6127 - 2.1.1 CAD (intro)

answer with term

1. I/SVC

2. RA

3. (TV)

4. RV

5. PA

6. lungs

7. LA

8. (MV/BV)

9. LV

10. aorta

blood flow to the heart, then to the tissues

Arteries

responsible to transport blood throughout the body

Peripheral artery disease

problem in the arteries of arms or legs

Coronary artery disease

problem in the arteries of the heart

Left Coronary Artery

• Left Circumflex Artery (LCA)

• Left Anterior Descending Artery (LDA)

Right Coronary Artery

• Right Marginal Artery (RMA)

• Posterior Descending Artery

Collateral Circulation

• formation of tiny blood vessels to re-route blood around a blocked or damaged area

Coronary Artery Disease (CAD)

• Coronary Heart Disease (CHD)

• Ischemic Heart Disease (IHD)

• Atheroma

• Thrombosis

• Spasm of the coronary artery

Vascular supply to the heart are impended by these (3)

Atheroma

• Accumulated fatty deposits and scar tissues

• Leads to restriction in blood flow and risk of thrombosis

Atherosclerosis

• A condition in which patchy deposits of plaque (atheroma or atherosclerotic plaque) develop in the wall of the medium and large sized arteries, leading to reduced or blocked flow

COMPLICATION
stroke

AFFECTED SITE
cerebral arteries

COMPLICATION
stroke

AFFECTED SITE
carotid arteries

COMPLICATION
aneurysm

AFFECTED SITE
aorta

COMPLICATION
angina & MI

AFFECTED SITE
coronary arteries

COMPLICATION
hypertension

AFFECTED SITE
renal arteries

COMPLICATION
peripheral vascular disease

AFFECTED SITE
iliac arteries

COMPLICATION
peripheral vascular disease

AFFECTED SITE
femoral arteries

COMPLICATION
peripheral vascular disease

AFFECTED SITE
tibial arteries

1. injury/dmg to arteries (endothelial linings)

2. migration of monocytes & accumulation of fatty streaks (↑macrophages, T-cells)

3. smooth muscle & fibroblast make up a fibrous cap (plaque: collagen, proteoglycans, elastin, glycoproteins) surrounding cells and necrotic tissue

steps of plaque formation (3)

ANTHEROSCLEROSIS

healthy artery

• Blood flow

• Low risk of heart disease

ANTHEROSCLEROSIS

partially blocked artery

• Artery narrowed by atherosclerosis 

• Increased Health Risk

ANTHEROSCLEROSIS

blocked artery

• Plaque build-up in the lining of artery 

• Can lead to stroke and heart disease

FIBROUS PLAQUE

stable plaque

• Static

• Grows slowly 

• Ibig sabihin lumalaki lang siya

FIBROUS PLAQUE

unstable plaque

• Rupture

• Causing thrombosis

• Anytime pwede siya magrupture and once magrupture, dun na pwedeng magkaroon ng stroke or heart attack

Thrombus

• Blood clot

• Stationary and only located in that one specific area

Embolus

• Fragment of blood clot travelling through vein

• Basically a thrombus na nagtravel na

• ↓ blood flow (myocardium)

• ↑ O2 demand

ETIOLOGY (2)

ETIOLOGY

• Atherosclerosis

• Coronary spasm

• Traumatic injury

• Embolic event

ETIOLOGY

↓ blood flow (myocardium)

ETIOLOGY

• Diastole

• Systole

ETIOLOGY

↑ O2 demand

Myocardial Ischemia

• Oxygen demand exceeds myocardial oxygen supply

• May be silent if:

  • the length is sufficient

  • Afferent cardiac nerves are damages

  • Inhibition of pain at the spinal or supraspinal

Angina

Transient chest discomfort that are attributed to insufficient myocardial oxygen

• Class I

• Class II

• Class III

• Class IV 

angina classifications based on severity

angina classifications based on severity

Class I

Ordinary activity does not cause angina, such as walking and climbing stairs

angina classifications based on severity

Class II

Slight limitation of ordinary activity

angina classifications based on severity

Class III

Marked limitation of ordinary physical activity

angina classifications based on severity

Class IV

Inability to carry on any physical activity without discomfort

• stable

• unstable (rest)

• angina decubitus (nocturnal)

• prinzmetal (variant)

angina classifications based on symptoms

angina classifications based on symptoms

stable angina

• Characterized by chest pain and breathlessness on exertion, symptoms are relieved promptly with rest

• Patient has a reproducible pattern of pain or other symptoms

• Components to consider: quality of pain, location of pain, duration of pain, factors provoking pain, and factors that relieve pain

• also attributed to stable plaque (only slow growth; no rupture)

angina classifications based on symptoms

stable angina (symptoms)

• Pressure or burning sensation over the sternum but not always radiating (only in the chest area)

• Pain usually lasting for 0.5 to 30 minutes

• Precipitating factors include exercise, cold weather, emotional stress

• Relief occurs with rest and nitroglycerin

angina classifications based on symptoms

unstable angina (rest angina)

• > 20 minutes occurring within a week of presentation

• ↓ response to NTG

angina classifications based on symptoms

unstable angina (increasing angina)

• Previously diagnosed angina with distinctly more frequency of pain, longer duration or lower threshold

• ↓ response to NTG

angina classifications based on symptoms

angina decubitus

• Nocturnal angina: angina at night or during sleep

• Occurs when patient is in a recombinant position or lying down without any apparent cause, not necessarily at night (as long as during sleep)

• Gravitational force shifts fluid within the body with a resultant increase in ventricular volume

angina classifications based on symptoms

prinzmetal angina

• Variant angina

• Large coronary artery spasms that reduce blood flow (large artery is affected)

• Due to a thrombi or plaque formation

• Occurs at rest rather than exertion

• ECG shows ST-elevation

• resting ECG

• exercise test

• myocardial scintigraphy

• stress echocardiography

• coronary angiography

diagnostic tests (5)

DIAGNOSTIC TEST

resting ECG

typically done when lying down and relaxed

DIAGNOSTIC TEST

exercise test

done while the patient exercises (treadmill, stationary bike)

DIAGNOSTIC TEST

myocardial scintigraphy

uses a contrast agent to show blood flow in the heart and detect blockages/plaques

• specific to prinzmetal

• kidney function (creatinine) must be checked prior to using a contrast agent

DIAGNOSTIC TEST

stress echocardiography

done while the patient exercises / given medication to ↑HR, then an ultrasound will check the heart function and blood flow under stress

DIAGNOSTIC TEST

coronary angiography

1. catheter is inserted in leg & guided up the aorta

2. catheter tip stops @ LCA

3. contrast agent is injected into arteries (x-ray shows stenosis in LCA)