What are the untreatable risk factors for CAD?
male gender age genetics
What is the estimated lifetime risk of DM for persons in the US?
Diabetes and insulin resistance are associated with inflammation, oxidative stress, and dyslipidemia that predispose to _______.
_____ are associated with inflammation, oxidative stress, and dyslipidemia that predispose to atherosclerosis.
Diabetes and insulin resistance
In the normal coronary circulation, autoregulation provides protection from _____.
moderate changes in perfusion pressure
What contributes to fibrous plaques and occlusive atherosclerotic plaques?
activated macs (foam cells) smooth muscle proliferation forms fibrous caps progressive lipid accumulation in core of plaque
When is the LV perfused?
When oxidized, ____ becomes pro-inflammatory and athrogenic.
Factors that increase myocardial O2 demand?
1. HR 2. wall tension 3. inotropic state
An _____ causes a drop in perfusion pressure.
epicardial coronary stenosis
Tachycardia can compromise ______.
The dyslipidemic triad includes ____, ____, and ____.
high HDL low LDL high triglycerides
What are the beneficial effects of HDL?
1. inhibits oxidation of LDLs 2. inhibits tissue factor 3. enhances reverse cholesterol transport 4. stimulates NO production 5. inhibits endothelial adhesion molecules *** all oppose atherosclerosis
Oxygen delivery (mol/min) = coronary flow rate (ml/min) x _______
arterial oxygen content (mol O2/ml blood)
What are the acute vascular events associated with plaque rupture/fissure and thrombosis?
unstable angina MI stroke critical leg ischemia
Oxygen delivery (mol/min) = ______ x arterial oxygen content (mol O2/ml blood)
coronary flow rate (ml/min)
What is a reperfusion injury?
early reperfusion that can provoke an additional injury
______ = coronary flow rate (ml/min) x arterial oxygen content (mol O2/ml blood)
Oxygen delivery (mol/min)
How is O2 supply increased in chronic stable angina treated?
prevent HTN, give beta blockers, vasodilators, coronary angioplasty or bypass surgery, treat anemia and hypoxemia
Smoking confers a 50% increase in ___ risk.
How is O2 demand reduced in chronic stable angina?
antihypertensive drugs, rate slowing drugs (beta-blockers, Ca++ channel blockers, limit preload (diuretics, nitrates), negative inotropes (beta blockers, Ca++ channel blockers)
______ limits coronary flow and cause myocardial ischemia (tissue blood flow insufficient to meet oxygen requirements), particularly when cardiac work and oxygen demand increase.
Obstructive coronary lesions
Oxygen supply may be compromised by ____ or ____.
What is the cardinal symptom of an MI?
severe and unremitting chest discomfort at rest (although 30% of MI’s are “silent”)
In coronary heart disease, autoregulation may be exhausted when ______ across an epicardial coronary stenosis.
When is troponin elevated?
in an acute MI
What causes unstable angina?
Near-complete occlusion of vessel with thrombus
What is different about the coronary circulation?
1. the myocardium depends on aerobic metabolism for energy supply 2. Under resting conditions, a near-maximal amount of oxygen is extracted from coronary arterial blood; therefore, the only effective means of increasing myocardial O2 supply is to increase blood flow rate 3. the LV is perfused in diastole only
What attributes to a fatty streak?
endothelial injury lipid deposition mac and T cell recruitment
______ (dental, respiratory, immunologic diseases) may also increase the risk of atherosclerotic cardiovascular events.