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what does ischemic mean?
lack of oxygen
what is ischemic/coronary heart disease? (IHD/CHD)
it's deficiency of blood supply to the heart muscle leading to lack of oxygen which is essential for the proper functioning of the heart
what are 98% cases of CHD a consequence of?
consequence of longstanding atherosclerosis and atherosclerosis plaques that block the coronary arteries
what are the 2 other minor mechanisms that CHD is a consequence of?
- conditions that compromise blood supply (valvular disease)
- conditions that diminish the oxygen carrying capacity of the blood (anemia)
what is myocardial ischemia?
an imbalance between myocardial oxygen supply and myocardial oxygen demand
what is myocardial ischemia a consequence of? (3)
- greater the 50% diameter narrowing of blood vessel
- thrombus formation following plaque rapture
Myocardial infraction impairs the pumping ability of the heart because of what 3 reasons?
- insufficient oxygen
- reduced nutrient availability
- inadequate removal of metabolic wastes
What are the 2 types of CHD/IHD?
- acute coronary syndrome (ACS)
- chronic coronary artery disease (CCAD)
What are the 3 clinical features under acute coronary syndrome?
- unstable angina
- myocardial infraction
- sudden cardiac death
what are the 2 clinical features under chronic coronary artery disease?
- stable angina
- coronary artery disease
what is angina pectoris and what is it causes by?
- primary symptom of CHD/IHD
- caused by brief episodes of myocardial ischemia
what are the symptoms of angina pectoris? (4)
- burning over/near sternum
- often radiates to left jaw,shoulder,arm
- chest tightness
- shortness of breath
what are the 3 types of angina pectoris?
- stable of typical angina
- unstable or crescendo angina
- variant or prinzmetal angina
what is stable or typical angina?
most common form due to fixed atherosclerotic narrowing of cornary artery that obstructs blood flow
what triggers stable or typical angina and how can it be relieved?
- triggered by increase oxygen demand (stress, exercise)
- relieved by decreased oxygen demand (rest) or increased oxygen supply (vasodilation)
what is unstable or crescendo angina and what is it caused by?
- pain occurs at rest, increasing in frequency or severity
- caused by rupture of an atherosclerotic plaque which reduces blood flow
what is variant or prinzmetal angina?
uncommon form, occurs independently of atherosclerosis
what is variant or prinzmetal angina caused by and how does it usually occur?
- caused by spasms of the coronary artery which results in abrupt reduction in blood flow
- usually occurs at rest (more commonly early in the morning)
what are the 4 clinical features of CHD/IHD?
- angina pectoris
- myocardial infraction
- chronic CHD/IHD with cardiac failure
- sudden cardiac death
what is chronic CHD/IHD with cardiac failure?
it's progressive heart failure due to ischemic myocardial damage
when does chronic CHD/IHD with cardiac failure occur?
occurs when enlargement of surviving muscle can no longer compensate for progressive loss of myocytes
what happens to the size of the heart for chronic CHD/IHD with cardiac failure patients?
patients have enlarged hearts
what is sudden cardiac death?
unexpected sudden death from cardiac causes
what would an autopsy for sudden cardiac death show?
severe coronary atherosclerosis
what sudden cardiac death attributed (related) to?
what is arrhythmia ?
what 3 prospective epidemiological studies have contributed significantly to our understanding of the pathogenesis of ischemic/coronary heart disease?
- seven countries study
- Framingham Study
- MONICA project
what did the seven countries study examine?
examined the effects of diet
what was the purpose of the Framingham study?
to determine the risk factors
what was the most important finding from the Framingham study?
that CHD is multifactorial
what was the purpose of the MONICA project?
to monitor international trends in mortality from CVD and changes in major CVD risk factors
what are the "four horseman of the apocalypse" main modifiable risk factors?
- cigarette smoking
- elevated cholesterol (hypercholesterolemia)
what is the 5th risk factor for the major risk factors for CHD?
inflammation with elevated C-protein (CRP) as a measure of vascular inflammation
what are the 3 non modifiable risk factors?
- increasing age
- gender (male>female, except postmenopausal)
what are the 2 contributing environmental risk factors?
- physical inactivity
Nicotine is a powerful _______________that elevates blood pressure and causes hypertension.
smoking elevates ______________.
How do they contents of tobacco such as carcinogens, ROS and other constituents effect CHD?
they are highly inflammatory to blood vessels and appear to be co-factors in atherogenesis
what is atherogensis?
progressive inflammatory disease
what is hyperhomocysteinemia? (2)
- elevated homocysteine in the blood
- potentially modifiable independent risk factor for atherogenesis involving the coronary circulation
what is hyperhomocysteinemia caused by?
enzymatic defects or vitamin B deficiencies (B12,folate) involved in pathways of homocysteine metabolism
what are Apolipoproteins?
- proteins that bind lipid
- can influence the risk of developing coronary heart disease
High Levels of ________ have been found to decrease the risk of CHD due to the removal of cholesterol from arteries. where is this found?
- found on surface of HDL (good cholesterol)
High levels of ________ increase the risk of CHD due to cholesterol transport into tissues. where is this found?
- found on surface of LDL (bad cholesterol)
How are most risk factors for CHD modifiable?
through lifestyle choices
What are 4 things that can aid with the prevention of CHD?
- early detection of treatable conditions through regular physical checkups
- effective medication treatment to maintain cholesterol, blood pressure and blood glucose limits
- sodium restriction
- weight reductions incorporating healthy nutrition and regular exercise