myocardium – n. 心肌
pumping action – 泵血活动
coronary artery – 冠状动脉
exit – v. 退出，离开
sinuses of Valsalva – Valsalva窦
clamp – v. 夹住，夹紧
render – v. 提供，给予，使变得
lumen – n. 管腔
atheroma – n. 粉瘤
intima – n. 内膜
atherosclerosis – n. 动脉粥样硬化
deposit – n. 沉积物
immune factor – 免疫因子
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————RN/ISPN Review ————
Coronary Artery Disease 冠状动脉疾病
The myocardium must receive a constant supply of blood to have the oxygen and nutrients needed to maintain a constant pumping action. The myocardium receives all of its blood from two coronary arteries that exit the sinuses of Valsalva at the base of the aorta. These vessels divide and subdivide to form the capillaries that deliver oxygen to heart muscle fibers.
Unlike other tissues in the body the heart muscle receives its blood supply during diastole, while it is at rest. This is important because when the heart muscle contracts, it becomes tight and clamps the blood vessels closed, rendering them unable to receive blood during systole, which is when all other tissues receive fresh blood. The openings in the sinuses of Valsalva, which are the beginnings of the coronary arteries, are positioned so that they can be filled when the blood flows back against the aortic valve when the heart is at rest. The pressure that fills these vessels is the pulse pressure (the systolic pressure minus the diastolic pressure)—the pressure of the column of blood falling back onto the closed aortic valve. The heart has just finished contracting and using energy and oxygen. The acid and carbon dioxide built up in the muscle cause a local vasodilation, and the blood flows freely through the coronary arteries and into the muscle cells.
In CAD the lumens of the blood vessels become narrowed so that blood is no longer able to flow freely to the muscle cells. The narrowing of the vessels is caused by the development of atheromas, or fatty tumors in the intima of the vessels, in a process called atherosclerosis. These deposits cause damage to the intimal lining of the vessels, attracting platelets and immune factors and causing swelling and the development of a larger deposit. Over time, these deposits severely decrease the size of the vessel. While the vessel is being narrowed by the deposits in the intima, it is also losing its natural elasticity and becoming unable to respond to the normal stimuli to dilate or constrict to meet the needs of the tissues.
1. Which coronary artery provides blood to the left atrium and left ventricle:
A. Right marginal artery
B. Posterior descending artery
C. Left circumflex artery
D. Right coronary artery 2. Which patient(s) are most at risk for developing coronary artery disease? Select-all-that-apply:
A. A 25 year old patient who exercises 3 times per week for 30 minutes a day and has a history of cervical cancer.
B. A 35 year old male with a BMI of 30 and reports smoking 2 packs of cigarettes a day.
C. A 45 year old female that reports her father died at the age of 42 from a myocardial infraction.
D. A 29 year old that has type I diabetes.
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答案 Answer
1. C. Left circumflex artery Rationale: The LCA provides blood to the left atrium and left ventricle. 2. B, C, D. Rationale: Remember risk factors for developing CAD include: smoking, family history, diabetes, being overweight or obese, and high cholesterol.
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