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IschemicHeartDiseaseKongxiangqingMD
DEFINITIONDuetoatheroscleroticnarrowingofcoronaryartery,mostcommoncauseofstenosisofcoronaryartery,coronaryarterialinsufficiencyleadstointermittentmyocardialischemiaoreventhedeathofmyocardium.
PathophysiologyMyocardialoxygendemandexceedssupply.
SupplyreducedStenoticatheromatousdiseaseofepicardialcoronarydiseaseThrombosiswithinthearteriesSpasmofnormalcoronaryarteryInflammation–arteritisCongenitalcoronaryanomaly
ProgressionofAtherosclerosisAdaptedfromStary,inFusteretal,eds.AtherosclerosisandCoronaryArteryDisease.1996.Coronaryarteryatlesion-pronelocationTypeIIlesionTypeIII
(preatheroma)TypeIV
(atheroma)TypeVa
(fibroatheroma)TypeVI
(complicatedlesion)Adaptivethickening(smoothmuscle)IntimaMediaMacrophagefoamcellsSmallpoolsofextracellularlipidFibrousthickeningCoreofextracellularlipidThrombusFissureandhematoma
Thick,VascularSmooth
MuscleCell(VSMC)-richfibrouscapTheStableAtheroscleroticPlaque
ThinFibrousCapLipidCoreUnstablePlaque
ThrombusInflammatory
CellsFew
SMCsActivated
MacrophagesRupturedPlaque
DemandincreasedInconditionsrequiringincreasedcardiacoutput–Exercise,stress,thyrotoxicosisInconditionsnecessitatinggreatercardiacworktomaintainanadequateoutput–aorticstenosisInconditionswhereperipheralvascularresistanceisincreased–hypertension
FactorsinvolvedinischemiaSupplyfactorcommentsCoronarybloodflowDecreasedbyfixedstenosisVasculartone—dependonanumberoffactors,I.e.nitricoxide(endotheliumdependentrelaxingfactor)OxygencarryingcapacityReducedinanaemiaandcarboxyhemaglobinemiaDemandfactorCommentsHeartrateExercrise,emotioncontractilityDecreasedbyrestandnegativelyinotropic(betablocker)WalltensionIncreasedbyleftventriculardilation
RiskfactorsAge,sex(manwomen),familyhistoryDiet–muchfatDisturbanceoflipid–hypercholesterolaemiaHypertensionSmokingDiab
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