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What percentage of coronary heart disease (CHD) cases are attributed to atherosclerosis?
Which statement accurately describes the process occurring during coronary thrombosis?
How often does someone in the UK die from coronary heart disease (CHD)?
What prominent symptom is associated with stable angina?
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What is a significant consequence of the rupture of an atheroma?
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What is the main cause of variant angina?
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What describes the overall economic impact of coronary heart disease in the UK as of 2018?
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Which mechanism primarily leads to foam cell formation during atherosclerosis?
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What is indicated by a complete and permanent occlusion of a coronary artery?
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Which factor does NOT typically contribute to coronary artery spasm?
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What characterizes the pathological conditions referred to as coronary heart disease?
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What is a primary determinant of myocardial ischaemia?
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Which of the following statements is true regarding myocardial ischaemia?
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What is a common statistic associated with coronary heart disease in the UK?
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Which term describes the lack of oxygen and nutrient supply to an organ or tissue?
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Which type of ischaemia reflects an imbalance during physical activity?
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What is the primary contributing factor to the morbidity associated with coronary heart disease?
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What aspect of coronary heart disease contributes to it being a leading cause of death worldwide?
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How does the demand for myocardial oxygen change during physical exertion?
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What is one of the main socio-economic impacts of coronary heart disease?
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What is one of the key processes involved in the pathogenesis of coronary heart disease?
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Which of the following clinical manifestations are associated with coronary heart disease?
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Which consequence is a direct result of myocardial ischaemia?
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What major factor predisposes individuals to coronary heart disease?
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In understanding cardiovascular diseases, which area is crucial for students to have knowledge of prior to the lectures?
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Which of the following terms best describes the obstruction in coronary arteries leading to coronary heart disease?
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Which of the following is NOT a major consideration in the natural history of coronary heart disease?
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Which process describes an abnormality in coronary arteries potentially leading to coronary heart disease?
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What topic is covered in relation to clinical management of coronary heart disease?
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What is a primary reason for reviewing previous lectures on the circulatory system before starting this series?
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What is the primary effect of coronary microvascular dysfunction on the heart?
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Which mechanism is primarily responsible for microvascular obstruction in coronary microvascular dysfunction?
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What is the underlying cause of microvascular angina?
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Which of the following characterizes endothelial dysfunction within the context of coronary microvascular dysfunction?
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In the context of coronary microvascular dysfunction, what does microvascular remodelling lead to?
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What functional abnormalities may contribute to coronary microvascular dysfunction?
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Which of the following is a potential consequence of reduced coronary flow reserve?
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What role does the coronary microvasculature play in relation to epicardial coronary arteries?
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What is a sign of impaired coronary blood flow during physical activity?
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What does INOCA stand for in relation to coronary microvascular dysfunction?
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Study Notes
Coronary Heart Disease Overview
- Coronary heart disease (CHD) is a pathological state caused by reduced or inadequate blood flow to the heart, often due to obstructive or constrictive diseases of coronary arteries.
- CHD is the leading cause of death worldwide.
- One in eight deaths in men and one in fourteen deaths in women in the UK are due to CHD.
- Overall, CHD costs the UK economy £12.7 billion annually.
- CHD can manifest clinically as chest pain, sudden cardiac death, and acute coronary syndromes (ACS).
- ACS includes unstable angina and acute myocardial infarction (NSTEMI, STEMI).
- Atherosclerosis, coronary thrombosis, coronary artery spasm, and coronary microvascular dysfunction are the major pathological processes that can cause CHD.
Atherosclerosis
- Atherosclerosis is a chronic inflammatory process that occurs over time.
- It is an asymmetric deposition of lipids and fibrous tissue on the inner wall of arteries.
- It is responsible for more than ninety percent of CHD cases.
- It begins early in life with the formation of a “fatty streak” on the arterial wall.
- In the coronary arteries, it is mainly LDL deposition in the sub-endothelial space that initiates the process of atherosclerosis.
- Oxidation of LDL and recruitment of monocytes into the sub-endothelial space is a key feature of atherosclerosis.
- Foam cells are formed when macrophages differentiate and ingest oxidized LDL.
- SMC migration, proliferation, and de-differentiation result in the formation of fibrous plaques or atheromas.
Atherosclerosis - Consequences
- Partial coronary occlusion leads to stable angina.
- Endothelial or vascular dysfunction can lead to coronary artery spasm.
- Ulceration or rupture of atherosclerotic plaque can result in coronary thrombosis.
Coronary Thrombosis
- The formation of a blood clot within coronary arteries is called coronary thrombosis.
- It is seen in thirty to ninety percent of patients with ACS.
- Coronary thrombosis usually occurs on top of ruptured atheroma.
- Platelet aggregation and activation of the coagulation cascade play important roles.
Coronary Thrombosis - Consequences
- Complete and permanent occlusion of a coronary artery leads to STEMI.
- Subtotal or intermittent occlusion of a coronary artery leads to UA/NSTEMI.
- Thromboembolism in a distal artery can occur.
Coronary Artery Spasm
- Coronary artery spasm is a transient and spontaneous vasoconstriction of a coronary artery.
- Spasm may happen in normal coronary arteries, vessels with mild atherosclerosis or during ongoing coronary thrombosis.
- Coronary artery spasm is the underlying cause of variant angina.
Coronary Artery Spasm - Mechanisms
- Local endothelial injury can increase reactivity to vasoconstrictors.
- Abnormal release of vasoconstrictors or an imbalance in the release of vasodilators can lead to spasm.
- Enhanced smooth muscle cell contractility can lead to spasm.
Coronary Artery Spasm - consequences
- Subtotal or intermittent occlusion of a coronary artery can occur.
- Focal occlusion of a coronary artery can occur.
Coronary Microvascular Dysfunction
- Damage to the inner walls of small coronary arteries is referred to as coronary microvascular dysfunction.
- It can cause microvascular spasms, decrease blood flow to the heart muscle, and reduce coronary flow reserve.
- Damage can be structural (microvascular remodeling) or functional (endothelial dysfunction).
- It is associated with microvascular angina.
Coronary Microvascular Dysfunction - Mechanisms
- Microvascular modeling results in luminal narrowing, leading to microvascular obstruction.
- Endothelial dysfunction can lead to reduced vasodilator response and decreased coronary blood flow during exercise or stress.
- Functional abnormalities of smooth muscle cells can regulate arteriolar tone.
Coronary Microvascular Dysfunction - Consequences
- Reduced coronary flow reserve.
- Increased risk of myocardial ischemia.
- INOCA (Ischemic Non-Obstructive Coronary Artery Disease)
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Description
This quiz covers essential information about Coronary Heart Disease (CHD), including its causes, symptoms, and economic impact. Learn about the role of atherosclerosis and the various clinical manifestations of CHD, as well as its significance as a leading cause of death worldwide.
