BIOL122 Lecture Notes - Lecture 5: Troponin, Calcium Channel Blocker, Transdermal Patch
Coronary Artery Disease (CAD)
Myocardial requirements:
• Adequate blood flow: oxygen and nutrients
• Balance between oxygen supply and demand: oxygen demand increases if
HR speeds up or force of contraction becomes stronger.
Coronary artery disease:
• Narrowing/ blockage of coronary arteries: atherosclerosis
• Inadequate blood flow to myocardium: less oxygen and nutrients, damage
and death of cells
Risk factors of CAD:
- Aging
- Smoking
- Family history
- Hypertension
- Obesity
- Diabetes
- Lack of exercise
- Hyperlipidaemia
Pathogenesis of CAD: severe chronic atherosclerosis that causes narrowing of
the lumen of one or more coronary arteries
Angina pectoris:
• Chest pain caused by insufficient blood flow and oxygen to heart muscle:
imbalance between hearts oxygen demand and supply
• Blood flow is restored, pain recedes and heart is not permanently
damaged
Forms of Angina Pectoris:
- Stable angina: chest pain associated with exertion
- Unstable angina: chest pain with less exertion
- Variant angina: pain occurs at rest
Pathogenesis (angina)
• Atherosclerosis develops in coronary artery
• Plaques protrude into lumen
• Partial obstruction to blood flow
• Less oxygen available to myocardium
• Increased cardiac demand (exercise)
• Anaerobic respiration
• Increased adenosine phosphate in ECF
• Chest pain
Consequences of Ischemia:
• Heart attack
- Part of the heart muscle is destroyed, causing serious and in
some cases fatal heart damage
• Irregular heart rhythm (arrhythmia)
- Electrical impulses in heart may malfunction, causing your
heart to beat too fast, too slow or irregularly
• Heart failure
- Damage to heart muscle can reduce its ability to effectively
pump blood. Over time this can lead to heart failure
ECG changes (myocardial ischemia)
Abnormalities in ST segment:
Myocardial infraction:
• Reduced blood flow through coronary arteries
• Myocardial cells die from lack of oxygen
• Collagen scar forms
Pathogenesis:
• Disruption of atherosclerotic plaque: rupture
• Clotting cascade (thrombus)
• Coronary artery occlusion
• Myocardial cell death
• Scar tissue formation
Clinical manifestations (MI)
• Severe crushing chest pain
• Angina pectoris before MI in some people
• Shortness of breath due to pulmonary congestion and oedema
• Cardiogenic shock
• Dysrhythmia
Diagnosis: (MI)
• ECG:
+ to detect ischemia or acute coronary injury
+ STEMI, NSTEMI
• Cardiac markers:
+ creatine kinase, troponin
+ leak out of injured myocardial cells into blood
+ levels rise over time
Treatment:
• Glyceryl trinitrate: vasodilator
• Coronary stenting: pushes back plaque and restores blood flow
• Coronary artery bypass graft: healthy blood vessel is connected to coronary
artery slightly past site of blockage
Stroke:
Brain blood supply:
• Receives 20% of cardiac output: top priority for blood, nerve cells will die
without oxygen
• Cerebral arteries: middle, anterior and posterior
• Circle of Willis: back up routes for blood flow
• Cerebral blood flow stable:
Document Summary
Myocardial requirements: adequate blood flow: oxygen and nutrients, balance between oxygen supply and demand: oxygen demand increases if. Hr speeds up or force of contraction becomes stronger. Coronary artery disease: narrowing/ blockage of coronary arteries: atherosclerosis. Inadequate blood flow to myocardium: less oxygen and nutrients, damage and death of cells. Pathogenesis of cad: severe chronic atherosclerosis that causes narrowing of the lumen of one or more coronary arteries. Angina pectoris: chest pain caused by insufficient blood flow and oxygen to heart muscle: imbalance between hearts oxygen demand and supply, blood flow is restored, pain recedes and heart is not permanently damaged. Stable angina: chest pain associated with exertion. Unstable angina: chest pain with less exertion. Pathogenesis (angina: atherosclerosis develops in coronary artery, plaques protrude into lumen, partial obstruction to blood flow, less oxygen available to myocardium. Increased adenosine phosphate in ecf: chest pain. Part of the heart muscle is destroyed, causing serious and in some cases fatal heart damage.