CORONARY ARTERY DISEASE PATHOPHYSIOLOGY

Non Modifiable Factors Age Gender Family History Modifiable factors Smoking Lack of exercise Stress Diet high in fat Hypertension Elevated Serum cholesterol levels Alcohol consumption Diabetes Mellitus

Non-specific injury to arterial wall (Endothelial Injury)

Desquamation of endothelial lining

Increased Permeability or Adhesion of Molecules

Lipids (LDL) and Platelets Assimilate in the Area

Oxydized LDL attracts monocytes and macrophages to the site

Plaques begin to form from cells which imbibed into the endothelium

Lipids are engulfted by the cells (foam cells) and Smooth Muscle Cells Develop

Disruption of Plaque Continuous aggregation of platelets

Thrombus Formation

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Rapid increase in size of the thrombus in Coronary Artery Wall

Coronary Atherosclerotic Heart Disease/CAD

Reduction of blood flow

Decreased Blood Supply to the Myocardium

Decreased Myocardial Oxygen Supply

Myocardial Ischemia

Anaerobic metabolism Necrosis

Myocardial Cell

More Lactic Acid Production

Inflammatory response

Increase WBC Chest Pain Acidosis

Myocardial cells are sensitive to changes in pH and become less functional

Released of endogenous pyrogens

Pyrogens will stimulate the release of prostaglandins

Conduction System Disorder Prostaglandins will reset the Hypothalamic thermostat to high temperature Decreased myocardial contractility Fever/Hyperthermia Decreased Cardiac Output Decreased systemic circulation

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Hypotension

Redirection of blood away from the skin to the major organs

Sympathetic receptors are stimulated Inadequate Pallor Increase in heart rate/ pumping action as a compensatory mechanism Fatigue Weakness Tachycardia Deterioration of hearts ability to pump cerebral perfusion oxygenated blood to other organs Decreased perfusion of

Loss of Consciousness /Dizziness

Dyspnea, and Body

Moderate left ventricular failure Decreased arterial pressure

Stimulation of Baroreceptors

Right side of the heart continuously propel blood to the lungs

Peripheral Vasoconstriction

Left ventricle is unable to fully eject the returning blood to systemic circulation

Pulmonary Congestion Hypertension

Dyspnea

Adventitious breath sounds

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