00:00
Now that we've
clarified that topic.
00:02
Let's take a look at the
blood vessels and the changes
that happen in heart disease.
00:07
Now we've covered this
in detail in other areas,
but I want to give
you a quick review.
00:12
This is a beautiful
drawing and it's worth just
hanging out here
for a little bit
so you can make sense of
all that we have here.
00:19
I'll help you with
your learning.
00:20
Now first let's look at the key.
00:22
I want to orient you,
see the endothelial cells
and what they look like.
00:27
So look at the normal
vessel farthest on the left,
endothelial cells,
see those all the way around.
00:34
Then look at the structures
that are the neutrophils.
00:36
Found them?
Cool!
Now look for the platelets.
00:41
I want you to look through each
one of these five drawings
and see where you
see them present.
00:48
Now note the red blood cells
or those biconcave disc their
job is to carry hemoglobin
and therefore oxygen
to the tissues
look for them in all four,
and five of the drawings.
01:03
Now lastly,
you've got a thrombus
so you don't see
that in the first one
not in the second
one, not in the third,
but look at what's going on
in that fourth and fifth one.
01:16
Yeah those both have thrombi.
01:19
They both have a clot.
01:21
But I want you to notice the
difference between 4 and 5.
01:25
Okay, it's clearly much bigger
in the fifth one or infarct.
01:31
So see that's what happens in
these blood vessels as they change.
01:35
Let's start back
at the normal one.
01:36
Now you've been introduced
to all the players.
01:38
So, you know what those are.
01:39
Look at the normal vessel.
01:41
Everybody's there.
01:42
Everything's moving freely.
01:44
That's a good blood supply.
01:46
Now someone who has that.
01:48
What is that yellow stuff
on the top for the roof
of their vessel there?
That's atherosclerotic plaque.
01:55
So this likely happened
over a period of time.
01:57
There's some type
of initial injury,
fatty substances and the
inflammatories responded,
the platelets put out
that growth factor,
then you got all that
stuff trapped in there
and it eventually became
hardened tough fibrous plaque
that's made the vessel smaller.
02:13
Now that's why you can
have exertional angina.
02:16
That means if I'm at rest
with exertional
angina, I'm fine.
02:20
My heart muscle,
I shouldn't have any chest pain
because there's still enough blood
scooting by there to be okay,
but if I do something that requires
the heart to need more oxygen,
I work hard,
I do some heavy lifting,
I do something
that makes my heart
pump harder and faster.
02:37
Now I'm going to...
02:39
it's not going to be adequate
oxygen supply to my heart
because of the exertion
because I'm asking
more of my heart.
02:46
It's wanting more
oxygen delivered
and because that vessel has
been narrowed from plaque
just can't provide it.
02:54
That's what causes
exertional angina.
02:57
These patients,
if we have them rest or maybe
take a little nitroglycerin.
03:01
It should go away and they
know what starts the angina,
they know it starts
the chest pain
because they were out
shoveling something or running
or doing some type of
exercise or activity
that exerted them.
03:13
So if you're helping a patient
with exertional angina,
we likely know they have it.
03:18
They know this brings it on.
03:20
They've been diagnosed with this
before then they have a plan.
03:23
They know what to do.
03:24
Now look at the the next one.
03:27
Vasospastic angina.
03:29
What's different about that
vessel compared to the first two?
It's a lot smaller.
03:35
You got it.
03:36
That's because,
its kind of clamping down
so you can see we've
got much less area
for the blood to be delivered to
you, right?
That pipe is much much smaller
because of the vasospasm.
03:49
Now remember what's all
the way around that vessel
right, smooth muscle.
03:55
So that's why I can
clamp down like that.
03:59
So you liked it a normal vessel.
04:01
We've looked at why people with
exertional angina can be fine
if they're at rest,
but if they do something
that raises their heart rate
or elevates that
then we know that's why
they can have chest pain.
04:12
Vasospastic means
they didn't wasn't because
they were doing exercise.
04:15
It can just randomly happen
and with that smooth
muscle all the way around.
04:20
It's no problem for it
to clamp down in a spasm.
04:23
Here's the last two that It's
really important you understand.
04:27
This is much different.
04:30
Okay with unstable angina
or what's the difference
between unstable and exertional?
Will see what's going on here.
04:39
We have narrowing
of the arteries.
04:41
Yeah, both pictures have
atherosclerotic plaque.
04:45
That's the same both
pictures of red cells
still got those players there
but introduction, right there.
04:54
You've got a thrombus.
04:56
So this is what can
happen in unstable angina.
05:00
This is why it's a
medical emergency.
05:03
See it's narrower now that
clot, that thrombus
that's developed
from many places
have no idea right now
where it's coming from.
05:11
That's not the most
important point.
05:13
Let's just say you've got a
clot, a thrombus.
05:15
It's broken off,
it traveled around
and it got caught in an area
where the artery had narrowed.
05:22
And now that thrombus
is a problem.
05:24
Is there any blood flow?
Yes, that's why it's unstable
see how we have some of those
red cells there for you,
you can see they're
still getting through,
we've got platelets there,
The red cells are still there,
but move over to infarct.
05:39
Yeah, you can see there's
some very tiny spaces
but not enough
that's really going to be
able to make a difference
for the heart.
05:46
So that's when we're at infarct.
05:50
Unstable angina is much
much closer to infarct
than exertional angina
when it becomes unstable angina,
our next step and it
might not be very long
is when it turns into
infarcted tissue.
06:03
So that's why you need to
recognize the signs and symptoms
intervene as quickly as possible
and help that patient
move on to a
healthier next step.
06:13
It's not just us who are
important piece of the puzzle.
06:16
The patient also
needs to recognize
when their angina is different
because unstable angina
will present differently
than exertional.
06:23
But now that you've got
a picture in your mind,
I'd pause for a minute
go back and spend some time
just on your own without
listening to my voice
and look at the differences
and the similarities
on how the vessels look
and each one of
these five states.
06:41
Okay, welcome back.
06:43
Now that you've got a really
clear picture in your mind
of what's going on
in these vessels.
06:47
It's going to make
understanding the treatment plan
for each one of
these much simpler.
06:51
Now prinzmetal angina,
that's a vasospasm.
06:55
Now while you're
picturing in your mind.
06:56
Yeah that really small
artery, cool.
07:00
It's a vasospasm.
07:01
There's really not a lot of
rhyme or reason sometimes
on way it happens.
07:05
So we treat that one
a little differently.
07:07
Now chronic stable angina.
07:10
That's because there's
a fixed stenosis.
07:13
Not a clot that's
blocking everything off
but there's a fixed stenosis.
07:18
It's also called demand
ischemia or exertional ischemia.
07:22
Think back to the picture
we just talked about.
07:25
Okay.
07:26
So which one
of those pictures represented
chronic stable angina?
How did it look different from
unstable angina or infarct?
Great!
Thanks for hanging with
us and doing the work
as we walk through it.
07:39
We're going to save
you time and studying
I promise.
07:43
Now last one unstable angina.
07:46
What was different
about this one?
You've got that thrombus.
07:49
It's blocked it off right
now there's no blood
or very limited blood being
supplied to the heart.
07:54
So this one is the
medical emergency.
07:57
This is a crisis
because we don't want unstable
angina to become infarct.
08:04
Okay, so you've got the
three types of angina here
before you go on,
pause for just a minute,
play with these concepts,
make sure your very clear on
the difference of these names
that we use and you can picture
what the artery looks like
in each one of these states.