CAD, ACS Flashcards
What are the risk non-modifiable risk factors for Coronary Artery Disease (CAD)?
- increasing age
- men > women
- family history
What are the risk modifiable risk factors for Coronary Artery Disease (CAD)?
- smoking, increases LDL and decreases HDL
- HTN
- uncontrolled DM
- obesity
- contraceptive use, usually if > 35 y/o
- HLD
What does ASCVD stand for?
atherosclerotic cardiovascular disease
What is the dosage of atorvastatin when starting a patient in high-intensity statin therapy?
40 or 80mg
How do statins affect the patients lipid profile?
- HMG-CoA reductase inhibitor
- decreases LDL
- modestly decreases TG
What are potential complications of hyperlipidemia?
- atherosclerosis
- pancreatitis
- steatosis, fatty liver
What are the potential complications of statin therapy?
- rhabdomyolysis
- hepatitis
When should high intensity statin therapy be started?
1) clinical ASCVD (CAD, MI, etc)
2) LDL > 190
3) DM + 40 to 75yr + LDL >70
4) 40 to 75yr + LDL>70 + 10 ASCVD 10 risk of stroke/MI >7.5%
What is the dosage of rosuvastatin when starting a patient in high-intensity statin therapy?
20 or 40 mg
What baseline labs need to be drawn prior to starting high intensity statin therapy?
- creatine kinase to monitor for rhabdomyolysis
- LFT’s to monitor for hepatitis
How do bile acid sequestrants affect the patients lipid profile?
- inhibits bile acid absorption in the GIT
- lowers LDL
- causes diarrhea
What is the class and MOA of Cholestyramine?
- bile acid sequestrant
- lowers LDL
- inhibits bile acid absorption in the GIT
What is the class and MOA of Ezetimibe?
- lowers LDL
- inhibits cholesterol absorption in the GIT
- causes diarrhea
What effect do Fibrate medications have on the lipid profile?
-decrease TG
- slightly decrease LDL
- poss increase HDL
What is the difference between angina and an acute myocardial infarction?
- angina is discomfort or pressure in the chest with no myocardial damage
- MI is necrosis of the myocardial tissue
What is the underlying cause of an acute myocardial infarction?
- myocardial O2 demand is greater the ability of the coronary arteries to supply
- blockage of blood supply to myocardial tissue
What are risk factors for the having an acute myocardial infarction?
- CAD
- HTN
- metabolic syndrome
- obesity
- DM
- male
- sedentary lifestyle
- diet
- stress
How long should it take for a STEMI patient to receive fibrinolytics upon arrival to the hospital (door to fibrinolytics)?
within 30 min
How is the door to angioplast/heart cath time for a STEMI patient?
within 90 mins
What should be suspected if a patient presents with intermittent chest pain/discomfort that has the same onset, intensity and duration. It usually induced by exercise, exertion or stress and last between 5-20 mins?
Stable angina
Why is nitroglycerin given a patient with stable angina?
it causes vasodilation of the coronary arteries, which increases the blood and O2 supply to the myocardium
What is the term for chest comfort or pain at rest with transient ECG changes in the ST segment?
Prinzmetal angina
- aka: vasospastic or variant
What is Prinzmetal angina?
- aka: vasospastic or variant
- term for chest comfort or pain at rest with transient ECG changes in the ST segment
What is the difference between prinzmetal and stable angina?
1) Onset:
- prinzmetal (PM): usually occurs at rest
- stable angina is usually triggered by exertion
2) Symptoms:
- PM: chest pain or discomfort that can move to arm, shoulder, or head
- stable: feels like pressure or indigestion
3) Pattern:
- PM: last up to 30mins and can recur
- stable: lasts 5-30 mins and is regular, predictable
4) ECG
- PM: ST-segment elevation
- stable: ST depression
What is/are the main causes of Prinzmetal angina?
coronary arterial spasms
- may be precipitated by sumatriptan, amphetamines, EtoH, cocaine
What is/are the treatment(s) for Prinzmetal angina?
Calcium channel blockers to manage the coronary arterial spasms
What is/are the treatment(s) for stable angina?
- lifestyle modifications (diet, exercise, smoking cessation)
- nitrates
- beta blockers
- calcium channel blockers
What are common symptoms a woman would report if having an myocardial infarction?
- GI like symptom
- pain that radiates to the back
Lack of pain during an Myocardial Infarction is common in what patient population?
diabetics and elderly secondary to neuropathies
Should a cardiac workup be completed on an woman presenting with GI-like symptoms, fatigue, SOB and pain radiating to their back?
Yes, these are common presentations in women experiencing a myocardial infarction or unstable angina