CAD Flashcards
What is Coronary Artery Disease?
Diseases in which atherosclerosis or fat deposits (plaque) which is when LDL deposits cholesterol between the layers of the artery wall
form in the coronary artery from inflammation, lipid deposits
fat obstructs blood flow and oxygenation of the surrounding muscle tissue and cause MI (heart attack)
Briefly explain the continuum of CAD.
when LDL deposits cholesterol between the layers of the artery wall. The body sends macrophages to engulf the cholesterol (forms foam cells when they’re full of cholesterol)
as more foam cells collect in the artery wall, a foam streak develops and becomes a plaque which narrows the blood vessel
plaque develops a fibrosis coating on its outer edges , but if the foam cells becomes too full of cholesterol, the foam cells can explode, travel, and block other arteries.
over time a clot can develop and create a complete occlusion
collateral collision (astamosis can occur) to make up for the lack of poor perfusion
What are some modifiable and non-modifiable risk factors for CAD?
non modifiable
1.) males >females
2.) males >45
females >55
estrogen has cardio protective effects????? (not after menopause)
3.) genetics- fam history of MI
modifiable
1.) elevated serum lipids
2.) HTN (vascular stretches to compensate)
3.) Tobacco use (nicotine inc lipd levels and inc radical levels)
4.) physical inactivity
5.) obesity
What medications are used to treat CAD?
Lipid lowering -
Restrict lipoprotein production
(statins : ATORVASTIN)
Niacin - lipid secretion of VDL and LDL
Fibric Acid Derivative - decreases VDLs secretion and dec triglycerides by doing so - FENOFIBRATE, GEMFIBROZIL
Decrease Cholesterol absorption in intestine
- Ezetimbe
Increase Lipoprotein removal
Bile acid seq. ( Welchol) , they bind with bile acids in intestines to form a complex that excretion lipids via feces
Cholesterol and triglycerides reduce with omega 3’s, inhibit synthesis of triglycerides
- Antiplatelt therapy is useful
Describe the surgical interventions used to treat CAD.
coronary artery bypass graft (bypass the area thats not being refused) CABG
Goal is revascularization of area of heart where blood Flow is reduced and bring blood oxygen and nutrients to area beyond blockages to ensure function and contractility
NECROTIC TISSUE CANNOT BE PERFUSED
What is angina? What are the types and how do they differ?
chest pain due plaque rupture and vasospasm with or without underlying atherosclerosis
cause: reduced blood flow through blocked areas, an increase in O2 demand and dec in supply
What is Acute Coronary Syndrome?
A group of conditions : unstable angina, nstemi and stemi , everything thats NOT Stable angina
type of coronary heart disease
Compare and contrast ischemia, injury, and infarction.
Ischemia - lack of oxygen, reversible
Injury - damage from lack of oxygen , can reverse ongoing damage to prevent further injury
Infartion - irreversible damage
What is the difference between chronic stable angina vs. unstable angina? (both involve ischemia)
chronic stable - angina develops when there is an inc demand in oxygenation due to the plaque being in the vessel. the vessel get dilate enough to get blood flow to the brain
unstable angina - the plaque ruptures and a thrombus forms, causing partial occlusion of the vessel. angina pain occurs at rest or progresses rapidly over a short period of time
Describe the medical management of chronic stable angina.
REST
Tell patient about precipating factors, things that can trigger (sex, eating large, walking up steps)
take meds 30 -60 minutes before doing an activity that will exasterbate it
Meds:
Nitrates to relieve pain
Short or long acting (should be relieve in 5 minutes after dose) , but if not relieved, it should be repeated for us to 3 doses
If pain is not received after, call 911
can be sublingual or topical
can cause orthostatic hypotension
WATCH BP
DONT COMBINE IWTH ERECTILE DYSFUNCTION MEDS
*ACE inhibitors to decrease risk of MI
Describe the interprofessional care associated with unstable angina. Consider medications and procedures, as well as diagnostic tests.
Vital signs - elevated Heart rate
Pulse ox - SpO2 because the heart isn’t perfusions , compensatory mechanisms?
Mental status - AAO x4 ?
Physical exam -
12 Lead ECG - Picks up subtle changes (cause it won’t show triponins in labs since theres no infarction)
Labs
Review the management of Acute Coronary Syndrome.
Explain the goal of cardiac rehabilitation.
- goal is to reduce further complications from heart disease
- optimize cv performance
- Combine cardiac health education and exercise
- restore a patient confidence with this capability
phase 1 :
phase 2:
phase 3: maintenance level , muscle strengthening and maintain the lifestyle change
What preventative measures are recommended for CAD? Briefly describe them.
physical activity (30 - 60 min x5 a week)
nutritional therapy (fruits and veggies every day)
dont smoke
maintain healthy weight
watch BP
how to diagnosis cad
ekg/ecg
exercise stress test
x ray
What are the presentations of angina in women?
SOB
Fatigue
substernal pain or pressure (throat, back, jaw, neck)
could be diffuse (back etc)
Nstemi vs Stemi
Nstemi - the plaque ruptures and the partial occlusion to the vessel causes injury and infarct to the subendocardial myocardium, causing subendocardial infarct
Stemi - COMPLETE occlusion of the blood vesel lumen, resulting in transdermal injury of infarct to the myocardium.
Shown through ECG and rise in tropinions
Stable Anginad: Chronic Stable Angina vs Prinzmetal Angina
Chronic Stable Angina -
causes by physical exertion, stress
- happens in a pattern
HEALS WITH REST or sublingual nitroglycerin to treat the recent angine , treated outpatient
Prinzmetal Angina - random vasospasm of coronary artery leading to temporary supply ischemia
Often overnight at rest due to an increase myocardial O2 demand
Maintenance: Calcium Channel blockers (prevents calcium from entering the heart which relaxes it)
Nitrates (Sublingual nitro)
may disappear spontaneously
Coronary angiogram vs. angioplasty definitions
Diagnostic and treatment methods
Angiogram - cardiac catheterization, diagnostic only
Angioplasty - percutaneous transluminal coronary angioplasty (PTCA)
- stent balloon and forces an opening of the blocked artery , balloon removed and stent lifted
post-procedural care, and complications
of angiogram/plasty
vital signs, neurons check, pain assessment
accès site , distal pulses
flush out dye with IV FLUIDS causes dye can be toxic
bedrest for 6 hours postop
resume meds and cardiac diet
complications:
in edema, Hematoma
eccohmosyis, taunt skin
typically forms retroperitoneal or femoral
report to provider
CABG immediate post-op priorities,
ABCs
Chest tube output
Urine output (kidneys take hit of lack of perfusion, see if it changes)
Monitor hemodynamics with a swan gans catheter to calculate # hemodynamically
Replete electrolytes
Warm the patient
Recovery plans via anesthesia team
Pain management
ACS Pharmacologic Therapy:
Anti- Ischemic therapy:
- oral beta blockers
- ace inhibitors
- IV Nitroglycerin
- Supplemental oxygen if SpO2 90%
Anticoagulation:
- heparin (unfractioned)
Antiplatelet
- aspirin (non enteric coated)
- clopidogrel
- ticagrelor
Ace inhibitors :
prevents cardiac remodeling in the acute phase
