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The Atherosclerotic Process
The progressive __________ and
hardening of the artery due to the
build up of _________
Coronary Artery Disease
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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 arteryEndothelial 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
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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” Platelets
1.
2.
3.
Platelets are drawn to site of damaged
endothelial cells
Platelets release platelet derived
growth factors to help heal injured site
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

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
______ 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
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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
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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

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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 skin
First Aid Treatment?
Stroke
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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)
Stroke
Cerebral Vascular Accident
Signs
 Weakness, paralysis,
on one side of body
 Blurred vision in one
eye (unequal pupils)
 Sudden headache
 Dizziness, loss of
balance
First 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