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Unlock your guides7.2 Coronary Artery Disease and Myocardial Infarction
3 min read•july 24, 2024
is a sneaky process that builds up over time, narrowing arteries and starving the heart of oxygen. It's like plaque slowly clogging pipes, but in your blood vessels. This gradual damage can lead to serious heart problems if left unchecked.
is the end result of atherosclerosis in the heart's arteries. When these vital blood vessels get too narrow, the heart muscle suffers. This can cause chest pain, heart attacks, and other complications that seriously impact your health and quality of life.
Atherosclerosis and Coronary Artery Disease
Pathophysiology of atherosclerosis
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- Atherosclerosis development progresses through several stages
- Endothelial dysfunction damages arterial lining initiates process
- Lipid accumulation in arterial walls forms fatty streaks (LDL cholesterol)
- Inflammatory response recruits immune cells (macrophages, T-cells)
- Smooth muscle cell proliferation creates fibrous cap over lipid core
- Plaque formation narrows artery lumen reduces blood flow
- Progression of atherosclerosis in coronary arteries gradually worsens over time
- Narrowing of arterial lumen decreases blood flow capacity
- Reduced blood flow to myocardium leads to (oxygen deprivation)
- Potential plaque rupture and thrombosis causes acute coronary events (heart attack)
- Effects on coronary circulation impair heart function
- Decreased oxygen supply to heart muscle reduces contractility
- Impaired removal of metabolic waste products (lactic acid) further damages tissue
Process of myocardial ischemia
- Myocardial ischemia occurs when oxygen demand exceeds supply
- Imbalance between oxygen supply and demand stresses heart muscle
- Causes: atherosclerosis, coronary vasospasm, or increased myocardial workload ()
- Reversible if blood flow restored quickly (within minutes)
- Progression to myocardial infarction happens if ischemia persists
- Prolonged ischemia leads to cell death () of heart muscle
- Necrosis begins after 20-40 minutes of ischemia spreads from endocardium to epicardium
- Infarct expansion over several hours increases damaged area
- Types of myocardial infarction classified by ECG changes
- ST-elevation myocardial infarction (STEMI) indicates full-thickness damage
- Non-ST-elevation myocardial infarction (NSTEMI) suggests partial-thickness injury
Risk Factors, Clinical Manifestations, and Management
Risk factors for coronary disease
- Modifiable risk factors can be controlled or eliminated
- Hypertension damages arterial walls increases plaque formation
- contributes to cholesterol buildup in arteries
- reduces oxygen in blood promotes plaque formation
- accelerates atherosclerosis through multiple mechanisms
- increases strain on heart elevates other risk factors
- weakens heart muscle reduces overall cardiovascular health
- Non-modifiable risk factors cannot be changed
- increases risk as arteries naturally stiffen over time
- associated with earlier onset of CAD
- indicates genetic predisposition
- affects risk (higher in South Asians, African Americans)
- Clinical manifestations vary in severity and duration
- presents as chest pain or pressure (often radiating)
- occurs due to reduced cardiac output
- results from inadequate blood supply to muscles
- may indicate
- common in inferior wall MIs
- often accompanies acute coronary events
Complications of myocardial infarction
- Complications can occur acutely or develop over time
- Arrhythmias disrupt normal heart rhythm (ventricular fibrillation, atrial fibrillation)
- develops when damaged heart can't pump effectively
- results from severe pump failure
- rare but often fatal complication
- inflammation of heart lining can occur days after MI
- Immediate management focuses on restoring blood flow and limiting damage
- improves myocardial oxygenation
- reduces myocardial oxygen demand (morphine)
- prevent further clot formation (aspirin, clopidogrel)
- reduces risk of additional thrombosis (heparin)
- aim to restore blood flow quickly
- uses drugs to dissolve clots (tPA)
- (PCI) mechanically opens blocked arteries
- Long-term management prevents future events and promotes recovery
- Medication therapy reduces risk factors and supports heart function
- decrease heart rate and blood pressure
- improve cardiac remodeling
- lower cholesterol levels
- Lifestyle modifications address modifiable risk factors
- improves functional capacity and quality of life
- Regular follow-up and monitoring detect complications early
- Medication therapy reduces risk factors and supports heart function
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