Med-Surg Fall 2024 Final Exam Review
Week Nine: Coronary Artery Disease
CORONARY ARTERIES OVERVIEW
“Heart Disease” is the common term.
The coronary artery is the main artery for transporting and perfusing O2 to the heart.
Women’s arteries tend to be smaller, which makes them more at risk for heart disease.
Coronary Artery Disease: A type of blood vessel disorder that is included in the general category of
atherosclerosis (narrow/thick arteries)
Atherosclerosis = CAD
- Can occur in any artery in the body, not just coronary.
- Begins as soft deposits of fat in the arteries and hardens with age.
- It is caused by endothelial injury
Characterized by:
-Deposits of cholesterol and lipids, primarily within walls of the artery.
-Endothelial injury, platelets stick to it when they normally do not, this happens from bad habits.
Atheroma’s (fatty deposits): preference the coronary arteries.
In the artery…
- There may be a crack in the endothelium where plaque and blood build up, which will decrease BF,
which leads to a lack of O2, which can cause an MI due to blocked coronary artery from plaque buildup.
PATHOGENESIS OF ATHEROSCLEROSIS
A. Damaged endothelium (a tear forms)
B. Fatty streak and lipid core formation
C. Fibrous plaque builds
D. Complicated lesions: Plaque ruptures and blood and platelets get stuck forming a thrombus (clot)
This happens over time..
Step 1. A fatty streak starts (this is permanent).
Step 2: Fat deposits in the fatty streak.
Step 3: Blood vessel becomes narrowed and impairs BF as plaque thickens.
,ETIOLOGY & PATHOPHYSIOLOGY
Healthy endothelium should not be reactive to platelets and leukocytes and fibrin.
Once it is damaged, things will stick to the wall of the endothelial lining. This injury is the leading cause of
atherosclerotic disease.
Occurs from: Hyperlipidemia, HTN, Diabetes, infections, immune reactions.
Bacteria and or viruses may have a role in damaging endothelium and causing inflammation.
ex.) Endocarditis of myocardium.
C-reactive Protein (CRP)
- Inflammation marker (non-specific)
- Will be high in patients with CAD.
- Chronic exposure of CRP triggers ruptures of plaques.
Steps of developing CAD:
1. Endothelial alteration: platelets are activated
-Growth factor stimulates smooth muscles and thicken the arterial wall.
-Cells trap lipids, which calcify overtime, forms an illient to the endothelium where platelets aggregate.
2. Thrombin is generated.
-Fibrin formation and thrombi occur causing further narrowing / total occlusion.
Collateral Circulation:
Ex.) EC row has an accident? Get off at the next exit.
Our blood vessels do the same thing, they will take detours around atherosclerotic plaques to avoid getting
stuck.
This is why someone who is older has a better change of surviving a heart attack then someone who is younger
and has not developed this kind of circulation.
TYPES OF DIETARY FATS
Saturated (hardest to break down):
- Animal fat, oils, butter, cream cheese, sour cream.
Monounsaturated (medium):
- Fish oil, avocados, nuts, olives.
Polyunsaturated (the best):
-Vegetable oils, seeds, margarine.
, Week Nine: Angina
Ischemia: decreased blood flow to tissue.
- Often the demand is greater than the supply. If the coronary artery is already clogged, then it makes it
more likely to develop ischemia.
Infarction: absent blood flow to tissue.
- This is irreversible and causes cell death (necrosis). This is usually due to thrombis.
- Distal (apex) of the heart is not being perfused.
POSSIBLE RISK FACTORS FOR MI
Anemia: low iron, low HBG and low carrying capacity.
Hypoemia: low O2 in the blood
Low blood volume
Asthma and COPD: not getting proper gas exchange
ASSESSMENT OF CHEST PAIN
Use your OPQRSTUA
Angina should not radiate, that is your indicator something is very wrong.
TYPES OF ANGINA
Chronic Stable Angina -Angina stops when activity stops.
-Comes on with coughing, exertion, caffeine, exercise.
-Stops 15 minutes after rest begins.
Unstable Angina -Very dangerous, emergency.
-You have pain at rest, and pain after pharmacological intervention.
-If blood flow is not fixed and restored, MI may occur.
Vasospastic Angina -Caused by spasms in the arteries
(Prinzmetal/ Variant) -ONLY ONE that is caused by atherosclerosis.
-Chest pain is the main symptom.
-Will work with the medications.
-Caused from spasms.
Week Nine: Coronary Artery Disease
CORONARY ARTERIES OVERVIEW
“Heart Disease” is the common term.
The coronary artery is the main artery for transporting and perfusing O2 to the heart.
Women’s arteries tend to be smaller, which makes them more at risk for heart disease.
Coronary Artery Disease: A type of blood vessel disorder that is included in the general category of
atherosclerosis (narrow/thick arteries)
Atherosclerosis = CAD
- Can occur in any artery in the body, not just coronary.
- Begins as soft deposits of fat in the arteries and hardens with age.
- It is caused by endothelial injury
Characterized by:
-Deposits of cholesterol and lipids, primarily within walls of the artery.
-Endothelial injury, platelets stick to it when they normally do not, this happens from bad habits.
Atheroma’s (fatty deposits): preference the coronary arteries.
In the artery…
- There may be a crack in the endothelium where plaque and blood build up, which will decrease BF,
which leads to a lack of O2, which can cause an MI due to blocked coronary artery from plaque buildup.
PATHOGENESIS OF ATHEROSCLEROSIS
A. Damaged endothelium (a tear forms)
B. Fatty streak and lipid core formation
C. Fibrous plaque builds
D. Complicated lesions: Plaque ruptures and blood and platelets get stuck forming a thrombus (clot)
This happens over time..
Step 1. A fatty streak starts (this is permanent).
Step 2: Fat deposits in the fatty streak.
Step 3: Blood vessel becomes narrowed and impairs BF as plaque thickens.
,ETIOLOGY & PATHOPHYSIOLOGY
Healthy endothelium should not be reactive to platelets and leukocytes and fibrin.
Once it is damaged, things will stick to the wall of the endothelial lining. This injury is the leading cause of
atherosclerotic disease.
Occurs from: Hyperlipidemia, HTN, Diabetes, infections, immune reactions.
Bacteria and or viruses may have a role in damaging endothelium and causing inflammation.
ex.) Endocarditis of myocardium.
C-reactive Protein (CRP)
- Inflammation marker (non-specific)
- Will be high in patients with CAD.
- Chronic exposure of CRP triggers ruptures of plaques.
Steps of developing CAD:
1. Endothelial alteration: platelets are activated
-Growth factor stimulates smooth muscles and thicken the arterial wall.
-Cells trap lipids, which calcify overtime, forms an illient to the endothelium where platelets aggregate.
2. Thrombin is generated.
-Fibrin formation and thrombi occur causing further narrowing / total occlusion.
Collateral Circulation:
Ex.) EC row has an accident? Get off at the next exit.
Our blood vessels do the same thing, they will take detours around atherosclerotic plaques to avoid getting
stuck.
This is why someone who is older has a better change of surviving a heart attack then someone who is younger
and has not developed this kind of circulation.
TYPES OF DIETARY FATS
Saturated (hardest to break down):
- Animal fat, oils, butter, cream cheese, sour cream.
Monounsaturated (medium):
- Fish oil, avocados, nuts, olives.
Polyunsaturated (the best):
-Vegetable oils, seeds, margarine.
, Week Nine: Angina
Ischemia: decreased blood flow to tissue.
- Often the demand is greater than the supply. If the coronary artery is already clogged, then it makes it
more likely to develop ischemia.
Infarction: absent blood flow to tissue.
- This is irreversible and causes cell death (necrosis). This is usually due to thrombis.
- Distal (apex) of the heart is not being perfused.
POSSIBLE RISK FACTORS FOR MI
Anemia: low iron, low HBG and low carrying capacity.
Hypoemia: low O2 in the blood
Low blood volume
Asthma and COPD: not getting proper gas exchange
ASSESSMENT OF CHEST PAIN
Use your OPQRSTUA
Angina should not radiate, that is your indicator something is very wrong.
TYPES OF ANGINA
Chronic Stable Angina -Angina stops when activity stops.
-Comes on with coughing, exertion, caffeine, exercise.
-Stops 15 minutes after rest begins.
Unstable Angina -Very dangerous, emergency.
-You have pain at rest, and pain after pharmacological intervention.
-If blood flow is not fixed and restored, MI may occur.
Vasospastic Angina -Caused by spasms in the arteries
(Prinzmetal/ Variant) -ONLY ONE that is caused by atherosclerosis.
-Chest pain is the main symptom.
-Will work with the medications.
-Caused from spasms.
