Health science 2211-Lecture 5

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CanuckGirl
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257691
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Health science 2211-Lecture 5
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2014-02-01 14:17:24
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Coronary Ischemic Heart disease
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Coronary/Ischemic Heart disease
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  1. what does ischemic mean?
    lack of oxygen 
  2. 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
  3. what are 98% cases of CHD a consequence of?
    consequence of longstanding atherosclerosis and atherosclerosis plaques that block the coronary arteries 
  4. 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)
  5. what is myocardial ischemia?
    an imbalance between myocardial oxygen supply and myocardial oxygen demand 
  6. what is myocardial ischemia a consequence of? (3)
    • greater the 50% diameter narrowing of blood vessel
    • thrombus formation following plaque rapture
    • both 
  7. Myocardial infraction impairs the pumping ability of the heart because of what 3 reasons?
    • insufficient oxygen
    • reduced nutrient availability 
    • inadequate removal of metabolic wastes 
  8. What are the 2 types of CHD/IHD?
    • acute coronary syndrome (ACS)
    • chronic coronary artery disease (CCAD)
  9. What are the 3 clinical features under acute coronary syndrome?
    • unstable angina
    • myocardial infraction
    • sudden cardiac death 
  10. what are the 2 clinical features under chronic coronary artery disease?
    • stable angina
    • coronary artery disease 
  11. what is angina pectoris and what is it causes by?
    • primary symptom of CHD/IHD
    • caused by brief episodes of myocardial ischemia 
  12. what are the symptoms of angina pectoris? (4)
    • burning over/near sternum 
    • often radiates to left jaw,shoulder,arm
    • chest tightness
    • shortness of breath 
  13. what are the 3 types of angina pectoris?
    • stable of typical angina
    • unstable or crescendo angina
    • variant or prinzmetal angina 
  14. what is stable or typical angina?
    most common form due to fixed atherosclerotic narrowing of cornary artery that obstructs blood flow
  15. 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)
  16. 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
  17. what is variant or prinzmetal angina?
    uncommon form, occurs independently of atherosclerosis 
  18. 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)
  19. what are the 4 clinical features of CHD/IHD?
    • angina pectoris
    • myocardial infraction
    • chronic CHD/IHD with cardiac failure
    • sudden cardiac death 
  20. what is chronic CHD/IHD with cardiac failure?
    it's progressive heart failure due to ischemic myocardial damage 
  21. when does chronic CHD/IHD with cardiac failure occur?
    occurs when enlargement of surviving muscle can no longer compensate for progressive loss of myocytes 
  22. what happens to the size of the heart for chronic CHD/IHD with cardiac failure patients?
    patients have enlarged hearts 
  23. what is sudden cardiac death?
    unexpected sudden death from cardiac causes
  24. what would an autopsy for sudden cardiac death show?
    severe coronary atherosclerosis 
  25. what sudden cardiac death attributed (related) to?
    lethal arrhythmia 
  26. what is arrhythmia ?
    irregular heartbeats 
  27. 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
  28. what did the seven countries study examine?
    examined the effects of diet 
  29. what was the purpose of the Framingham study?
    to determine the risk factors 
  30. what was the most important finding from the Framingham study?
    that CHD is multifactorial 
  31. what was the purpose of the MONICA project?
    to monitor international trends in mortality from CVD and changes in major CVD risk factors
  32. what are the "four horseman of the apocalypse" main modifiable risk factors?
    • cigarette smoking
    • hypertension
    • elevated cholesterol (hypercholesterolemia)
    • diabetes
  33. 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
  34. what are the 3 non modifiable risk factors?
    • genetics
    • increasing age
    • gender (male>female, except postmenopausal)
  35. what are the 2 contributing environmental risk factors?
    • obesity 
    • physical inactivity 
  36. Nicotine is a powerful _______________that elevates blood pressure and causes hypertension.
    vasoconstrictor
  37. smoking elevates ______________.
    serum cholesterol
  38. 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 
  39. what is atherogensis?
    progressive inflammatory disease
  40. what is hyperhomocysteinemia? (2)
    • elevated homocysteine in the blood 
    • potentially modifiable independent risk factor for atherogenesis involving the coronary circulation
  41. what is hyperhomocysteinemia caused by?
    enzymatic defects or vitamin B deficiencies (B12,folate) involved in pathways of homocysteine metabolism 
  42. what are Apolipoproteins?
    • proteins that bind lipid
    • can influence the risk of developing coronary heart disease 
  43. High Levels of ________ have been found to decrease the risk of CHD due to the removal of cholesterol from arteries. where is this found?
    • ApoA1 
    • found on surface of HDL (good cholesterol)
  44. High levels of ________ increase the risk of CHD due to cholesterol transport into tissues. where is this found?
    • ApoB
    • found on surface of LDL (bad cholesterol)
  45. How are most risk factors for CHD modifiable?
    through lifestyle choices
  46. 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 

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