

Treatment

• supplemental O2

• Short-acting sublingual nitroglycerin

• IV nitroglycerin

• Morphine sulfate

• Oral beta blockers

• High intensity statin therapy

• Antiplatelet therapy and anticoagulation therapy

• Invasive strategies

unstable angina

Chest discomfort that occurs unexpectedly or worsens over time; it reduces blood flow like a heart attack, but troponin levels remain normal

plaque disruption and platelet aggregation

when the thrombus starts to block blood flow and causes pain in the chest, even when at rest

Vasospastic angina

type of chest pain caused by a sudden, temporary tightening or spasm of the coronary arteries that temporarily reduces blood flow to the heart

ST segment elevation MI (STEMI)

A severe heart attack caused by a complete blockage of a coronary artery, leading to rapid muscle death and specific ST-segment elevation on an ECG

More precise definition of a heart attack

• STE refers to ECG tracing of ST segment elevation

• MI refers to myocardial infarction

Preventation of death requires RAPID

• recognition

• reperfusion treatment

• management

Pathogenesis

• disruption of atherosclerotic plaque leads to thrombosis and disrupts blood flow

• Imbalance of myocardial oxygen supply and demand results

Causes

• Nonobstructive CAD

• Coronary artery vasospasms

• Contusions related to trauma

• Cocanine abuse

• Hematologic problems

Clinical Manifestations

• classic chest pain and dyspnea

• malaise and fatigue

• radiating pain

• Diaphoresis, dizziness, weakness, palpitations, altered mental status, feeling of doom

• Tachycardia or bradycardia

Dignosis

• ECG

• Cardiac Troponins

RAPID RESPONSE TEAM in hospital

risk factors

____ for STEMI

• same for CAD

• air pollution

• prinzmetal angina/ vasospastic angina

• Contusions related to trauma to cornary arteries

• cocaine abuse

• aortic insuffciencies

• hematologic problems

• a fib (embolus)

Embolus

A piece of a thrombus (or another foreign substance) that breaks loose, enters the circulation, and moves to another part of the body

Embolism

The medical emergency or blockage that happens when the traveling embolus finally lodges in a narrow vessel and cuts off blood flow.

Common Heart attack warning signs

Name these