cardiovascular

Question 1

Define coronary artery disease (CAD)

Answer 1

a type of blood vessel disorder that we consider in the general category of atherosclerosis.

Question 2

Define atherosclerosis

Answer 2

begins as soft deposits of fat that harden with age “hardening of the arteries”

Question 3

progressive disease

Answer 3

• chronic endothelial injury
• fatty streak
• fibrous plaqu
• complicated lesion

Question 4

atherosclerosis of the coronary arteries can result in…

Answer 4

impaired blood flow to the myocardium

Question 5

List some non-modifiable risk factors for CAD?

Answer 5

• age
• gender
• ethnicity
• genetics

Question 6

total cholesterol normal levels

Answer 6

below 200

Question 7

triglyceride normal levels

Answer 7

below 150
- changes more quickly depending on diet

Question 8

LDL cholesterol normal levels

Answer 8

below 130
- mostly related to diet and medication

Question 9

HDL cholesterol normal levels

Answer 9

men: higher than 40
women: higher than 50

Question 10

Which patient would be at a higher risk for CAD based on their lab values:

a. male patient with total cholesterol of 160, triglycerides of 120, LDL of 100, HDL of 65

b. female patient with total cholesterol of 162, triglycerides of 123, LDL of 121, HDL of 66

c. male patient with total cholesterol of 250, triglycerides of 167, LDL of 145, HDL of 23

d. female patient with total cholesterol of 172, triglyceride of 130, LDL of 115, HDL of 72

Answer 10

C

Question 11

what are other CAD contributing modifiable risk factors?

Answer 11

• high fasting blood glucose (diabetes, metabolic syndrome)
• high homocysteine level (damages the lining of blood vessels, promotes plaque buildup, alters clotting mechanism)
• substance abuse (cocaine/methamphetamine)
• psychosocial (type A personality, acute and chronic stress, anxiety, hostility, anger, lack of social support, depression)

Question 12

what kind of tests can be used to diagnose CAD?

Answer 12

EKG
stress test
echocardiogram
chest x-ray
blood test
coronary angiography and cardiac catheterization

Question 13

How do statins (atorvastatin, etc) restrict lipoprotein production?

Answer 13

block synthesis of cholesterol in the liver

Question 14

how do bile-acid sequestrants (colestid) increase lipoprotein removal?

Answer 14

binds with bile to remove LDL and cholesterol

Question 15

how do cholesterol absorption inhibitors (ezetimibe) decrease cholesterol absorption?

Answer 15

inhibits intestinal absorption of cholesterol

Question 16

define angina pectoris

Answer 16

chest pain or discomfort due to the narrowing of the coronary arteries (CAD)

Question 17

what are the symptoms of chronic stable angina?

Answer 17

pressure, fullness, squeezing or pain

Question 18

what are some precipitating factors of angina?

Answer 18

• physical exertion
• temperature extremes
• strong emotions
• consumption of heavy meals
• tobacco use and environmental tobacco smoke
• sexual activity
• stimulants
• circadian rhythm patterns

Question 19

define silent ischemia

Answer 19

ischemia: oxygen supply is inadequate to meet metabolic needs

• no subjective symptoms
• most common in diabetics
• documented by ECG changes

Question 20

describe prinzmetal’s angina

Answer 20

• rare
  
  • occurs at rest and not with increased physical demand

Question 21

prinzmetal’s angina risk factors

Answer 21

• hx of migranes, raynaud’s or smoking

Question 22

What can cause prinzmetal’s angina?

Answer 22

• Spasm of coronary artery
• Increased O2 demand
  * Trigger substances (smoking, alcohol, cocaine)
  * Medications that narrow blood vessels (sumatriptan/Imitrex)
  * Exposure to cold
  * During REM sleep

Question 23

describe microvascular angina

Answer 23

Chest pain in the absence of significant CAD or coronary spasm of a major coronary artery
- Prolonged angina with
exertion

Question 24

What causes microvascular angina?

Answer 24

Caused by coronary
microvascular disease
- spasm or atherosclerosis
of distal, small branches
of coronary vessels
- More prevalent in women

Question 25

indications for short-acting nitrates

Answer 25

symptoms or prophylactic

Question 26

administration of short-acting nitrates

Answer 26

sublingual NTG or NTG spray

Question 27

indications for long-acting nitrates

Answer 27

reduce incidence of angina

Question 28

long-acting nitrate administration

Answer 28

Oral (isosorbide)
- Nitroglycerin (NTG) ointment
* Prevents angina for 3-6 hours
- Transdermal patch
* Releases NTG over 24-hour period

Question 29

what other medications can be used to treat CAD?

Answer 29

• beta-blocker (metoprolol, propranolol)
• ACE/ARB
• Calcium channel blockers
• sodium current inhibitor (ranolazine)

Question 30

medical treatments for CAD

Answer 30

• Cardiac catheterization/coronary angiography
  - Visualize blockages (diagnostic)
  - Open blockages (interventional)
  * Percutaneous coronary intervention (PCI)
  * Balloon angioplasty
  * Stent