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CORONARY ARTERY DISEASE

PATHOPHYSIOLOGY
Non Modifiable Factors Modifiable factors
Age Smoking
Gender Lack of exercise
Family History 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 Myocardial Cell Necrosis

More Lactic Acid Production Inflammatory response

Increase WBC
Chest Pain Acidosis

Myocardial cells Released of endogenous pyrogens


are sensitive to
changes in pH and
become less Pyrogens will stimulate the release of
functional 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 Decreased
perfusion of Pallor
cerebral oxygenated blood to
Increase in heart perfusion other
organs
rate/ pumping action

as a compensatory
mechanism Loss of Consciousness
Dyspnea, Fatigue
/Dizzine ss and Body Weakness

Tachycardia
Deterioration of hearts ability to pump

Moderate left ventricular failure


Decreased arterial pressure

Right side of the heart continuously


Stimulation of Baroreceptors propel blood to the lungs

Left ventricle is unable to fully


eject
Peripheral Vasoconstriction the returning blood to systemic circulation

Pulmonary
Congestion
Hypertension

Dyspnea Adventitious breath


sounds

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