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Coronary Heart Disease

The document discusses coronary heart disease, including: 1) The coronary circulation system and how coronary blood flow is controlled. 2) Coronary atherosclerosis and the steps in clot formation. 3) The different types of coronary heart disease such as chronic ischemic heart disease, acute coronary syndrome, and myocardial infarction. 4) Tests used to assess coronary blood flow and serum cardiac markers. 5) Treatment options including therapeutic lifestyle changes, medications, and revascularization procedures.

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265 views4 pages

Coronary Heart Disease

The document discusses coronary heart disease, including: 1) The coronary circulation system and how coronary blood flow is controlled. 2) Coronary atherosclerosis and the steps in clot formation. 3) The different types of coronary heart disease such as chronic ischemic heart disease, acute coronary syndrome, and myocardial infarction. 4) Tests used to assess coronary blood flow and serum cardiac markers. 5) Treatment options including therapeutic lifestyle changes, medications, and revascularization procedures.

Uploaded by

api-3739910
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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CORONARY HEART DISEASE

I. Coronary Circulation
 Coronary Arteries:
1. Left coronary artery
 left anterior descending artery
 left Circumflex artery

2. Right coronary artery


 posterior descending artery

 Control of coronary blood flow:


1. metabolic control
• adenosine, K ions, lactic acid, CO2

2. endothelial control
• endothelial cells antithrombogenic property
• vasodilating factor - EDRF
• vasoconstricting factor – ET-1

3. collateral circulation

 Assessment of coronary blood flow:


1. electrocardiography (ECG)

2. exercise stress testing


 treadmill test
 bicycle exercise

3. pharmacologic stress test


 adenosine
 dipyridamole

4. nuclear imaging
 myocardial perfusion imaging -“ cold spot”
 acute infarct imaging - “ hot spot”

5. cardiac catheterization

6. serum cardiac enzymes


II. Coronary Atherosclerosis:
• fixed or stable plaque

• unstable plaque

• thrombosis & vessel occlusion


• white platelet- containing thrombi
• red fibrin - containing thrombi

 steps in clot formation:


• release of ADP , thromboxane A2 & thrombing
• receptors on platelet surface activated
• fibrinogen binds adjacent platelets

III. Types of Coronary Heart Disease:

Coronary heart disease (CHD)

Chronic ischemic heart disease Acute coronary syndrome

Stable Variant Silent No ST- elevation ST – elevation


angina angina myocardial
infarction

unstable non-ST- elevation Q- wave AMI


angina AMI

 serum cardiac markers:


1. myoglobin
• increases within 1 hr after MI
• peaks within 4- 8 hrs

2. creatine kinase –MB (CK-MB)


• increases within 4-8 hrs of MI
• decreases to normal within 2-3 days

3. troponin T & I
• increases slowly up to 3- 4 days

 Tissue changes after MI:


 0 – 0.5 hrs  reversible injury
 1 – 2 hrs  onset of irreversible injury
 4 – 12 hrs  onset of coagulation necrosis
 18 -24 hrs  continued necrosis
 1 – 3 days  total coagulation necrosis
 3 – 7 days  infarcted area soft with yellow center & hyperemic edges
 7 – 10 days  onset of scar tissue generation
 8th week  scar tissue replacement complete

III. Tx of Coronary Heart Disease (CHD):

1. Therapeutic lifestyle change (TLC)

2. pharmacologic
• beta – blockers
• calcium channel – blockers
• nitroglycerin / nitrates
• lipid- lowering agents (ie. statins)

• antiplatelets
a. aspirin
b. ticlopidine
c. clopidrogel

• anticoagulant
a. heparin
b. warfarin

• thrombolytics
a. streptokinase
b. urokinase

3. Revascularization procedures
a. percutaneous transluminal coronary angioplasty (PTCA)
b. coronary artery bypass grafting (CABG)

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