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Physiology > Coronary Heart Disease > Flashcards

Coronary Heart Disease Flashcards

1
Q

What is CHD caused by?

A

Atherosclerosis

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2
Q

What are the 4 steps of the atherosclerosis process?

A
  1. Injury to the lining of an artery
  2. Formation of a fatty streak
  3. Formation of an advanced complicated lesion
  4. Formation of a fibrous plaque: calcification
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3
Q

What is the first step of the atherosclerosis process?

A

Injury to the lining of an artery

  • endothelial dysfunction: adhesion and permeability
  • leukocytes adhesion to the endothelium
  • leukocytes migration to the intima
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4
Q

What is the second step of the atherosclerosis process?

A

Formation of a fatty streak

  • smooth-muscle cells migration to the intima
  • macrophages ingest lipid-containing particles: form foam cells
  • enlarged, yellow and streaky intima
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5
Q

What is the third step of the atherosclerosis process?

A

Formation of an advanced complicated lesion

  • macrophages and muscle cells accumulate in the intima
  • formation of a necrotic core
  • formation of a fibrous-cap
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6
Q

What is the fourth and final step of the atherosclerosis process?

A

Formation of an unstable fibrous plaque

  • thinning of fibrous plaque and potential rupture
  • haemorrhage from plaque microvessels
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7
Q

What are the complications of a fibrous plaque formation?

A
  • thrombus formation: heart attack or stroke
  • ulceration
  • artery wall can rupture: internal bleeding
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8
Q

What is the fourth and final step of the atherosclerosis process described as?

A

A clinical threshold

Disease begins to limit normal functioning

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9
Q

What disease can atherosclerosis in the aorta provoke?

A

An aneurysm

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10
Q

What disease can atherosclerosis in the brain provoke?

A

A haemorrhagic stroke

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11
Q

What disease can atherosclerosis in a limb provoke?

A

Gangrene

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12
Q

What disease can atherosclerosis in the heart provoke?

A

An infract

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13
Q

What is the Morris et al. (1953) study? (epidemiology)

A
  • Review of cross-sectional studies comparing the incidence rates of CVD-related things in men depending on occupation
  • men with physically active jobs had half the number of heart attacks and sudden deaths compared to those with sedentary jobs
  • Effect only visible after 40 y/o
  • Limitation: Self-selection bias? Healthiest men took the more active jobs?
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14
Q

What are some epidemiology studies which find effect of PA on CVD incidence?

A
  • Morris et al. (1953) and (1980)
  • Harvard Alumni Study by Paffenbarger et al. (1978)
  • Aerobic Centre Longitudinal Study (Steven Blair)
  • Shiroma and Lee (2010)
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15
Q

What is the Aerobic Centre Longitudinal Study by Steven Blair (1998)?

A
  • Compared cardiovascular death rates and fitness

- Found a dose-response: the lower the fitness the higher the death rate in men and women

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16
Q

What is the Shiroma and Lee study (2010)?

A
  • Meta-analyses on prospective cohort studies
  • Mean CHD risk reduction between active and non-active of 20-40% in men and women
  • Strong observational study design by minimising potential bias from recall of PA
17
Q

What is a limitation between studies regarding the definition of different PA intensities?

A
  • Adjectives used (vigorous, heavy, moderate) do not have a precise meaning
  • the work activity described by Paffenbarger and Hale (1975) as ‘heavy’ would have been well below what Morris et al. (1980, 1990) qualify as vigorous
18
Q

What is the Harvard Alumni Study by Paffenbarger et al. (1978)?

A
  • Compared self-reported PA habits in men with the incidence of heart attacks and CHD risk
  • Results: men who were active at university but did not maintain high levels of PA since did not have lower CHD risk
19
Q

What is the Cooper Longitudinal Study?

A
  • 25 year follow-up comparing cardiorespiratory fitness and coronary heart calcification with CVD risk
  • if low fitness and high calcification: high incidence of CVD
20
Q

How does exercise reduce CVD risk?

A

At a physiological level, exercise appears to affect the development of atherosclerosis
Exercise targets the pathways involved in atherosclerosis

21
Q

Can exercise replace drugs? (+ ref)

A

Naci & Ioannidis (2013)

  • exercise appears to benefit mortality to similar extents as drug interventions
  • but very few studies compared exercise mortality benefits with drug interventions
  • medical research is favoured compared to lifestyle changes
22
Q

What are the CHD risk factors?

A
  • smoking
  • age
  • family history
  • physical activity
  • inappropriate blood lipid profile
  • hyperglycaemia
  • hypertension
  • obesity
  • personality/stress
23
Q

What are the CHD risk factors which PA can improve?

A
  • inappropriate blood lipid profile
  • hyperglycaemia
  • hypertension
  • obesity
  • personality/stress
24
Q

What is the issue of the lack of evidence of exercise benefits on CVD?

A
  • clinicians are constricted to prescribe drugs
  • but could exercise with or without drugs be prescribed?
  • we don’t know what kind, how much or how often exercise should be prescribed
25
Q

What is the effect of delaying rehabilitation post myocardial infraction?

A

Each week of delay in training requires one additional month to achieve the same benefits on left ventricular remodelling (Gielen et al. (2015)

26
Q

What are 2 of the risk benefits of exercise?

A
  • the majority of heart attacks occur within seconds of exertion
  • high risk of death during exercise in low habitual exercisers
27
Q

What is the Siscovick (1984) study?

A
  • the risk of exercise depends on familiarity with exercise tasks
  • in low habitual exercisers, high risk of death with exercise due to considerable heart strain, increased myocardial work and heart attack risk
  • need to consider risk factors before recommending exercise
28
Q

What is the Ragosta (1984) study?

A
  • the majority of health attacks occur within seconds of exertion
  • exercise increases the strain on the heart which could pose a risk for people with developing atherosclerosis
29
Q

How/For whom can vigorous exercise be dangerous? (Thompson et al. 2007)

A
  • fatality from vigorous exercise is very low under medical supervision
  • vigorous exercise is very risky for least active but not at all risky for most active
  • exercise-associated acute cardiac events mostly due to congenital or hereditary conditions in young people
  • exercise-associated acute cardiac events mostly due to heart attacks in older people
30
Q

How does CHD risk evolve with regular/increased PA?

A
  • total incidence of cardiac events at rest and during exercise decreases with increased activity levels
  • BUT regular PA including vigorous exercise reduces CHD events over time
31
Q

What is the role of PA in rehabilitation? (+ref)

A
  • Joliffe et al. (2001)

- 27% reduction in overall mortality with exercise-based cardiac rehabilitation

32
Q

What is the rate of attendance of cardiac rehabilitation in the UK?

A

Only 43%

Physiology (5 decks)

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