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ABC OF INTERVENTIONAL CARDIOLOGY – PART 2

Bệnh động mạch vành hầu như luôn luôn do thu hẹp atheromatous và tắc tiếp theo của tàu. Sớm atheroma (từ athera Hy Lạp (cháo) và oma (một lần)) xuất hiện từ tuổi trưởng thành trẻ tuổi trở đi. Một tấm bảng trưởng thành bao gồm hai thành phần, mỗi liên quan với một quần thể tế bào cụ thể nào đó. | 1 Pathophysiology and investigation of coronary artery disease Ever D Grech In affluent societies coronary artery disease causes severe disability and more death than any other disease including cancer. It manifests as angina silent ischaemia unstable angina myocardial infarction arrhythmias heart failure and sudden death. Pathophysiology Coronary artery disease is almost always due to atheromatous narrowing and subsequent occlusion of the vessel. Early atheroma from the Greek athera porridge and oma lump is present from young adulthood onwards. A mature plaque is composed of two constituents each associated with a particular cell population. The lipid core is mainly released from necrotic foam cells monocyte derived macrophages which migrate into the intima and ingest lipids. The connective tissue matrix is derived from smooth muscle cells which migrate from the media into the intima where they proliferate and change their phenotype to form a fibrous capsule around the lipid core. When a plaque produces a 50 diameter stenosis or 75 reduction in cross sectional area reduced blood flow through the coronary artery during exertion may lead to angina. Acute coronary events usually arise when thrombus formation follows disruption of a plaque. Intimal injury causes denudation of the thrombogenic matrix or lipid pool and triggers thrombus formation. In acute myocardial infarction occlusion is more complete than in unstable angina where arterial occlusion is usually subtotal. Downstream embolism of thrombus may also produce microinfarcts. Investigations Patients presenting with chest pain may be identified as having definite or possible angina from their history alone. In the former group risk factor assessment should be undertaken both to guide diagnosis and because modification of some associated risk factors can reduce cardiovascular events and mortality. A blood count biochemical screen and thyroid function tests may identify extra factors underlying the onset of .