Atherosclerotic Disease Flashcards
This is a disease primarily of the arterial endothelium, plaques invade tunica intima and cause thickening and scarring of the tunica media
Atherosclerotic Disease
The different sites that are most commonly affected by Atherosclerotic Disease are
Coronary arteries Cerebral arteries Carotid arteries Aorta Lower extremity arteries
Risk factors for atherosclerotic disease
1) Hypercholesterolemia
2) Hypertension
3) Diabetes Mellitus
4) Male gender
5) Smoking
6) Family history
What is the coronary atherosclerosis that leads to coronary arterial narrowing.
-also is known as the number one killer in the United States.
Atherosclerotic Coronary Artery Disease (CAD)
These clinical findings might indicate what type of atherosclerotic disease?
(a) Chest pain
(b) Left shoulder pain
(c) Indigestion
(d) Nausea/Vomiting
(e) Pale
(f) Diaphoresis
(g) New heart murmur
(h) Rales on pulmonary examination
(i) S3
(j) S4
(k) Sudden cardiac death
CAD
Coronary artery disease
What Labs/Studies would you order for Coronary artery disease?
(a) Lipid panel (looking for LDL which is bad cholesterol, and HDL which is good cholesterol).
(b) EKG
(c) Fasting glucose
(d) Troponin
What are some non-pharmacological tx you can use for CAD?
What is the most important?
1) Lifestyle changes: Increase activity and exercise.
2) Low fat diet high in fruits and vegetables.
3) MOST important SMOKING CESSATION.
4) Moderate use of alcohol.
5) Control of HTN, Diabetes, and hypercholesterolemia
What are the Pharmacological Treatments for CAD?
HMG-CoA reductase inhibitors (Statins)
-Atorvastatin(lipitor) 10mg tit up to 80 before bed
Aspirin 81 mg QD
What medication has this MOA
They work by inhibiting the rate limiting enzyme in the formation of cholesterol.
HMG-CoA reductase inhibitors
Atorvastatin
What medication has this MOA
Irreversible inhibits platelets
Aspirin
Your pt has suspected CAD pt has a history of prior GI bleed. Can you prescribe both Atorvastatin 10mg QD before bedtime and Aspirin 81 mg QD?
You can give Atorvastatin but not Aspirin
-prior GI bleed is a contraindication.
What are surgical interventions for CAD?
- Stenting
- Coronary Artery Bypass Grafting (CABG)
- Primary percutaneous coronary intervention
If your CAD pt shows signs of Acute Myocardial Infarction then need to ______
MEDEVAC STAT.
What is the #1 thing for initial care for your CAD patients?
Risk factor modification
True/false
For you CAD patients you don’t need to treat underlying HTN, Diabetes, and Hypercholesterolemia if you’re already treating with aspirin.
False, treat the underlying issues
What are the complications that can result from CAD?
(a) AMI
(b) CHF
(c) Arrhythmias
(d) Sudden cardiac death
(e) (Structural) Valvular heart disease
(f) Unstable Angina
What is occlusive atherosclerotic lesions that develop in the legs, and sometimes, in the arms causing decreased perfusion of the extremities
Atherosclerotic Peripheral Vascular Disease (PAD)
PAD are symptoms of what process?
systemic atherosclerosis process
PAD can be diffuse but usually occurs segmentally. What are some examples of where it can developAorto-Iliac segments
Aorto-Iliac segments
Femoral- Popliteal segments
Tibial segment
PAD is a high correlation in smokers and patients with ______
Diabetes
A patient with some of these symptoms might suggest what type of Atherosclerotic Disease?
(a) Claudication: Cramping pain or tiredness in the thigh, calf, or foot with walking or exercise and relieved by rest.
(b) Diminished femoral, popliteal, or pedal pulses.
(c) Tissue ulceration and gangrene.
(d) Erectile dysfunction
(e) Loss of hair
(f) Thinning and cool skin
(g) Atrophy of muscles
Atherosclerotic Peripheral Vascular Disease (PAD)
Your PAD pt has cramping pain and tiredness in the leg that is not relieved by rest. What may they be at risk for?
amputation
What could be some differential diagnoses for PAD?
(a) DVT
(b) Muscle strain or cramp
(c) Neuropathy
What are the labs/ imaging you would consider for your PAD pt?
(a) Doppler examination with ABI
(b) CT Angiography and Magnetic Resonance Angiography if intervention is required.
(c) Lipid panel
(d) Chemistry - to evaluate for renal dysfunction
What are some NON-pharmacological tx for PAD
1) SMOKING Cessation……..
2) Risk factor reduction
3) Weight loss
4) Consistent moderate exercise
What is a pharmacological tx for PAD that you may see your patients taking?
Phosphodiesterase inhibitor
Cilostazol
.
what medication has this MOA; what is it used to treat?
Inhibits phosphodiesterase type 3, reducing platelet aggregation, produces vasodilation
Phosphodiesterase inhibitor
Treatment of PAD
_______are thrombus or plaque that breaks off and travels until the lumen becomes too small for the emboli to continue to move
Emboli
is a blood clot that forms as a plaque ruptures and platelets start to adhere and aggregate on the rupture site.
Thrombus
What causes Acute Arterial Occlusion of a Limb
Acute occlusion due to emboli or thrombus
Emboli large enough to occlude proximal arteries are almost always
from where?
the heart
what are the signs of severe arterial ischemia?
six 6 Ps
1) Pain
2) Pallor (or mottled with delayed capillary filling)
3) Poikilothermia (coolness)
4) Pulselessness
5) Paresthesia
6) Paralysis
What med would you give to your pt who has an Acute Arterial Occlusion of a Limb
Enoxaparin (Lovenox) 1mg/kg SQ
Heparin Sulfate 5000-10,000 Units IV STAT
Immediate Revascularization within how many hours. Delays increase risk of
irreversible tissue damage. Risk approaches 100% at ___ hours.
3 hours to decrease risk
6 hours approaches 100%
What should your initial care for a pt with an Acute Arterial Occlusion of a Limb
(a) Give dose of Heparin immediately
(b) MEDEVAC immediately, do not delay.
what is the risk of amputation and morbidity rate of Acute Arterial Occlusion of a Limb
10-25% risk of amputation and 25% hospital mortality rate.
In your pt who has a suspected occlusive cerebrovascular disease what test would you do to r/o hypoglycemia?
Glucose
In your pt who has a suspected occlusive cerebrovascular disease It is okay to allow the blood pressure to be SBP of ____ in an acute stroke situation?
180
