Approach to Coronary Heart Disease Flashcards
There are 2 groups of risk factors for coronary heart disease, namely___
Modifiable and non-modifiable
Name 4 non-modifiable risk factors for coronary heart disease
Age
Gender
Race/Ethnicity
Family history of CVD
Name 4 modifiable risk factors for cardiovascular disease
Blood pressure
Diabetes
Hyperlipidemia
Smoking
Review this slide on CAD Prevention
Ms. A is a 48-yo female high school teacher who has no abnormal symptoms and is coming in for a routine visit.
Family History:
Mother with stroke at age 53; Father with myocardial infarction age 58
BP: 145/90, taking amlodipine
Diabetes: No history, normal blood sugar
Lipids (mg/dL): Total cholesterol 190, HDL 30 (low), Triglycerides 190 (high), LDL 122 (high)
Tobacco: Smokes 5 cigarettes a day
***
What are 3 things you could do/give to reduce a pts risk for coronary artery disease?
Lifestyle changes
Statins to control lipids
Aspirin to reduce risk of MI **does cause increased risk of GI bleeding**
Define myocardial ischemia
Myocardial ischemia: supply-demand mismatch – not enough O2 to the heart to meet its O2 needs
Name 6 conditions that can increase myocardial oxygen demand
Increased physical activity
Infection
Severe hypertension (effects on afterload)
Acute congestive heart failure
Blood loss
Pregnancy
Name some possible causes of myocardial ischemia (4)
(Obstructive) Coronary artery disease
Coronary vasospasm (Prinzmetal’s angina)
Microvascular heart disease
(Extracardiac problems like pulmonary disease)
Explain this slide
Ischemia causes abnormal contraction/relaxation of heart, anaerobic metabolism>>lactate production, ECG changes
Symptoms are the last to arise
Describe a typical angina presentation
Pt may describe what feels like indigestion, an chest “tightness/squeezing”, pressure, aching
**pain can radiate to the neck or arm**
Certain groups of people, namely ___, often present with ___, as opposed to typical angina symptoms
Certain groups of people, namely women, diabetics and the elderly often present with non-specific symptoms as opposed to typical angina symptoms
3 characteristics of angina are ___
What is the difference between typical and atypical angina?
Classical symptoms
The symptoms are precipitated by stress (physical or emotional)
The symptoms are relieved by rest or nitroglycerin (**recall that this is a nitrate med used for vasodilation)
***
Typical angina = experiences all 3; atypical = experiences only 1-2/3
Describe the difference between stable vs unstable angina
Stable angina: angina with exertion/stress and is relieved by rest
Unstable angina: angina w/ decreasing exertion/occurs even at rest
**stable angina suggestive of stable plaque, unstable angina suggestive of unstable plaque (might be rupturing/have ruptured)
Define a myocardial infarction
MI: Irreversible necrosis of the myocardium due to prolonged ischemia
(can cause decreased heart function/unstable rhythms)
For a STABLE patient, how would you perform the diagnosis for angina? myocardial ischemia?
For angina - from pts history
Myocardial ischemia - stress test/CT angiogra,/invasive coronary angiogram
(which one you use depends on risk of pt)
On which group of patients (high vs low risk) would you perform a stress test/coronary CT angiogram/invasive coronary angiogram?
Intermediate risk pts: stress test/coronary CT angiogram
High-risk pts: invasive coronary angiogram
Review this slide on stress testing
Describe what happens with a coronary angiography/catheterization
Access coronary arteries and visualize where the blockage is (if there is one)
Treat blockage with stents + ballon angioplasty
When would you perform coronary artery bypass grafting (CABG)?
Performed on pts w/
3 vessel disease
Left main coronary artery or proximal LAD disease (+/- multi-vessel disease)
Diabetes (w/ multi-vessel disease)
How do you treat stable angina from coronary artery disease?
- Lifestyle changes
- Medical management: aspirin, statins (lowers lipids), beta blockers (decrease O2 demand), nitrates, antihypertensives, ranolazine, +/- cardiac rehab
- Revascularization
Review this slide on Dx and Rx for CAD
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