EXAM 2 PATHOPHISIOLOGY – CV, Resp,
Musculoskeletal
1. Discuss pathophysiology of coronary artery
disease (CAD).
•Coronary Arteries: Supply blood to the heart
oAtherosclerosis – plaque formation on artery walls
▪Plaque formation starts forming in early adulthood
▪Usually forms in the bigger vessels
❖Coronary artery beds, aorta, carotids, vertebral, renal,
femoral
▪Protrudes into lumen, partially or completely obstructing
blood flow
▪Leading factor in cardiovascular disease
▪Fibrotic plaques become calcified, hemorrhagic,
ulcerated, or thrombosed
▪Injury of Endothelial cells in tunica intima- inflammatory
process begins
▪LDL cholesterol invades tunica intima layer
❖Macrophages “eat up” LDL & die (foam cells)
❖Foam cells accumulate; build fatty layers (fatty streaks)
▪Smooth muscle cells of tunica media migrate to fatty
streaks
❖Form fibrous cap (collagen & elastin) over fatty streaks
and lays down calcium deposits (PLAQUE structure)
▪Process repeats, artery becomes stiff, plaque narrows
lumen & decreases blood flow (less O2 to tissue)
Acute Coronary Disease
▪Plaque is a problem (atherosclerosis)
❖Unstable plaque – ruptured and thrombus
❖Stable plaque – obstructs blood flow
▪Plaque vulnerability to rupture: size of lipid core; lack of stabilizing smooth muscle cells;
presence of inflammation; stability and thickness of fibrous caps
2. Describe the pathophysiology of the different types of angina.
CHRONIC STABLE ANGINA: Predictable
➢Imbalance between blood flow and the metabolic demands of myocardium
➢Physical exertion, emotional stress, exposure to cold
oSteady constricting, squeezing, or suffocating sensation
oIncreases in intensity at onset and end of episode
oRelieved with rest and nitroglycerin
oDelay of more than 5-10 minutes for relief is a sign of more severe ischemia!
PRINZMENTAL ANGINA (variant angina):
➢Coronary artery Spasm
➢Happens at rest; usually at night
UNSTABLE ANGINA:
➢Acute coronary syndrome
