CAD BOOK Flashcards
most prevalent type of cardiovascular disease in adults.
Coronary artery disease (CAD)
an abnormal accumulation of lipid, or fatty substances, and fibrous tissue in the lining of arterial blood vessel walls
Atherosclerosis
These substances block and narrow the coronary vessels in a way that reduces blood flow to the myocardium.
Lipid, fatty substances and fibrous tissue
involves a repetitious inflammatory response to injury of the artery wall and subsequent alteration in the structural and biochemical properties of the arterial walls
Atherosclerosis
The inflammatory response involved with the development of atherosclerosis begins with injury to the–and progresses over many years
Vascular endothelium
The injury may be initiated by
Smoking
Tohacco use
Hypertension
Hyperlipidemia
The endothelium undergoes changes and stops producing the
Normal antithrombotic
Vasodilating agents
The macrophages ingest lipids, becoming –transport the lipids into the arterial wal
Foam cells
also release biochemical substances that can further damage the endothelium by contributing to the oxidation of low-density lipoprotein (LDL
Activated macrophages
is toxic to the endothelial cells and fuels progression of the atherosclerotic process
Oxidized LDL
protrude into the lumen of the vessel, narrowing it and obstructing blood flow
Atheromas or plaques
can resist the stress of blood flow and vessel movement
Thick plaque
If the cap is thin and inflammation is ongoing, the lesion becomes what is called
Vulnerable plaque
attracts platelets and causes thrombus formation
Ruptured plaque
A thrombus may then obstruct blood flow, leading to – and cause—
ACS and MI
Clinical manifestations
Ischemia
Angina pectoris
Epigastric distress
Pain radiates to jaw or left arm
indigestion, nausea, palpitations, and numbness
This impediment to blood flow is usually progressive, causing an inadequate blood supply that deprives the cardiac muscle cells of oxygen needed for their survival. The condition is known as
Ischemia
A decrease in blood supply from CAD may cause the heart to abruptly stop beating; this is known as
Sudden cardiac death
The most common manifestation of myocardial ischemia is the
Onset of chest pain
also known as bad cholesterol, is a well-known risk factor and the primary target of cholesterol-lowering therapy.
Elevated LDL
People at the highest risk for having a cardiac event are those with known
CAD, diabetes, peripheral arterial disease, abd aortic aneurysm, carotid artery disease
is a tool commonly used to estimate the risk for having a cardiac event within the next 10 years
Framingham Risk Calculator
a cluster of metabolic abnormalities known as
Metabolic syndrome
Non modifiable
Fam hx of CAD
Age
Gender
Race
Hx of premature menopause
Primary hypercholesterolemia
Modifiable
Hyperlipidemia Tobacco use Hypertension Diabetes
Metabolic syndrome Obesity
Physical inactivity
Chronic inflammatory conditions (e.g., rheumatoid arthritis, lupus, HIV/AIDS) Chronic kidney disease
are known to modify insulin action and contribute to atherogenic changes in the cardiovascular system
Asipokines, free fatty acids
is known to be an inflammatory marker for cardiovascular risk, including acute coronary events and stroke
C reactive protein (CRP)
Prevention
Controlling Cholesterol Abnormalities
*Dietary measures
*Physical Activity
*Medications
Promoting Cessation of Tobacco Use
Managing Hypertension
Controlling Diabetes
Four elements of fat metabolism
Total cholesterol, LDL, HDL, triglycerides
known to affect the development of heart disease
Fat metabolism
Cholesterol is processed by the gastrointestinal (GI) tract into lipoprotein globules called
Chylomicrons
Patients who have had an acute event of MI. require assessment of their LDL cholesterol level within a few months of the event or procedure, because LDL levels may be low immediately after the acute event or procedure
PCI
CABG
lipids should be monitored every
4-12 wks an dthe 3-12 mos
LDL cholesterol
less than 100 mg/dL
Total cholesterol
less than 200 mg/dL
HDL cholesterol
greater than 40 mg/dL for males and greater than 50 mg/dL for females
Triglyceride
less than 150 mg/dL
is also a clear predictor of coronary events.
total cholesterol level
is made up of fatty acids and is transported through the blood by a lipoprotein.
Triglycerides
Dietary measures
AHAs diet
Mediterranian
Plant foods
Limit sugar intake
The label information of interest to a person attempting to eat a heart-healthy diet is as follows:
Serving size, amt of total fat per serving, amt of saturated fat, trans fat, amt of cholesterol and amt of fiber
Physical Activity
elevated triglyceride level need wt reduction and increase PA
Aerobic act -150 per wk
Vigorous intensity aerobic act 75 minutesnper week
Muscle strength training 2 or more days a week
Medications
Lipid-lowering medications
*HMG CoA statins, fibrates, resins, cholesterol inhibitors, PCSK9
is known to accelerate the development of heart disease
Diabetes
