CAD and Acute Coronary Syndrome (ACS) Flashcards
What is stent re-stenosis?
Overgrowth of plaque on the new stent. Will close the stent up and will need new procedure. This is avoided with anti platelet therapy
What is DAPT (dual antiplatelet therapy)?
Aspirin + clopidogrel (Plavix)
Given for about 12 months after stent to prevent stent re-stenosis.
What are the 2 preferred veins harvested for CABG?
Saphenous
Left internal mammary (1st choice) called LIMA
What is cardiopulmonary bypass?
A machine that allows the heart to be stopped during bypass surgery. Blood is diverted through pump to be oxygenated and then returned to feed vital organs
What is medical name for hardening of the arteries?
Artherosclerosis
What are stages of artherosclerosis?
- Chronic injury (HTN, DM, Smoking, etc)
- Fatty streak (lipid accumulation)
- Fibrous plaque (lumen narrows, blood flow reduced)
- Complication (rupture of plaque, thrombus formation, total or near total occlusion)
What is collateral circulation?
Angiogenesis in areas of poor circulation.
This happens gradually.
An older person’s heart is more equipped to handle ischemia than a younger persons because they have had time to develop collateral circulation.
Non modifiable risk factors for CAD
White
Male
Age (Over 45 for men, Over 55 for women)
Fam hx
Modifiable RF for CAD
Normotensive
DM
Cholesterol
Obesity
Activity
Smoking
Stress/Anger/depression
Substance abuse (meth, cocaine)
What should be avoided in low cholesterol diet?
Red meat
High fat dairy
Egg yolks
What is chronic stable angina?
Chest pain over long period of time that is predictable in pattern, duration, intensity
How will EKG change in ischemic episode?
ST segment depression
T wave inversion
Returns to baseline when ischemia subsides
What is Prinzmetal’s angina?
PRINTZ-MUH-TALLS
Vasospastic angina
Rare, occurs at rest
RF: Migraine, Raynauds (hands lose circulation) heavy smoker, asian
Usually associated with alcohol or cocaine
Cyclic, short bursts of pain same time every day
Spasms of coronary artery
What is microvascular angina?
Chest pain in absence of CAD or coronary spasm
Ischemia or arteriosclerosis of SMALL distal vessels of heart
More common in women
What is unstable angina?
New
Occurs even at rest
Lasts more than 10 min
Chronic angina that has changed in intensity, duration, severity
What is overall goal for patient with angina?
Increase O2 supply
Decrease O2 demand
What are things we will do to take care of patient with chest pain?
Sit upright
O2
EKG
Pain relief
Labs for cardiac biomarkers
Chest Xray
Assess heart/lung sounds/VS
What are main classes of meds given to patients with CAD?
Nitrates (short and long acting)
ACE inhibitors (–pril drugs)
Beta blockers (–lol drugs)
Calcium channel blockers
How are short acting nitrates taken?
Stored?
1 tab SL
If in 5 minutes pain is unrelieved call EMS
Stored in dry, dark place with no heat. Bottle good for 6 months after opening.
How will you know if nitro is potent?
Tingling under tongue (if SL)
SE of nitro?
Headache, flushing, dizziness, drops BP
–Have them seated before taking–
What are some long acting nitrates?
Isosorbide dinitrate (Isordil) and isosorbide mononitrate (Imdur)
What do ACE inhibitors do?
Main complaint?
Suffix?
Vasodilate
Cough/angioedema
—Pril
What do beta blockers do?
Caution in which patients?
Suffix?
Block Sympathetic NS effects like:
Reduces HR
Calms heart muscle
Relaxes smooth muscle of vessels
Caution in: asthma (can cause wheezing)
Caution in bradycardia and hypotension
Caution in DM (can mask signs fo hypoglycemia)
—–LOL
