cardiovascular Flashcards
Define coronary artery disease (CAD)
a type of blood vessel disorder that we consider in the general category of atherosclerosis.
Define atherosclerosis
begins as soft deposits of fat that harden with age “hardening of the arteries”
progressive disease
- chronic endothelial injury
- fatty streak
- fibrous plaqu
- complicated lesion
atherosclerosis of the coronary arteries can result in…
impaired blood flow to the myocardium
List some non-modifiable risk factors for CAD?
- age
- gender
- ethnicity
- genetics
total cholesterol normal levels
below 200
triglyceride normal levels
below 150
- changes more quickly depending on diet
LDL cholesterol normal levels
below 130
- mostly related to diet and medication
HDL cholesterol normal levels
men: higher than 40
women: higher than 50
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
C
what are other CAD contributing modifiable risk factors?
- 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)
what kind of tests can be used to diagnose CAD?
EKG
stress test
echocardiogram
chest x-ray
blood test
coronary angiography and cardiac catheterization
How do statins (atorvastatin, etc) restrict lipoprotein production?
block synthesis of cholesterol in the liver
how do bile-acid sequestrants (colestid) increase lipoprotein removal?
binds with bile to remove LDL and cholesterol
how do cholesterol absorption inhibitors (ezetimibe) decrease cholesterol absorption?
inhibits intestinal absorption of cholesterol
define angina pectoris
chest pain or discomfort due to the narrowing of the coronary arteries (CAD)
what are the symptoms of chronic stable angina?
pressure, fullness, squeezing or pain
what are some precipitating factors of angina?
- physical exertion
- temperature extremes
- strong emotions
- consumption of heavy meals
- tobacco use and environmental tobacco smoke
- sexual activity
- stimulants
- circadian rhythm patterns
define silent ischemia
ischemia: oxygen supply is inadequate to meet metabolic needs
- no subjective symptoms
- most common in diabetics
- documented by ECG changes
describe prinzmetal’s angina
- rare
- occurs at rest and not with increased physical demand
prinzmetal’s angina risk factors
- hx of migranes, raynaud’s or smoking
What can cause prinzmetal’s angina?
- 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
describe microvascular angina
Chest pain in the absence of significant CAD or coronary spasm of a major coronary artery
- Prolonged angina with
exertion
What causes microvascular angina?
Caused by coronary
microvascular disease
- spasm or atherosclerosis
of distal, small branches
of coronary vessels
- More prevalent in women
indications for short-acting nitrates
symptoms or prophylactic
administration of short-acting nitrates
sublingual NTG or NTG spray
indications for long-acting nitrates
reduce incidence of angina
long-acting nitrate administration
Oral (isosorbide)
- Nitroglycerin (NTG) ointment
* Prevents angina for 3-6 hours
- Transdermal patch
* Releases NTG over 24-hour period
what other medications can be used to treat CAD?
- beta-blocker (metoprolol, propranolol)
- ACE/ARB
- Calcium channel blockers
- sodium current inhibitor (ranolazine)
medical treatments for CAD
- Cardiac catheterization/coronary angiography
- Visualize blockages (diagnostic)
- Open blockages (interventional)
* Percutaneous coronary intervention (PCI)
* Balloon angioplasty
* Stent
