Page 227 - Color Atlas Of Pathophysiology (S Silbernagl Et Al, Thieme 2000)

A. Coronary Blood Flow B. Pressure Gradients in Myocardium
Systole Aorta Left
Aortic pressure (mmHg) 100 Aorta Right 120/80 mmHg
Diastole
120
120/80 mmHg
coronary a.
coronary a.
120/80 mmHg
80
100
60 Left RV LV 120/8
flow (ml/min) Q 20 0 Transmural Circulation
25/3
coronary a.
Phasic . 15 Right (after Berne and Levy) Transmural pressure gradient
coronary a.
high:
pressure gradient
10
5 low: systolic 120 ® 0
0 systolic 25 ® 0 diastolic 8 ® 0
0 0.2 0.4 0.6 0.8 1.0 diastolic 3 → 0 Coronary
Time (s)
(after Ross)
C. Components of O 2 Balance in Myocardium
Sympathetic stimulation Plate 7.22
Coronary dilation
(coronary reserve) Hypertension
Aortic regurgitation etc.
Wall tension K
1/Coronary resistance P ventr × r
Diastolic = 
2×wall thickness
perfusion pressure O 2 supply O 2 demand
Arterial Heart rate
O 2 concentration Contractility
Coronary insufficiency
D. Atherosclerosis of Coronary Arteries
Risk factors Right Left Obstruction of
of atherosclerosis coronary a. coronary a. coronary a.
Smoking
Overweight moderate
Lack of exercise Circumflex a.
Food (fat, cholesterol) Atheroma
Psychological stress Ant.
Lipid metabolism interventr. a. severe
Diabetes mellitus Septal
Hypertension branches
Age etc. Left Atheroma
marginal a.
Right Diagonal a. complete
marginal a.
Post. interventr. a.
Frequent Second most Thrombus 217
occurence frequent occurence
Silbernagl/Lang, Color Atlas of Pathophysiology © 2000 Thieme
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