Myocardial perfusion in health & disease
21 important questions on Myocardial perfusion in health & disease
What parts of the heart are perfused by which coronary arteries?
- Left:
- left arterial descending artery (LAD)
- left circumflex artery (LCx)
These have branches, that supply the complete wall of the heart.
What are the layers of the wall of the heart?
myocardium
Inside (towards lumen): endocardium
What is unique about coronary arteries?
This effect is largest on the left side.
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Which of the vessels are squeezed the most?
How does the heart cope with its high metabolic rate (due to it always working)?
- It has a high oxygen extraction
- It has a high capillary density
How does oxygen uptake in the heart change during exercise?
Therefore, the blood flow increases drastically (up to 6 times).
How do heart rate and myocardial blood flow change during exercise?
What vessels mainly regulate the perfusion in the coronary microcirculation, and how do they regulate the perfusion?
In general terms, what arteries/arterioles respond to what kind of stimuli?
Besides metabolic stimuli, what stimuli also can effect the control of microvascular tone?
This mechanism is very complicated and it is a fine balance.
Between what levels in blood pressure can the coronary autoregulation keep the pressure constant?
In what layer is the coronary autoregulation somewhat less accurate?
What is a common coronary artery disease?
What does stenosis in a coronary artery cause in the flow?
What parameter decides whether a stenosis has to be treated?
What is the difference between patients with macrovascular and microvascular problems?
- Microvascular: not really a flow-limiting stenosis (normal coronary arteries), just microvascular problems (limited flow reserve) → there is not really a treatment for this
How much is this last microvascular group a problem?
What is suggested about how the microvascular problems occur, when there is no stenosis?
What are three factors that can determine the damage during ischemia?
- Duration of O2 impairment
- Sensitivity for O2 impairment
- Collateral circulation
What two things can limit the infarct size during ischemia?
- Having a higher number of collaterals (like in the guinea pig)
What is one remarkable difference between males and females for the prevalence of macro- and microvascular disease?
- Females more often have microvascular disease
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