Welcome back, let us take a look at our coronary
artery disease, cardiovascular. With this
topic, we begin referring to some of those physiologic
concepts that we looked at earlier in terms
of how does our heart exactly work? What does
it require in terms of its activity? It requires
energy, requires oxygen, it requires ATP. While
there is really two components here that we
are going to delineate and then we will go
into a little bit of biochemistry that becomes
extremely important for us. It is all part
of once again connecting all the dots.
Let us first talk about the supply that is
required for the heart so that it can work
properly, so that it can create enough ATP
through oxidative phosphorylation so on and
so forth. What if the supply was cut off?
Now we got issues. If the supply has been
cut off, well now at this point the coronary arteries
are not supplying enough oxygen to the heart.
Supply is being compromised. Atherosclerosis
up and down the body is what you are thinking.
As soon as you hear the prefix athero, you
should be referring to lipid. Earlier we talked
about arterial. With arterio it is just an
umbrella. There could be many types of pathologies
taking place in a blood vessel that may result
in arteriosclerosis or when it comes specific
to athero with our topic of the supply being
dropped decreased to the heart then has to
refer to lipid accumulation within the, well
in this case, a coronary artery. The lipid
does not have to be specific. The lipid does
not just have to target the coronary artery.
It can affect the peripheral blood vessels
and, therefore, your patient may then present
with claudication, peripheral vascular disease.
Your patient might have issues with seeing
properly, slurred speech, one side of the
body, which is just quite weak. Welcome to stroke or
cerebrovascular type of accident. So atherosclerosis
can be up and down the body may be your male
patient has a hard time getting it up. What
does that mean? Erectile dysfunction. So what
I am saying to you is make sure that you understand
the full presentation of your patient before
you come to any type of diagnosis to confirm it.
So here atherosclerosis in the coronaries
would then be called coronary arterial disease.
Depending as to how much buildup of the lipid
in their coronary artery is then going to
dictate what kind of diagnosis you have and
what kind of presentation you might have?
What about this chest pain initially if let
us say the atherosclerosis within the coronary
artery was only 50 or 60 percent. This will
be stable angina. There will be pain only
upon exertion. What do you if you get passed
70 percent occlusion and get into 80, 90
percent? My goodness, gracious. The supply
to the heart through the coronary artery is
drastically diminished and we have issues
now, even at rest. Welcome to unstable or crescendo type of angina.
You see what I'm trying to get at. What is important for you to
also keep clear is to make sure is that you
delineate your cardiovascular diseases. What
does that mean? Remember when you say cardiovascular,
it is once again entire circulatory system
including peripheral vascular disease, including
cerebral vascular accident, including your
coronary arterial disease. You call that cardiovascular
disease. Is that clear? And that is how you
and me as clinicians will then refer to your
atherosclerotic process. But if it is specifically
in the heart, then you call coronary arterial
disease. Hope that is clear? What is my problem?
Supply. What is going to happen? At some point,
the heart is not going to work anymore depending
as to level of occlusion. Next, let us talk about the