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XIO > CAD > Flashcards

CAD Flashcards

1
Q

CAD There are multiple causes (Bill has spasms)

A

Atherosclerosis
Thrombosis
Spasm of coronary arteries

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2
Q

The most prevalent cause is

A

ATHEROSCLEROSIS

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3
Q

Atherosclerosis is

A

insidious, progressive disease that results in coronary arterial narrowing or complete occlusion.

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4
Q

CAD: INCIDENCE / PREVALENCE - is it common?

A

LEADING CAUSE OF DEATH WORLDWIDE

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5
Q

CAD ETIOLOGY - fatty

A

CAD has a long latent period. Fatty streaks can appear within the aorta during childhood.
Symptoms don’t occur until plaque occludes 75% of the vessel’s lumen.
This usually happens in late middle age.

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6
Q

Risk factors for developing CAD include (Bill is a crepe homo)

A

AGE GENDER
FAMILY HISTORY RACE
HYPERLIPIDEMIA HIGH-FAT DIET
HOMOCYSTINE HTN
SMOKING DM
OC’s (Oral Contraceptives) OBESITY
PHYSICAL ACTIVITY STRESS/ANXIETY
ELEVATED hs-CRP

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7
Q

AGE:

A

AGE: In general CAD is seen in middle and old age

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8
Q

GENDER:

A

Women get CAD 10 years later than men.
42% of Women vs 23% of men die within one year after MI
Ten years after menopause, CAD rates are the same for both sexes.

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9
Q

family hx - before what age? (think of mom)

A

Positive family history of a close relative with an MI or STROKE before age 60

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10
Q

race

A

Nonwhite populations of both genders

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11
Q

HYPERLIPIDEMIA (Elevated Cholesterol) - leading cause of what diseases?

A

Leading cause of atherosclerosis and CAD.

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12
Q

HOMOCYSTINE (homo is an error)

A

Hyper-Homocystine is a genetic error of metabolism.
High levels are associated with ↑ atherosclerotic CAD.

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13
Q

HYPERTENSION - what area does it damage?

A

HTN causes damage to the endothelium of the arterial bld vessels where plaque can adhere

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14
Q

Cessation of smoking drops the coronary risk by

A

± 50% within 1 year. (more cigarettes the higher the risk)

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15
Q

DIABETES MELLITUS - how much does it raise chance of CAD?

A

Diabetes triples or quadruples the risk of developing CAD.

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16
Q

ANGINA: what happens? (my angie)

A

Chest Pain
Caused by diminished blood supply to myocardium.
Transient
Pain usually lasts 3 to 5 minutes
Relieved by rest or Nitroglycerin.

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17
Q

Angina: progression

A

Risk factors contribute to plaque formation
Atherosclerosis develops
At 75% occlusion myocardium is deprived of blood flow when there is a increase demand on the heart (5 E’s)

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18
Q

ANGINA
PRECIPITATING FACTORS- The 5 E’s (Angie E’s)

A

The 5 E’s
Exertion (painting, lifting, sexual activity…)
Emotion (Stimulates the sympathetic nervous system – Anger, fear)
Eating (Large heavy meal – ↑ workload to heart)
Extremes (hot/cold) (warn pts if they’re traveling to cold or hot places)
Excitation (overly excited)
Cigarette smoking (Vasoconstriction & ↑ HR)

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19
Q

There are a range of clinical presentations of CAD (4 - stable…)

A

Stable Angina
Unstable Angina
Myocardial Infarction
Sudden Cardiac Death

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20
Q

STABLE ANGINA

A

Predictable
Caused by similar precipitating factors
May describe it as “my usual chest pain”.
Pain better with rest, or nitroglycerin

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21
Q

UNSTABLE ANGINA

A

Previously stable angina changes pattern
Unpredictable
Can occur with increasing frequency
Can be provoked by minimal or no exercise
Unstable angina may require immediate hospitalization and eval for MI

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22
Q

UNSTABLE ANGINA - outcome?

A

May result from a deterioration of a once stable plaque

Pt is at risk for of complete thrombus formation

Lesion can become stable again or it can progress to MI (it can go either way)

23
Q

VARIENT (PRINZMETAL) ANGINA - (The prince is a spaz)

A

Rare.
coronary spasm

24
Q

SILENT ISCHEMIA

A

ECG monitoring and stress testing demonstrates myocardial ischemia but patient doesn’t have pain. (zero symptoms)

25
Q

Diagnostic tests for Angina - (Angie exercises)

A

ECG
Exercise Treadmill
Angiogram

26
Q

What does CRP do? (Crp cooking)

A

CRP (c-reactive) is a good predictor of CV disease. CRP activates the clotting system
Inflammation starts and immune cascade begins leading to:
Thrombus formation
Thrombus grows and occludes vessel

27
Q

CRP C-Reactive Protein - it’s just elevated

A

hs CRP (highly sensitive CRP) is elevated in pts with atherosclerotic inflammation at risk for MI

28
Q

Treatment of Stable Angina - what meds? (3)

A

NITRATES
BETA-BLOCKERS
CALCIUM CHANNEL BLOCKERS
ASA
LIFE-STYLE CHANGES
quit smoking
Diet
Exercise
↓ stress

29
Q

TX of Stable ANGINA- TREAT CO-EXISTING MEDICAL CONDITIONS (that’s it)

A

CAD
DM
HTN
HYPERLIPIDEMIA
OBESITY

30
Q

Tx Hyperlipidemia
Reduce Cholesterol - Total cholest - what number? (Cholesterol in the year 200)

A

Low fat diet, exercise, and lipid lowering drugs

Total cholest < 200

31
Q

To lower LDL: (lov LDL)

A

HMG Co-A reductace “Statins” (Lovastatin).
Lo-fat, lo-cholesterol diet

32
Q

To raise HDL: (Nya had HDL)

A

Exercise
Niacin
low-cholesterol, low-fat diet

33
Q

To lower Triglycerides: (Tri Nya)

A

Exercise
Niacin
low-fat diet

34
Q

NITROGLYCERIN USE

A

SUBLINGUAL NTG Q5min X 3 DOSES FOR CHEST PAIN
KEEP NTG EASILY ACCESSIBLE (NTG NECKLACE)
KEEP IN TIGHTLY CLOSED DARK GLASS
DON’T CARRY IN POCKETS NEAR BODY AS HEAT WILL DEGRADE POTENCY.
CAUTION REGARDING POSTURAL HYPOTENSION - don’t stand up right after taking it - fall precaution
IF PAIN PERSISTS AFTER 3 DOSES SEEK IMMEDIATE MEDICAL ATTENTION!

35
Q

TREATMENT OF UNSTABLE ANGINA - just chest pain protocol

A

Change from stable to unstable Angina can be life threatening
Patient may be having an MI
INITIATE CHEST PAIN PROTOCOL

36
Q

Treatment for Unstable Angina - MONA BET

A

Morphine
Nitroglycerin
Oxygen
Nitroglycerin
ASA
Beta Blockers
ECG
PCI (Percutaneous coronary intervention) with GPll/lll inhibitor
Thrombolytics

37
Q

CHEST PAIN PROTOCOL - how often for BP?

A

ASSUME EVERY ADULT PT C/O CP IS HAVING AN MI UNTIL PROVEN OTHERWISE. ALSO CONSIDER DISSECTION AND PE.
ASSESS PAIN: Location, onset, duration, quality, radiates, 1/10 (assess EVERY time you give pt medication)
RISK FACTORS: Previous MI, CAD, DM, HTN, Hyperlipidemia
VS (cycle BP every minute)
O2 4L pnp, O2 Sat (ask pt if they need 02)
12 Lead EKG
ALERT MD
IV ACCESS
MEDICATIONS, DRUGS, ETOH, TOBACCO, FH
ASSOCIATED SYMPTOMS: SOB, DIAPHORESIS, PALPATATIONS
PHYSICAL EXAM: VS, CV (S3, S4, bruits, murm), RESP (O2 sat, rales)
CXR (CHF, pneumothorax, dissection, cardiomegaly)
TROPONIN, CK-MB, CBC, COAG’s (PT, INR), CHEM (Lytes, Creat, gluc…)
TX: PCI with stent and GPll/lll inhibitor (Abciximab…) or Thrombolytics

38
Q

look at slide

A

about locations of pain during MI

39
Q

(highly sensitive CRP) - better indicator of MI than

A

cholesterol alone

40
Q

pts on statins - does the lumen size change?

A

lumen size is unchanged***but lipid core is smaller - harder to get through.

41
Q

how does Hormone Replacement Therapy (HRT) effect CAD?

A

Hormone Replacement Therapy (HRT) may cause an increase in CV disease.

42
Q

CAD causes (Bill dissects)

A

Coronary dissesection
Aneurysm

43
Q

homocystine (amino acid - too much damages arteries) treatment (homo needs vitamins)

A

Tx with folic acid and vitamin B6, normal weight, exercise, and no smoking.

44
Q

stable angina - how much blockage?

A

Result of fixed lesions (blocks) of more than 75%.

45
Q

stable angina - is it during rest?

A

Usually exercised induced, rarely occurs at rest.

46
Q

stable angina - EKG

A

EKG → normal to ST depression

47
Q

angina labs (Angie needs a baseline) - 3 of them (Angie reacts w/ troponin and cholesterol)

A

Cholesterol panel, CRP test, troponin (get a baseline troponin first)

48
Q

hs CRP levels are a better indicator of

A

who will have an MI in the next few months than the Cholesterol level.

49
Q

CRP levels - the numbers (crepes are my fav number)

A

Levels of > 3.1 assocated with AMI

50
Q

LDL - what level is good? (LDL is 100%)

A

LDL to < 100 mg/dl in pts with CAD

51
Q

Triglycerides - what level is good? (Tri the videogame)

A

Triglycerides to < 140

52
Q

HDL - what level is good? (Hiddle is middle-aged)

A

HDL > 35.

53
Q

med to lower trigylcerides (tri the gem)

A

Gemfibrozil

54
Q

treatment for chest pain

A

PCI with stent and GPll/lll inhibitor (Abciximab…) or Thrombolytics

XIO (372 decks)

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