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” Platelets 1. 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 skin First 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)

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