S2W5 Myocardial ischaemia as a drug target DH

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Why is coronary circulation needed?
The muscle thickness means that nutrients can only feed the first layer of cells by diffusion alone, so an expandive network of blood vessels is required.
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What are the key arteries in coronary circulation?
Aorta, right coronary artery, posterior lateral artery, posterior descending artery, diagonal artery, left coronary artery, left circumflex artery, obtuse marginal artery, left anterior descending artery.
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What are some features of coronary circulation?
Maintain high basal rate of O2 supply
High capillary density
High oxygen extraction -~80% aerobic
increase proportional to an increase cardiac demand (increased O2 consumption with an increased blood flow)
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What are some problems with coronary circulation?
Systole impairs coronary perfusion
Coronary arteries are 'end arteries' so they have some structural problems.
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What two factors limit blood supply in the endocardial region?
Intraventricular pressure and cardiomyocyte shortening
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What factors lead to poor myocardial perfusion?
coronary artery narrowing
Atheroma formation
Thrombus
Vasospasm
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What is the pain associated with myocardial ischaemia?
AnginaW
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What are some diagnosis for myocardial ischaemia?
ECG
Angiogram
Biochemical markers
Aspartate transaminase
Creatine kinase
Troponin C
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Treatment for reversible ischaemia (angina)?
B adrenergic receptor blockers
Nitrates
Calcium entry blockers
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What is the role of B adrenergic receptor blockers?
Slow heart rate
Reduce force of contraction
Prevents response to exercise
Reduces arterial blood pressure
This all leads to a decreased demand and an improved perfusion
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What is the role of nitrates?
.i.e Glyceral trinitrate given as a tablet or spray
They donate NO and increase cGMP which causes a decrease in smooth muscle tone
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What is the role of calcium channel blockers?
.i.e amlodipine inhibit calcium influx to VSM, cardiomyocytes and conducting cells and prevent muscle contraction (hypertension)
Decrease afterload
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Other cards in this set

Card 2

Front

What are the key arteries in coronary circulation?

Back

Aorta, right coronary artery, posterior lateral artery, posterior descending artery, diagonal artery, left coronary artery, left circumflex artery, obtuse marginal artery, left anterior descending artery.

Card 3

Front

What are some features of coronary circulation?

Back

Preview of the front of card 3

Card 4

Front

What are some problems with coronary circulation?

Back

Preview of the front of card 4

Card 5

Front

What two factors limit blood supply in the endocardial region?

Back

Preview of the front of card 5
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