The Atherosclerotic Process

The progressive __________ and hardening of the artery

due to the build up of _________

Coronary Artery Disease Atherosclerosis of the coronary

arteries that feed the heart muscle (myocardium)

1.2 to 1.5 million heart attacks each year

450,000 to 500,000 deaths annually

Section of an artery- Endothelial Cells & their function

Release ___________: Keeps _______

from sticking to wall of artery

Stimulates _______ to relax (dilation) for optimal blood flow

Healthy Artery and Normal Blood Flow (left side diagram)

Four Pathological Mechanisms of Coronary Artery Disease

1. ______________________________2. ______________________________3. ______________________________4. ______________________________

(1)Factors that damage endothelial cells (EC’s) = dysfunctional

Cigarette smoke High blood cholesterol High blood pressure Diabetes (high blood sugar) High levels of homocysteine Excessive free radicals (oxidants)

(1)Damaged EC’s & (2)Platelet hyperactivity (right side diag.)

(2)“Hyperactive” Platelets1. Platelets are drawn to site of

damaged endothelial cells 2. Platelets release platelet derived

growth factors to help heal injured site

3. If platelets are “_____________”:- Release excessive growth factors that cause VSMC division & migration inward thus narrowing the lumen

(3)Oxidation of LDL Chol. & (4)Inflammatory Response

(3)Oxidation of LDL Cholesterol ______ cholesterol diffuses through EC’s in

and out of wall of artery. (concentration gradient)

If there is excessive amounts of LDL cholesterol it is more likely to become “________” (M-LDL) while in the arterial wall.

If oxidized, LDL cholesterol is toxic to the body and an immune inflammatory response is initiated.

(4)Inflammatory Response If LDL is oxidized (M-LDL) WBC’s

(__________) are drawn to the site and become ____________ (MAC) as they enter the wall of the artery

Macrophages scavenge “oxidized” LDL cholesterol and become ___________ – the major component of plaque

Plaque rupture and platelet clot (thrombosis) may form in artery

Plaque _________ and platelets rush to the rupture site

Clot forms that may obstruct artery and interrupt blood flow

If blood flow is significantly interrupted a heart attack or stroke may result

Heart Attack Myocardial Infarction: Death

(_______) of a portion of the heart muscle caused by coronary artery obstruction causing interruption of normal blood flow to an area of the heart (__________)

______________: chest pain caused by myocardial ischemia

Heart Attack(Myocardial Infarction)

Signs Chest pain (angina) Breathing Difficulty Pain in shoulders,

arms, jaw, back Nausea Pale skinFirst Aid Treatment?

Stroke Cerebral Vascular Accident: Death

(necrosis) of a portion of brain tissue caused by obstruction or rupture of a cerebral artery and interruption of normal blood flow to a part of the brain

___% Obstructive or ischemic ___% Hemorrhagic (____________ ruptures)

- aneurysm is a weakening and ballooning of a vessel

750,000 strokes/year (160,000 deaths)

StrokeCerebral Vascular Accident

Signs Weakness,

paralysis, on one side of body

Blurred vision in one eye (unequal pupils)

Sudden headache Dizziness, loss of

balanceFirst Aid Treatment?

Strategies for the Prevention &/or Treatment of the Pathological Mechanisms of CHD

Endothelial Cell Dysfunction?

Platelet Hyperactivity?

Oxidation of LDL Cholesterol?

Inflammatory Immune Response?

Coronary Bypass Surgery

Coronary Balloon Angioplasty