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Adult Coronary Artery Pathology > Adult Coronary Artery Pathology > Flashcards

Adult Coronary Artery Pathology Flashcards

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1
Q

what did Alexis Carrel recognize in the 1910s?

A

first to understand and recognize how angina and stenosis were related in canine models

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2
Q

who is Claude Beck and what did he develop?

A

developed methods to perfuse animal hearts by attaching adjacent tissues to form collateral blood flow to ischemic myocardium

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3
Q

what did Arther Vineberg discover?

A

implanting the internal mammary artery, through a tunnel in the myocardium, in animals, that shoed communication developed b/w the IMA and the coronaries

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4
Q

who is the “Father of Open Heart”

A

C. Walton Lillehei

first surgeon to correct a variety of congenital heart defects that were previously considered untreatable

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5
Q

what happened when the first use of IMA as a direct graft?

A

during a procedure, a right coronary artery was too damaged, and in desperation, William longhair placed an IMA as a direct graft to restore the flow

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6
Q

what did Sones and Shirey demonstrate?

A

feasibility of selective coronary arteriography by using a catheter to inject contrast solution into the coronary Ostia

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7
Q

what is coronary circulation?

A

the nourishment of the heart tissues via the heart’s own vessels

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8
Q

what are the two main coronary arteries that branch off of the aorta and have many sub branches that supply oxygenated blood to the heart?

A

right coronary artery

left main coronary artery

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9
Q

what is coronary dominance?

A

refers to which coronary artery feeds the PDA that supplies the inferior wall of the heart

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10
Q

what does it mean to be considered right coronary dominant?

A

one’s RCA feeds the PDA

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11
Q

ischemia results from

A

an imbalance in oxygen supply or demand

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12
Q

what is angina pectoris

A

clinical manifestation of ischemic myocardial tissue that is temporally, or permanently injured

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13
Q

what are typical anginas symptoms

A

mild discomfort
severe chest pain
pain radiating to the arms, shoulders, neck, jaw or back

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14
Q

what triggers stable angina

A

physical activity , which increases the myocardial oxygen demand

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15
Q

variant angina occurs when?

A

occurs mostly exclusively at rest and is not precipitated ny exertion

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16
Q

what is predominantly a disease of the left ventricle?

A

Acute MI

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17
Q

what does acute MI result in?

A

necrotic myocardial tissues that is permanently injured

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18
Q

what is the difference between unstable angina and acute MI in the lumen?

A

unstable angina has partial lumen obstruction

complete lumen obstruction will cause acute MI

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19
Q

what might occur any time after myocardial infarction, especially if left atrium is enlarged

A

arterial fibrilation

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20
Q

what is the most common complication of myocardial infarctions?

A

arrhythmias

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21
Q

what are other complications of acute MI

A 
ventricular fibrillation (VF) 
ventricular tachycardia (VT)
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22
Q

what is ventricular fibrillation?

A

essentially no blood is being pumped to the heart

usually seen in sudden cardiac death

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23
Q

what is ventricular tachycardia

A

significantly decrease the amount of blood pumped through the heart and increases oxygen demand

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24
Q

what is extreme LV failure called?

A

cariogenic shock

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25
heart failure after an acute MI occurs predominantly as
left ventricular failure, caused by impaired LV function from infarcted left wall tissue
26
although less common, what are other causes of cardiac failure?
papillary muscle dysfunction or rupture ventricular septal rupture free wall rupture
27
what is a ventricular aneurysm
outpouching of scar tissue from a wide base in the ventricular wall
28
what are the characteristics of a true aneurysm?
1. wide base 2. walls composed of myocardium 3. low risk of rupture
29
what is a risk of ventricular aneurysms?
have a low risk of rupture, but they can impair cardiac function causing heart failure
30
what is a pseudo aneurysm
an incomplete rupture of the free wall and is characterized by a narrow base with a saclike aneurysm extending from the wall
31
characteristics of pseudo aneurysm
1. narrow base 2. walls composed of thrombus and pericardium 3. high risk of rupture
32
what is Dressler's syndrome?
inflammatory response to injured tissue that develops in a few patients about 1-8 weeks after an acute MI
33
what does Dressler's syndrome present as?
pericarditis fever joint pain pericardial effusion
34
what is a recommended therapy for use after an acute MI when there is some form of LV dysfunction?
ACE inhibitors
35
what are used for hyperlipidemia and plaque stabilization
statins
36
ACS with non-ST segment myocardial infarction should not be given ____ if urgent surgery is considered likely
plavix
37
use for lipid-regulating drugs
treatment of hyperlipidemia
38
effects of nitrates (4)
- dilate arterial and venous systems - increase blood flow through coronary arteries - decrease cardiac workload - reduce myocardial oxygen demand
39
effects of beta blockers
- decrease heart rate, bp, and contractility of the heart - reduce myocardial oxygen demand - reduce incidence of arrhythmias
40
calcium channel blockers effects
- dilate arterial system (including coronary arteries) - decrease bp and contractility - reduce cardial oxygen demand - reduce incidence of arrhythmias
41
ACE inhibitors effects
dilate arterial and venous systems | decrease bp
42
anticoagulants effects
inhibit and prevent further clot formation
43
antiplatelets effects
inhibit thrombus formation by decreasing platelet aggregation
44
what is CABG (ACB)
performed to restore or increase blood flow to the myocardium
45
indications for ACB
- LM coronary artery stenosis - LM equivalent disease, significant stenosis (70%) of the proximal LAD and CIRC - multivessel disease, especially with high LAD stenosis or LV dysfunction
46
what is the primary vessel of importance and why?
LAD artery since it supplies a major portion of the myocardium, especially the left ventricle
47
the LAD must be grafted with the conduit that has the best latency rate. What does the latest research indicate this is?
the LIMA
48
what are other potential graft sites?
the RCA PDA of the RC marginal branch off the RCA
49
at 10 years, what is the LIMA and RIMA patency rate?
LIMA >95% RIMA 80-90%
50
what is a free IMA bypass graft?
a IMA graft that is anastomosed to the aorta for blood supply
51
what are possible bypass graft conduits?
the IMA SVG radial artery gastroepiploic artery
52
what is the leading indication for reoperation
vein graft atherosclerosis, which is buildup of fats, cholesterol and other substances in and on your artery walls (plaque), which can restrict blood flow
53
overall mortality with a first time elective CABG surgery is about
2%
54
what is the average length of stay after CABG
5-7 days
55
what does anti platelet therapy help in patients after an ACB
inhibits platelet adhesion in the new bypass grafts, especially in SVG grafts
56
main preoperative risk factor for develops of complications in surgery are
reoperation lung disease emergency surgery renal dysfunction
57
plunged CPB time is an indication for
preoperative MI bleeding respiratory complication cerebrovascular accident
58
coronary artery disease results from
progressive blockage of the coronary arteries by atherosclerosis
59
risk factors of CAD
``` hyperlipidemia hypercholesterolemia cigarette smoking hypertension diabetes obesity physical inactivity ```
60
non modifiable risk factor for CAD
family history of disease, age > 65, gender (time as high in men as women)
61
class I classification of CAD
no limitation of physical activity | ordinary physical activity does not cause undue breathlessness, fatigue, or palpitations
62
class II classification of CAD
slight limitation of physical activity | comfortable at rest but ordinary physical activity results in undue breathlessness, fatigue, or palpitations
63
class III classifications of CAD
marked limitation of physical activity | comfortable at rest but less than ordinary physical activity results in breathlessness, fatigue, and palpitations
64
class IV classification of CAD
unable to carry on any physical activity w/o discomfort symptoms at rest can be present if any physical activity is undertaken, discomfort is increased
65
left ventricular aneurysm ( LVA) results from
the occlusion of major coronary artery that produces an extensive transmural infarction
66
what are the two most common presentations of left ventricular aneurysm?
ischemic syndromes and CHF
67
surgical procedures for LVA
standard aneurysmectomy | endoaneurysmorraphy
68
what is ventricular septal defect (VSD)
extensive myocardial damage subsequent to occlusion of a major coronary vessel may result in septal necrosis and rupture
69
when does VSD occur?
usually in the first week of an infarction
70
the presence of a VSD is suggested by
a loud holosystolic murmur that reflects the left to right shunting across the ruptured septum
71
surgery is indicated on an emergency basis for nearly all post infarction VSDs to prevent
the development of progressive multi system organ failure
72
aortic stenosis results from
thickening, calcification, and or fusion of the aortic valve leaflets which produce an obstruction to LV outflow
73
development of aortic stenosis in younger patients is from
AS usually develops on congenitally bicuspid valves
74
development of AS in order patients
AS is degenerative change in trileaflet valves
75
what layer is the collagen and elastic fibers?
tunica externa or adventitia
76
what layer is the smooth muscle of the cell
tunica media
77
what layer is the internal elastic membrane, connective tissue, endothelial cells and lumen
tunica intima
78
vasoconstriction is due to
high blood pressure
79
vasodilation is due to
low blood pressure
80
do arteries or veins have more smooth muscle in their walls?
arteries have more smooth muscle in their walls than veins
81
what comes off the LCA
LAD circumflex diagonal marginal
82
what comes off the RCA
PDA | marginal
83
if the blood supply to the heart muscle is cut off entirely, what happens
a heart attack or MI may occur
84
stable angina
triggered by physical or mental exertion resolves with rest or meds
85
variant angina
occurs spontaneously vasospasm responds to meds
86
unstable angina
``` unpredictable may be caused by thrombus may happen at rest rest and meds do not help, may progress acute coronary syndrome that can lead to MI ```
87
ischemia
- reversible - t wave changes - coronary artery cannot supply enough oxygen rich blood to meet the heart's needs to cells resume contraction
88
injury
- reversible - ST abnormalities - coronary artery cannot supply enough oxygen rich blood to meet the heart's needs - becomes stunned and recovery is delayed
89
infarction
- irreversible cell death - pathological Q wave - coronary artery cannot supply enough oxygen rich blood to meet the heart's needs, complete depletion occurs, necrosis of cells results
90
MI tends to affect what ventricle more
left
91
NSTEMI
occluding thrombus sufficient to cause tissue damage and mild myocardial necrosis - elevated cardiac enzymes - ST depression
92
STEMI
- complete thrombus occlusion - more severe symptoms - elevated cardiac enzymes - ST elevations on ECG or new LBBB

Adult Coronary Artery Pathology (1 decks)

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