A&P Circ/Coronary/IHD #4
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1. Most common cause of death (35%) in the United States?
2. Modifiable Risk factors?
3. Nonmodifiable Risk factors
- 1. IHD
- 2. A. Cigarette smoking
- B. Hypertension
- Increases the risk of coronary events as a result of direct vascular injury, left ventricular hypertrophy, and increased myocardial oxygen demand
- C. Obesity
- D. Sedentary lifestyle
- 3. A. Increasing age
- B. Male gender
- C. Genetic predisposition/family history
1. Partially modifiable risk factors?
- 1. low LDL levels
- 2. diabetes
- 3. > Cholesterol/triglycerides
- 4. Personality
- 5. C-reactive protein
Entire blood flow through the heart is derived of?
1. Right and left coronary arteries
A. RCA supplies what areas of the Heart?
B. RCA prominence? Rt dominant supplies?
- A. 1. Rt atrium
- 2. Most of Rt. ventrical
- 3. Posterior inferior lft. Ventrical
- B. 1. 70-80%
- 2. PDA and Posterior Superior IV and inferior LV.
1. Left Dominant Prevalence
2. and supply?
3. What Condition has dual supply to post descending?
- 1. 10-15%
- 2. Cx supplies posterior descending
- 3. Co-dominant- Both RCA and Cx 15-20%
a. LCA Supplies What areas of the heart?
b. Two main branches of LCA?
- a. 1. Lft atrium
- 2. Most:
- - IV Septum
- - LV Septum
- - Anterior wall
- - Lateral wall
- b. Left anterior descending and Cx
1. LAD supplies?
2. Cx supplies?
3. Lft dominant supplies?
- 1. Septum & Anterior wall
- 2. Lateral wall
- 3. - Cx Crosses AV groove to PDA
- - posterior septum and inferior wall
1. SA node is supplied by what artery?
2. AV node is supplied by what artery?
3. Bundle of His?
- 1. 60% RCA or LAD 40%
- 2. RCA 85-90% or Cx 10-15%
- 3. Dual LAD and PDA
What Coronaries supply mitral Papillary muscle?
1. LAD and Cx marginal branches
1. Avg coronary blood flow/min?
2. Three coronary pathways?
- 1. 225-250ml/min
- 2. Epicardial, Subendocardial, and Intramuscular
- - Epicardial majority
- - Subendocardial insignificant 0.1mm
1. Is coronary flow intermittent or constant?
2. Intramyocardial pressures are close to aortic pressure mean what?
- 1. intermittent
- 2. low blood flow in coronaries
1. LV is perfused almost entirely during what phase and why?
2. RV is perfused during what phase?
- 1. Diastole - bc LV pressure matches aortic pressure
- 2. systole and diastole - bc RV pressure is not that high.
1. Coronary flow is what percent of total CO?
2. Coronary Perfusion Pressure (CPP) Derived?
3. Between the two which is a more important feature that dictates coronary flow?
4. decrease in aortic or increase in Vent pressure will result in?
- 1. 5%
- 2. Aortic end-diastolic pressure - Ventricular end-diastolic pressure
- 3. Aortic end-diastolic pressure
- 4. Decreased CPP = < coronary perfusion
1. What is the greatest determinant of myocardial blood flow?
2. How much oxygen does the myocardium extract relative to peripheral circulation?
3. Since extraction is already high, increases in metabolic demand must be met by what?
- 1. Myocardial O2 demand
- 2. 70% vs. 30%
- 3. Increase in flow
1. Coronary Dilators are important related to what Law?
1. poiseuille law r4 power.
1. give example CNS Direct and indirect effect on coronary flow
- 1. Direct stimulation or inhibition
- 2. Indirect - coronary dilation counters increased O2 requirements.
- the indirect effects are likely more important than the direct effects by offsetting the potentially deleterious responses caused by
- epinephrine, norepinephrine, and acetylcholine. Example increased metabolic requirements caused by epi/norepi offset by local blood flow
- regulatory mechanisms that dilate thecoronary arteries.
1. Coronary venous returns by way of?
2. What is Thesbesian veins?
- 1. Rt atrium via coronary sinus.
- 2. sm portion of coronary venous return that empties into all chambers of the heart. physiological shunt.
Three Causes of IHD?
- 1. Coronary thrombus
- 2. Coronary embolus
- 3. Coronary Artery Spasm
IHD results in
1. Angina Pectoris. what is cause by what?
2. High mortality associated with what coronary occlusions?
3. loss of autoregulation
4. partial coronary obstruction
- 1. Prob d/t glycolysis -> lactic acid
- 2. Lft main.
- - LAD is next most critical
1. non-transmural ekg will have ST?
2. transmural ekg will have ST?
- 1. ST depression
- 2. ST elevation
Three types of heart failure post MI?
- 1. Systolic - ejection deficiency
- 2. diastolic - decrease stretch during diastole
- 3. Systolic stretch - d/t buldge-> decreases CO
Pulmonary edema happens as a result of?
- 1. damming of pulmonary blood vessels.
- 2. usually happens as a result decreased renal perfusion.
Causes of Vfib?
- 1. Depletion of K+into extracellular space -> irritability
- 2. Can not completely repolarize bc a loss of K
- 3. SNS irritates hrt
- 4. dilation displaces conduction pathway
Systolic stretch can lead to what?
Morphine, Oxygen, Nitro, ASA
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