CAD Flashcards
What is the main cause of CAD.
Atherosclerotic plaque
What is CAD.?
Impaired blood flow to the myocardium
Is CAD a normal part of aging?
Yes, it begins at 15
What is the final stage of the process of CAD?
The formation of atheromas, which are complex lesions if lipids, fibrous tissue, collagen, calcium, cellular debris, and capillaries.
What can happen to atheromas?
The calcified lesions can rupture or ulcer are and stimulate a thrombosis.
What are the modifiable risk factors for CAD?
Increased serum lipid levels HTN Cigarette smoking Obesity DM stress Physical activity
What are the unmodifiable risk factors for CAD?
Age
Gender
Ethnicity
Genetics
How can we decrease HTN?
Regular BP check ups (every 3 months) Adequate BP medications Decrease salt intake Stop smoking Control and reduce weight (regular exercise)
How can we decrease elevated serum lipid levels?
Check them every 90 days (start treatment when LDL is at 190)
Decrease total fat intake (decrease animal fat)
Maintain ideal body weight
Exercise programs
Increase complex carbs and veggies
What is the main way to reduce a stressful lifestyle?
REST AND SLEEP
How often a week should you exercise?
3-4 times a week?
What is stable angina?
Most common and predictable form of angina. Occurs with predictable amount of activity and is common manifestation if CAD.
What is prinzmetal angina?
Typical angina that occur unrelated to activity and often at night. It is caused by coronary artery spasm with or without an atherosclerotic lesion.
What is unstable angina?
Occurs with increasing frequency, severity, and duration. Pain in unpredictable and occurs with decreasing levels of activity or stress and may occur at rest.m
What is ACS?
Coronary blood flow is acutely reduced but not fully occluded.
What do most people with ACS have?
Stenosis of one or more coronary arteries.
What is the underlying cause of ACS?
Rupture or eroded plaque
What happens when the ACS plaque ruptures?
The exposed lipid core of the plaque stimulates platelet aggregation and the extrinsic clotting pathway. Thrombin is generated and fibrin is deposited, forming a clot that severely obstructs blood flow.m
What causes angina?
Lactic acid released from the ischemic cells stimulate he pain receptors.
How do stable lesions occlude?
They gradually occlude the vessel lumen
How do unstable lesions occlude?
Prone to rupture and thrombus formation
What do stable lesions cause?
Angina
What do unstable lesions cause?
ACS
When does an MI occur?
When blood flow to a portion of cardiac muscle is completely blocked. (Irreversible)
How long is the time frame for ischemia to get fixed before irreversible hypodermic damage occurs?
20 minutes
What does pain feel like with ACS?
Chest pain, usually subs thermal or epigastric. Radiates to the neck, left shoulder or arm. May occur at rest and normally lasts loner than 10-20 minutes
What are CM of ACS?
Dyspnea, diaphoresis, pallor, and cool clammy skin. Tachycardia and HTN.
How is an MI distinguished?
It’s duration and continuous nature.
What is the onset of pain with MI.?
Sudden and usually not associated with activity.
What medications lower cholesterol?
Statins, bile acid sequestrants, nicotinic acid, and fibrates.
What is the first line drug to treat cholesterol?
Statins. They lower LDL and increase HDL
What is a major side effect is statins?
They may cause myopathy, all clients are instructed to report muscle weakness and brown urine.
What tests should be done during statin use?
Liver function tests, these drugs may increase liver enzymes.
What are drugs used to treat angina?
Nitrates, BB, and CCB
What do nitrates do?
They treat acute anginal attacks and prevent angina.
What is the drug of choice to treat acute angina?
Sublingual nitroglycerin.
What is the primary problem willing term nitroglycerin?
They can develop tolerance. (Pt. should do a nitrate free period of 8-10 hours a day, usually at night)
What is a common side effect of nitrates?
Headache.
What is the first line drug to treat stable angina?
Beta blockers (olol)
What is the action of BB?
They block cardiac stimulating effects of NE and epi, decreasing myocardial demand.
Who should never take a BB?
Asthma or COPD patients. Use cautiously in HF. And do not use to treat prinzmetal angina because it will make it worse.
What do CCB do?
Reduce myocardial oxygen demand and increase myocardial blood and oxygen supply.
What drugs are used to treat MI’s?
Fibrinolytics, antidysrhytmics, and analgesics.
What dosage of aspirin is given in an emergency situation for an MI?
160-325 mg and it should be chewed!
What analgesic is given sublingually during an MI?
Nitroglycerin 0.4 mg tablet every 5 min
Follow up with IV nitro for first 24-48 hrs
What does nitro do?
It is pain relief and it decreases myocardial oxygen demand and may increase the oxygen supply to the myocardium.
What is a side effect of nitro?
Reflex tachycardia or hypotension.
What medication should you ask the patient if they have taken in the past 24 hours before giving nitro?
Viagra
What is the next drug of choice for MI pain relief?
Morphine sulfate. Initial IV of 4-8 mg followed up by 2-4mg every 5 minutes.
What are Fibrinolytics?
Drugs that dissolve or break up clots
How soon should a fibrinolytic be given?
Within the first6 hours of the MI
What is a major side effect of Fibrinolytics?
Bleeding!
What is streptokinase?
Fibrinolytic.
What is the major side effect of streptokinase?
Anaphylaxis
What do ACEI do for patients with MI?
Reduce ventricular remodeling after an MI. REDUCING THE RISK for HF
What do anti platelet medications do?
Improves vessel opening with fibrinolytic activity so that lower doses will have to be used.
What are the interventions to treat CAD?
Risk factor management and prevention!
What is treatment for stable angina?
Rest or nitro
What is treatment for prinzmetal angina!
CCB
What are important assessment questions to ask patient with CAD?
P-what are precipitating factors? Q- qualit of pain or discomfort R- where does it radiate? S- severity if pain (0-10) T- when did pain begin?
What should we monitor or tell patients w take nicotinic acid?
It will cause flushing sensation and may increase BS,!!
What is the WORST complication of angina?
MI
What two antidysrhytmics do we give?
Atropine for bradycardia
Verapamil for Afib
What is the surgical treatment for CAD?
Per cutaneous coronary revasularization
Stent placement occurs with this.
What is a coronary artery bypass graft?
Surgery for CAD, using a section of a vein or an artery to create a connection, or bypass between the aorta and coronary artery. This allows blood to perfume to the ischemic portion of the heart.
What is the initial treatment for an MI?
M: morphine O: oxygen N:nitroglycerin A:aspirin B: beta blockers
What does the C-reactive protein indicate?
Elevated levels may be predictors of CAD
What does an ABI indicate?
An ABI of less than 0.9 indicates the presences of PAD
What does an ECG indicate?
ST segment greater than 3 mm is considered positive for CAD
What does CK level indicate?
It correlates with the size of the infarction. Appears within 4-6 hrs of AMI.
What does CK-MB indicate?
Greater than 5% is an indicator of MI. DOes not normally rise with any other reason than an MI.
What does a CBC indicate?
It looks at WBC count to check for inflammation,
What does an ECCHO indicate?
Cardiac wall motion and left ventricular function
