Coronary Artery Disease Pathophysiology

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					                       CORONARY ARTERY DISEASE
Non Modifiable Factors                                               Modifiable factors
Age                                                                            Smoking
Gender                                                                  Lack of exercise
Family History                                                                     Stress
                                                                           Diet high in fat
                                                              Elevated Serum cholesterol
                                                                    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

              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


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

      Decreased Cardiac Output                       Decreased systemic circulation

          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                                               /Dizziness                and Body

                        Deterioration of heart’s 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

                                        Dyspnea           Adventitious breath sounds


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