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PHA222 > CHD > Flashcards

CHD Flashcards

1
Q

What is tissue ischaemia and what can it be due to?

A

Reduced blood flow to an organ or tissue due to:
- lack if O2 and nutrients supply
- lack of washout of metabolic

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2
Q

Describe Myocardial ischaemia.

A
  • Reduced blood flow to the heart.
  • Ischaemia as an imbalance between myocardial demand and supply.
  • Concept of exertional demand and ischaemia and non-exertional supply ischaemia.
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3
Q

Define CHD

A

Pathological conditions and characterised by a reduced or inadequate blood flow to the heart.

Usually due to an obstructive/constrictive disease of coronary arteries

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4
Q

What are the characteristic of CHD?

A
  • Incurable
  • High morbidity and mortality
  • Highly dependent on environmental and cultural factors.
  • Preventable
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5
Q

Describe the process of CHD.

A
  1. Coronary artery obstruction or constriction.
  2. Reduced regional blood flow to the heart
  3. Oxygen and nutrient deprivation and accumulation of toxic waste.
  4. Leading to: metabolic and contractile dysfunction, electrical instability and myocardial cell death (infarction).
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6
Q

What are the clinical manifestations of CHD?

A
  • Angina pectoris - stable, variant and microvascular.
  • Immediate or sudden cardiac death.
  • Acute coronary syndromes (ACS) - unstable angina, acute myocardial infraction (NSTEMI, STEMI).
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7
Q

What are the pathological factors of CHD?

A
  • Atherosclerosis
  • Coronary thrombosis
  • Coronary artery spam
  • Coronary microvascular dysfunction
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8
Q

Define Atherosclerosis.

A

A progressive, degenerative arterial disease characterised by asymmetric deposition of lipids and fibrous tissue on the inside wall of arteries

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9
Q

Describe the disease process of Atherosclerosis.

A
  1. LDL deposition in sub-endothelial space.
  2. LDL oxidation + monocyte recruitment into sub-endothelial space.
  3. Macrophage differentiation + uptake of oxidised LDL.
  4. Foam cell formation
  5. SMC migration, proliferation and de-differentiation.
  6. Fibrous plaque or atheroma
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10
Q

What are the consequences of Atheroclerosis?

A

Impact on coronary function:
- Partial coronary occlusion - stable angina
- Endothelial/ vascular dysfunction - coronary artery spasm.
- Ulceration/ rupture - coronary thrombosis

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11
Q

Define Coronary Thrombosis.

A

Unwanted formation of a haemostatic plug or thrombus or blood clot within coronary arteries

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12
Q

What is the disease process of Coronary thrombosis?

A
  1. Rupture or ulceration of atherosclerotic plaque.
  2. Contact of blood elements with collagen and tissue factor.
  3. Platelet adhesion and activation - platelet aggregation - thrombus/ clot.
    Activation of coagulation cascade - fibrin formation and deposition - thrombus/clot
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13
Q

What are the consequences of Coronary Thrombosis?

A

Impact on coronary function:
- Complete and permanent occlusion of coronary artery - ACS (STEMI).
- Subtotal or intermittent occlusion of coronary artery- ACS (UA/NSTEMI).
- Thromboembolism in a distal artery

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14
Q

Define Coronary artery spasm.

A

A transient, spontaneous coronary vasoconstriction.

  • May occur in normal coronary arteries
  • May occur at mildly atherosclerotic sites or during ongoing coronary thrombosis.
  • The underlying cause of variant angina.
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15
Q

What are the disease mechanisms coronary artery spasm?

A
  • Local endothelial injury - increase reactivity to vasoconstriction.
  • Abnormal release of vasoconstrictors or local imbalance in release of vasodilators and constrictors.
  • Smooth muscle cell hyper-contraction/ hyper-reactivity
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16
Q

What are the consequences of Coronary artery spasm?

A

impact on coronary function:
- subtotal or intermittent occlusion of coronary artery
- complete focal occlusion of coronary artery

17
Q

Define Coronary microvascular dysfunction.

A

Damage to the inner walls of the small coronary blood vessels of the heart, leading microvascular spasm, decreased blood flow of the heart muscle and reduced coronary flow reserve.

18
Q

What is the are disease mechanisms for Coronary microvascular dysfunction?

A
  • Microvascular remodelling - luminal narrowing of the intramural arterioles and capillaries - microvascular obstruction.
  • Endothelial dysfunction - impaired vasodilator response and reduced coronary blood during exercise or stress.
  • Functional abnormalities of smooth muscle cells that regulate arteriolar tone.
19
Q

What are the consequences of Coronary microvascular dysfunction?

A

Reduced coronary flow reserve and increased risk of myocardial ischaemia - INOCA (microvascular angina) or MINOCA (myocardial infraction with no obstructive coronary artery disease)

20
Q

What are the medical and modifiable risk factors for coronary atheroma and CHD?

A
  • High blood cholesterol
  • Hypertension
  • Diabetes
  • Obesity
  • Poor diet
  • Cigarette smoking
  • Physical inactivity

PHA222 (13 decks)

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