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44 Cards in this Set
- Front
- Back
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Approximately 51% of americans have blood cholesterol
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higher than 200mg/dL
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Risk factors for coronary artery disease(8)
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Male Sex
Family History of CAD/sudden death before 55yoa Cigarette use HTN Low HDL DM History of cerebrovascular or occulsive peripheral disease severe obesity Hi risk: prior MI/ischemia |
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ATP III Lipid Guidelines:
LDL Ranges |
<100-normal
100-129 Near optimal 130-159 Borderline High 160-189 High >190 Very High |
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ATP II Lipid Guidelines:
HDL Ranges |
<40 Low
>60 High |
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Progression of Artherosclerosis
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Initial Lesion-->Fatty Streak-->Intermediate Lesion--->artheroma--->fibroatheroma---<complicated lesion
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Artherosclerotic plaques begin with
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altered endothelial integrity(damaged or stretched).
collagen exposure thrombus formation accumulation of monocytes |
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After endothelial cell is damaged, ___proliferates
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intimal and smooth muscle cells, promoted by growth factors from monocytes and platelets
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If chronic process stops, only___occurrs
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thickened intima
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Smooth muscle cell proliferation leads to
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deposition of connective tissue, collagen, elastic, proteoglygans
accumulation of lipids in matrix |
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Sources of oxidative stress
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LDL-C
Diabetes HTN Smoking |
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Inhibit platelet aggregation, prevent clotting, vasodilate
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NO
PGI2 TBx |
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Increase platelet aggregation, inflammation,
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PAI-1
Endothelin VCAM ICAM cytokines growth factors |
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Risk factors associated with increased oxidative stress(7)
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Hypercholesterolemia(inc LDL)
HTN Smoking DM Estrogen Deficiency Hyperhomocysteinemia Mechanical Injury |
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Vascular effects of superoxide and free radicals
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Inactivation of NO
Induction of cell growth Lipid peroxidation |
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Majority of MIs are caused by
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Non-flow limiting, unstable lesions
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Unstable lesions more risky because
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they contain smalll fibrous cap, plaques can rupture and form hematoma
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Unstable lesions have larger number of
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Activated macrophages and inflammatory cells
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Stable lesions have more
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fibrous cells
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Coronary artery disease can be manifested as (2)
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Artherosclerosis
Vasospasm |
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CAD decreases
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reserve capacity for inc coronary blood flow
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Manifestations of Artherosclerosis:
Heart(2) |
Angina Pectoris
Myocardial Infarction(total occlusion) |
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Manifestations of Artherosclerosis
Brain(2) |
Cerebrovascular Accident(total occlusion)
Transient Ischemic Attack |
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Manifestations of Artherosclerosis
Peripheral Arteries |
Aneurysm(aortal)-total occulsion
Peripheral vascular disease |
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Ischemia is
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lack of oxygen and deceased or no blood flow in tissue
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Most common presenting manifestation of ischemic heart disease more common in women
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angina
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Most common presenting manifestation of ischemic heart disease more common in men
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myocardial infaction
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Outcome of ischemic heart disease dependent on
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extent of artery obstruction
# of vessels involved |
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Other risk factors placing ischemic heart disease patients at hi risk
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Left main artery involvement
multivessel disease impaired left ventricular function 2+ of these: HRN Hx of MI Resting ST segment depression Critical narrowing(75%+) |
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Stable exertional angina
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myocardial ischemia that occurs when myocardial demand exceeds supply
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unstable angina
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New onset, occurs at rest or with minimal exertion
may exhibit crescendo pattern |
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transition from stable to unstable angina usually associated with
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transition from stable to unstable plaque that ruptures or fissures
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silent myocardial ischemia
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ischemia not accompanied by angina
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coronary vasospasm
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episodses of chest pain at rest,
assosciated w/ transient ST segment elevations |
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Myocardial Infarction
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result of occlusive or near-occlusive thrombus adjacent to ruptured plaque
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Causes of myocardial infarction
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Coronary artery disease
drugs(ie cocaine) vasospasm myocardial hypertrophy |
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In angina, underperfusion of endocardium results in
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shift to anaerobic metabolism
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In angina, left ventricular failure occurs, resulting in
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decreased stroke volume
increased LVEDP increased wall tension |
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Signs of angina
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substernal chest pressure or heaviness radiatic to L shoulder, arm, neck, and jaw
nausea diaphoresis SOB usu brought on by exercise or stress |
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Pain in angina typically lasts
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at least 2-10 min
no more than 30 min |
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atypical symptoms of angina
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epigastric pain
indigestion right arm pain light neadedness nausea SOB alone |
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in angina, ECG may show
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ST segment depression
T wave inversion |
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Ventricle most commonly affected in MI
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left ventricle
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With MI, serum enzymes used for confirmation because
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they dont peak until about 24 hours post-MI
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Treatment for angina
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drug therapy
coronary artery bypass stents angioplasty |
