CAD

Question 1

Coronary Artery Disease

Answer 1

type of vessel disorder that is included into atherosclerosis category

starts with soft diposits of fat that harden with age

can occur in any artery

Question 2

Coronary Artery

Answer 2

delivers blood to the myocardium of heart

Question 3

Pathophysiology (CAD)

Answer 3

focal deposits of cholesterol and lipid, primarily within the intimal wall of the artery (decreased blood flow)

endothelial lining is altered as result of inflammatory and injury

Question 4

Stages of CAD

Answer 4

1. FATTY STREAKS
   - earliest lesions and reversable (lipid filled smooth muscle cells)
2. FIBROUS PLAQUE
   - fatty streaks covered in collagen creating a fibrous plaque
   - narrows vessel lumen
3. COMPLICATED LESION
   - continued inflammation results in plaque instability, ulceration and rupture
   - thrombus formation
   - increased narrowing or total occlusion of lumen

Question 5

Risk factors of CAD

Answer 5

Modifiable

• elevated serum lipids
• HTN
• tobacco use
• obesity
• DM
• inactivity

Non-modifiable

• age
• men>women
• ethnicity
• family hx

Question 6

Health promotion CAD

Answer 6

Physical fitness
Nutritional therapy
Cholesterol-lowering drug therapy
Anti-coagulant therapy

Question 7

CAD Types

Answer 7

Chronic stable angina

Acute Coronary Syndrome

Question 8

Acute coronary syndrome types

Answer 8

Unstable angina (NSTEMI)
STEMI

Question 9

Unstable angina

Answer 9

chest pain:

• new to onset, occurs at rest
• medical emergency
• pain results from myocardial ischemia

Question 10

STEMI

Answer 10

ST elevated MI

Full thickness blockage MI

Question 11

NSTEMI

Answer 11

Non ST elevated MI

partial thickness blockage MI

Damage heart muscle

Question 12

Acute Coronary Syndrome

Answer 12

deterioration of plaque already formed in the cardiac arteries

once stable and now ruptured and causing causing platelets to aggregate and thrombus to form blocking a vessel

Question 13

Goal in NSTEMI/STEMI

Answer 13

angiogram in 90 minutes and ECG within 10 minutes

Question 14

Chronic Stable Angina

Answer 14

reversable myocardial ischemia

primary reason for decreased blood flow is narrowing of coronary arteries (atherosclerosis)

PREDICTABLE
-know pain and pattern (3-5 min)

Question 15

Precipitating factors of Chronic stable angina

Answer 15

physical exertion, temp extremes, strong emotions, conception of heavy metals, tobacco, sexual activity, circaneum rhythm

Question 16

Chronic Stable Angina Care

Answer 16

Antiplatelet agent/antianginal therapy
Beta blocker/management of BP
Cigarette smoking cessation/management of cholesterol
Diet and diabetes
Education and exercise
Flu vaccine

Question 17

Silent ischemia

Answer 17

asymptomatic

associated with diabetes

Question 18

Nocturnal Angina

Answer 18

occurs at night

Question 19

Angina decubitis

Answer 19

chest pain that occurs laying down

relieved by sitting and standing

Question 20

ACS goals

Answer 20

decreased demand for oxygen
increased oxygen supply and blood flow to cardiac arteries

relief of pain, preservation of myocardium
effective coping of anxiety

Question 21

ACS diagnostic studies

Answer 21

12-lead ECGs (rules STEMI in or out)

Laboratory studies

• urgently: serial troponins and ECG
• on admission: CBC, fasting lipids and glucose, ect

Chest x ray

echocardiograms

exercise stress test (rule out MI)

Question 22

Meds for Chronic stable angina

Answer 22

Nitrates - first line therapy, vasodilator, ex. nitrospray

Beta Adrenergic Blockers - reduce workload of the heart

Calcium Channel Blockers - dilate coronary arteries, used if BB dont work

Angiotensin-converting enzyme inhibitors - dilate BV

Opioids - decrease pain, decrease HR

ASA/antiplatelet agents - inhibits platelet aggregation
(check if GI bleeding)