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21st World Congress of the World Society of Cardio-Thoracic Surgeons


Terminology in Coronary Artery Disease


Aneurysm
An enlarged or dilated segment of a blood vessel. Aneurysms can be round (or saccular) or sausage shaped (fusiform). Regardless, the presence of an aneuryms indicates a loss in the strength and integrity of a blood vessel wall with subsequent dilatation of the weakened segment. Untreated aneurysms continue to enlarge and can rupture spontaneously, with disastrous bleeding and death.



Angina
Characteristic pain (in the thorax, arm, jaw, or back) which occurs during exertion in patients with certain kinds of heart disease. Anginal pain is usually prompted by stress (either physical or emotional) and relieved by rest, or specific medications which improve the delivery of blood to the heart.



Angiogram
A series of motion pictures taken of the blood vessels in a living patient. Angiograms are usually done in a selective manner, where only certain vessels are injected with a special x-ray sensitive dye and photographed with high speed cameras. The procedure takes place with the patient laying quietly on a specialized fluoroscopy table. Detailed anatomical roadmaps of the blood vessels can be obtained. These studies provide the essential information for diagnosing and treating arterial blockages in any system of the body, including the heart..



Angioplasty
Balloon dilatation...a procedure where an arterial blockage is expanded, or dilated, with a balloon. The procedure takes place under x-ray guidance in the cardiac catheterization laboratory. Expansion of the obstructing plaque can, in some cases, restore the flow channel and relieve symptoms of angina.



Anticoagulation
Treatment of clotting disorders with medications that impair the ability of the blood to form clots. The most commonly used blood thinner is warfarin (also known as Coumadin®)



Anticoagulants
Blood Thinners...medications which reduce or impair the ability of the blood to form clots. These medications are used to retard clot formation on artificial devices or in certain. The most common medications are oral warfarin (or Coumadin®) and intravenous heparin



Annulus
A ring of tough fibrous tissue at the base of the heart. This ring supports and anchors the heart valve(s) into the heart itself. There are 4 valve annuli...one each for the tricuspid, mitral, aortic, and pulmonary valves. These rings of fibrous tissue all converge together in the middle of the heart, and area known as the fibrous skeleton of the heart.



Aorta
The main blood vessel carrying all of the fresh blood out of the heart to the body. The aorta comes directly out of the heart and then courses through the body providing branches which deliver nourishing blood supply to every organ and tissue



Aortic Root
The opening at the junction between the heart chamber and the aorta itself. The root is characterized by an encircling band of firm fibrous tissue (the annulus) and the leaflets of the aortic valve.



Artery
Red blood...arteries are the blood vessels that carry the red or oxygen-rich blood away from the heart and towards the organs of the body. The arteries are thicker and stronger then veins. The blood pressure in the arteries is nearly 8 times higher than the blood pressure in the veins. Arteries are vulnerable to atherosclerosis and plaquing, while veins to not develop these degenerative lesions. The principle artery of the body (called the aorta) arises from the heart and delivers blood through its many branches to every tissue of the body.



Atrial appendage
Small outpouching of the atrial chamber, usually a remnant of the developmental process..



Atrial Fibrillation
A chaotic rhythm of the heart.... where the upper chamber of the heart quivers at rate of 600 times per minute or more. Only part of the contraction signals reach the lower chamber. Thus the actual rte of contraction in the lower pumping chambers is around 80 to 120/min. In AF, the patient feels an irregular heart beat (palpitations). If the rate goes too fast, medication need to be administered to slow the heart rate. Chronic AF can be associated with an increased risk of stroke so anticoagulation with Coumadin is recommnded.



Atherosclerosis
"Hardening of the arteries"...a process of inflammation, scarring and finally calcification which occurs in the inner 2 layers of the wall of human arteries. This process can lead to obstructive plaque buildup or weakening of the wall with aneurysm formation. The exact cause is not known, but atherosclerosis is one component of the aging process. Accelerated (or premature onset) of atherosclerosis frequently occurs and epidemiologic studies indicate heredity, hypertension, high cholesterol, smoking, diabetes and other conditions are prominent risk factors for early development of this condition. Atherosclerosis in the heart arteries can cause obstructing plaques, a condition better known as Coronary Artery Disease or CAD.



Arrythmia(s)
Abnormal heart beats...any disturbance in the cadence or regularity of the heart rythm. Some arrythmias are not dangerous, while some can cause stoppage of the heart contractions and death.



Calcification
Deposition of lumps or granules of calcium within the matrix of the tissues. A sign of chronic low-grade inflammation and/or other forms of local cell damage.



Cardiac Catheterization
A series of invasive examinations of the heart, typically including detail pressure measurements within the heart chambers, x-ray photographs (angiograms) of the pumping chambers and the coronary arteries, and the calculation of certain values based on these studies. The cardiac catheterization report is a summary of many different normal and abnormal states affecting the patient. The procedure requires the patient remain motionless under the fluoroscopy table until the measurements and pictures are completed. This study is the gold standard for diagnosis of most cardiac conditions.



Cardiopulmonary Bypass (CPB)
Another name for extracorporeal circulation (ECC). For a brief tour of ECC, click here.



Cath Lab
The specialized radiologic suite where cardiac catheterization is performed.



Cholesterol
A complex fatty molecule made by the liver and transported to the body in the circulating blood. Cholesterol is a 4 ring organic compound which is part of the normal cell wall of most mammalian cells. Excess cholesterol occurs in patients who either produce too much or fail to metabolize cholesterol. The walls of some arteries absorb circulating cholesterol and other fats from the blood and slowly form a reaction called atheromatous plaque. As this builds up, the artery can be progressively blocked.



Congestive Heart Failure
Build up of fluid in the body...a condition of generalized fluid retension causing swelling and shortness of breath. When the heart cannot deliver enough blood to the body, then fluid is retained in the lungs or other tissues. Patients with severe heart failure are incapacitated by symptoms of shortness of breath, air hunger when laying flat, fatigue, swelling in the feet, and other problems. Reduced life expectancy is common. There are many causes, including valve or coronary disease.



Coronary Artery(ies)
The blood vessels which bring red (oxygen-rich) blood to nourish the muscle cells of the beating heart.



Coronary Artery Disease (CAD)
Obstructive lesions in the native arteries feeding the heart muscle. CAD is due to progressive buildup of cholesterol, lipids (fat) and reactive inflammatory tissue in the middle layer of the coronary artery wall. As the plaque builds in size, the blood flow channel of that artery is progressively blocked. The disease is chronic and progressive. Sudden closure of an obstructed vessel can damage the heart supplied by the disease artery, causing an acute heart attack



Embolism
The name of an event where clots detach from their source and migrate through the circulation to another blood vessel or body organ.



Endocarditis or SBE
Valve Infection...Subacute Bacterial Endocarditis (SBE) refers to a progressing infection of the heart valve, leading to destruction of the valve leaflets, fibrous support structures, and other consequences.



Extracorporeal Circulation (ECC)
The technique of mechanically circulating the blood so the heart doesn't have to. The device used for ECC is called the heart-lung machine or the cardiopulmonary bypass circuit. This device drains the blue blood from the patient, places oxygen in the blood, and returns (or pumps) the red blood back into the aorta for distribution to the whole body. To prevent clotting in the heart-lung circuit, strong anticoagulation with heparin is needed.



Gradient
Pressure difference...the term "gradient" is used to specify the difference in blood pressure before and after a blockage or stenosis. The gradient is a pressure difference (calculated by subtracting the higher pressure before a blockage from the lower pressure beyound the blockage). The severity of a blockage and the impact on circulation hemodynamics can be estimated by the magnitude of the gradient. This is particularly useful in estimating the severity of obstructive heart valve conditions.



Heart Attack
Another term the sudden closure of a coronary artery with damage or death to the heart muscle fed by that arterial branch.



Heart-Lung Machine
Another term for machine which provides extracorporeal circulation (ECC)



Hemodynamics
Hydrolic performance...a term loosely used to describe the throughput of blood when referring to the performance of a heart, circulation, or a device in the circulatory system. There are several key measurements which compose the assessment of hemodynamic performance, such as the flow (i.e. volume of blood per minute), the flow velocity, and/or the pressure gradient needed to achieve the measured flow.



Hemorrhage
Bleeding



Left Atrium
The upper (or "priming") pumping chamber on the left side of the heart. The left atrium sits above the mitral valve and gently forces blood across the mitral valve into the left ventricle. This actions "primes" the lower pumping chamber to improve efficiency. At the same time, the left atrium provides a temporary storage site for blood returning from the lungs during the time that the left ventricle is actually squeezing.



Left Ventricle
The main pumping chamber of the heart. Oxygen-rich blood is pumped out of the left ventricle during a heart contraction and ejected into the aorta for distribution throughout the body.



Left Anterior Descending
The LAD is the most important coronary artery in the human heart. The LAD typically runs down the front surface of the heart in a groove between the right ventricle and the left ventricle. Acute closure of the LAD causes significant heart attacks, arrythimias, and heart failure.



Pulmonary Artery
The large artery which delivers blue blood from the body (and right ventricle) into the lungs where oxygen is absorbed.



Right atrium
The upper (or "priming") pumping chamber on the right side of the heart. The right atrium sits above the tricuspid valve and gently forces blood across the tricuspid valve into the right ventricle. This actions "primes" the lower pumping chamber to improve efficiency. At the same time, the right atrium provides a temporary storage site for blood returning from the lungs during the time that the right ventricle is actually squeezing.



Right Ventricle
The pumping chamber on the right side of the heart which pumps oxygen-poor blood into the pulmonary artery on its way towards the lungs.



Stenosis
Blockage or obstruction...a termed used to descibe an area or zone of narrowing in any channel, including the small coronary vessels.



Thromboembolism
Both clotting and embolic migration...in the same patient



Thrombosis
Clotting...The formation of blood clots on, or inside, of a blood vessel, heart chamber, or medical device



Vein
Blue blood...veins are the blood vessels that carry the oxygen-poor or blue blood from the body towards the heart.



Vena Cava
The large veins leading blue or unoxygenated blood into the right heart from the body.



Ventricle
A name used for the muscular pumping chamber. In the human, there are two venticles, the right and the left. The left ventricle pumps under much higher pressure and delivers the red or oxygen-containing blood to the aorta for distribution to the whole body.

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