Term
| myocardial oxygen consumption demand |
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Definition
| increases with higher :heart rate, systolic bp, contractility and ventricular size |
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Term
| myocardial oxygen consumption supply |
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Definition
| modified by perfusion pressure, coronary arterial resitance (atherosclerosis spasm), cocornary arteiroalar resitance ( autoregulation), Distribution of blood flow (endo vs. epicardial) and duration of diastole . |
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Term
| adenosien and coronary arteries |
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Definition
| formed when lack of oxygen, atp eventually becomes adenosine, presence of adenosine leads to vasodilation. |
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Term
| EDRF in coronary blood vessels |
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Definition
| also NO. stimualted via agonists such as Ach, histamine and serotnin- produced by endothelila cell, results in conversion of GTP to CMP, which reduces calcium i ncytoplas and induces relaxation |
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Term
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Definition
| endothelium derives substance- stiulates camp release cuasing relaxation. |
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Term
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Definition
| produced in endothelium produces smc coronary relaxation |
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Term
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Definition
| endothelium derived, causes CONTRACTION |
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Term
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Definition
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Term
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Definition
| generally five times amount eneded for supply. as get mroe oclcuded- blod vessel vasodilates to try to maintain supply, however as getsm ore and more occluded we fall below the amount and can no lognee ocmpensate. |
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Term
| occlusion - presure relation |
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Definition
| lower amoutn of obstruction = less presure drop across the lesion. More flow across obstruction = more pressure drop across lesoin |
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Term
| meausring coronary occlusion using pressures? |
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Definition
| measure aortic pressure, and Coronary pressure, if coronary /aortic ratio is less than .75-.8 means patient is at ischemic risk |
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Term
| most common reason for supply/demand imbalancei n coroanry arteries |
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Definition
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Term
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Definition
| foam cells from first decade, to fatty streaks, to intermediate lesion to atheroma to fibrous plaque, to complicated lesion/rupture. |
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Term
| initial lesion of atherosclerosis |
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Definition
| histologically normal, clinically silent, with some macrophag infiltrates and foam cells |
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Term
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Definition
| intracelular lipid accumulation , clnically silent |
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Term
| itnermediate lesions of atheoscelrosis |
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Definition
| still clincially silent. itnracellualr lipd accumulations with smal lextracelular lipid pools |
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Term
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Definition
| start having some symptoms. intracellualr lipid deposits with extracellular lipid core. |
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Term
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Definition
| fibrotic calcified layers resulting in siginicant perfusion problems |
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Term
| complicated lesion of atheroscelrosis |
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Definition
| rupture nad formation of thrombosis- cause coronary syndromes |
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Term
| histologic layers from lumen to basal layer |
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Definition
| intima, media and adevntiita |
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Term
| cellular composition of atheroma |
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Definition
| cholesterol dead cell, dendritic cel, foam cel, amcrophage, mast cel, monocyte, smoth msucle cel, t cell |
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Term
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Definition
| atheroma has not punctured endothelium- thick endothelial cap on top pof plaque. Consequenceo fplaque is only depepdnatn on elvel fo oc clusion |
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Term
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Definition
| due to a thin cap , rupture leads to exposure of subendothelium to collagen, and thrombos formation. usually ruptures at shoulders. |
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Term
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Definition
| due to dysfunciton fo warning sytem |
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Term
| chest pain quality during ischemic heart diseae |
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Definition
| dheaveiness/presusre on chest |
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Term
| ches pain location for ischemic hd |
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Definition
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Term
| chest painr adiation for IHD |
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Definition
| inner aspect of elft arm only , never on outosdie of left arm- can radiate to neck or hsoulder or across chest as well. |
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Term
| associated symptoms of IHD |
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Definition
| scared patient, sweating cold/clammy , nasuea |
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Term
| precipiating factors of IHD |
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Definition
| increasing o2 demand in anyway- i.e. cnreasing bp , heart rate contractility via walking fast or runinngetc. |
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Term
| frequency of ischemic episodesi s determiend by |
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Definition
| degree of obstruction by plaque or thrombos |
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Term
| descriptors of myocardial ischemia |
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Definition
| look at cartoon slide. elephant sititng on chest, a burning sensation , bra strap too tight, choking feeling, like a tooth ache. |
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Term
| aortic dissection symtpom |
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Definition
| tearing ripping pain going towards the back ( look at slide) |
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Term
| acute pericarditis symptom |
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Definition
| pain worse , lying down, during inspiration, pain relief sititng up leaing forward |
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Term
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Definition
| fist in middle of chest and sitting up to relive angina. sitting up decreases venous return to heart, makign heart wall gets small decreasing wal lstress and o2 demand |
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Term
| some clinical signs of ischemic heart disease |
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Definition
| picture: tumros ona chilles tendon, santomas- cholestero deposits. |
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Term
| look at ischemic ekgs in ischemci heart disease lecture |
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Definition
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Term
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Definition
| troponoins and CK isoenzymes |
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Term
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Definition
| sometiems at rest we dont see anything. so we utilize stress test. look at stress test ekg on meyrya ihd lecture |
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