Ch. 5 - Coronary Artery Disease Pt. 1 Flashcards
The circulatory system can be divided into what two separate entities?
The pulmonary circulation and the systemic circulation, which includes the coronary circulation
Although CAD is the leading cause of death for both males and females, who is more likely to develop CAD?
Males
Aside from age and gender, what are other risk factors for CAD?
Family history, hyperlipidemia, smoking, hypertension, diabetes mellitus, elevated homocysteine levels, elevated inflammatory markers such as plasma fibrinogen and C-reactive protein (CRP), and lifestyle factors such as obesity, atherogenic diet, lack of exercise, and psychosocial stressors
In addition to the consideration of cardiovascular risk factors, other markers that point to an increased risk of atherosclerosis should be considered in the assessment of the probability of CAD. These include:
Aortic sclerosis, a decreased ankle-brachial index, an increased carotid intimal-media thickness (IMT), the presence of microalbuminuria and/or renal insufficiency, and the presence of left ventricular hypertrophy (LVH) on electrocardiogram (EKG) or echocardiogram
What is another term for cardiac chest pain?
Angina pectoris. This occurs whenever myocardial oxygen demand exceeds oxygen supply
What is chest discomfort that occurs predictably and reproducible at a certain level of exertion and is relieved with rest or nitroglycerin?
Stable angina
Sometimes coronary artery disease can be totally asymptomatic. What is this called?
Silent ischemia. This can be diagnosed with cardiac testing. Silent ischemia carries the same prognosis as its symptomatic counterpart
What can prolonged total occlusion of a coronary artery lead to?
Injury and death of the heart muscle, a myocardial infarction (MI)
A hormone produced by the heart in response to the stretching of myocardial cells due to volume and/or pressure overload
Brain natriuretic peptide (BNP). Useful clinically in the diagnosis, prognosis, and treatment of congestive heart failure (CHF). BNP levels are high in females, older individuals, those with renal insufficiency, and those with cardiac diseases including CAD, CHF, atrial fibrillation, myocarditis, LVH, and valvular regurgitation. Many clinical studies have shown that elevated levels of BNP are associated with higher cardiac and all-cause mortality
What are some treatment options once the diagnosis of CAD has been confirmed?
Medical therapy, percutaneous transluminal coronary angioplasty (PTCA) and Atherectomy, and coronary artery bypass graft (CABG)
In what treatment is a balloon-tipped catheter inserted percutaneously into a peripheral artery, threaded through the aorta, ultimately reaching the coronary circulation
PTCA (percutaneous transluminal coronary angioplasty)
This procedure involves removing plaque from the inside of an artery either by shaving or cutting it away
Atherectomy. It is no more effective and has more complications than PTCA in treatment of CAD, and its use is limited to those lesions that are not amenable to PTCA (i.e., those lesions that are very tight or heavily calcified)
In this procedure, a new connection is made from the aorta to the coronary artery by use of a graft, a portion of an artery or vein that creates a detour for blood flow to the myocardium by bypassing the problematic blockage
CABG (coronary artery bypass graft)
The prognosis of CAD is variable and influenced by many factors that must be considered in the evaluation of a candidate for life insurance. What must be considered?
How has the CAD affected the heart?
How can the CAD further affect the heart or how much of the myocardium is in jeopardy?
How soon will further damage occur or what is the current stability of the CAD?
How will this individual do in the long term or what is the future stability of the CAD?
What is the best case for CAD?
Onset of CAD at later ages
Stable angina
Normal LV function and ejection fraction
Mild, single vessel disease excluding left main
No arrhythmias
No progression of disease
No diabetes or other significant chronic disease
Well-controlled cardiovascular risk factors including the use of a statin and asprin
Good exercise capacity
Negative stress test
What is considered high risk for those with CAD?
Early onset of CAD (before age 40)
Unstable or worsening disease, CHF, or poor LV function
Reduced ejection fraction
Severe three-vessel disease or left main disease, especially if not revascularized
Presence of arrhythmias - atrial fibrillation or ventricular premature complexes (VPCs)
Significant progression of dsiease over a short period of time
Poorly controlled cardiac risk factors
CHD in the setting of other medical conditions like valvular heart disease, pulmonary disease, renal disease, diabetes, or cerebral and/or peripheral vascular disease
Poor exercise tolerance
Severe stress testing abnormalities: drop in BP with exercise, early onset of ischemic changes, etc.
The gold standard test for diagnosing coronary artery disease (CAD) is:
1. An exercise tolerance test (ETT)
2. Coronary angiography
3. Thallium imaging
4. Electron beam computed tomography (EBCT)
- Coronary angiography
Modifiable risk factors for atherosclerosis include all of the following EXCEPT:
1. Family history
2. Smoking
3. Hypertension
4. Diabetes
- Family history
The METs level of an exercise EKG is determined by which of the following?
A. Calories burned at rest
B. Duration of exercise
C. Protocol used
B & C only
All of the following are layers of the heart wall EXCEPT:
1. Endocardium
2. Pericardium
3. Endometrium
4. Myocardium
- Endometrium
Medications that dilate the coronary arteries include which of the following?
A. Nitrates
B. Beta-blockers
C. Calcium channel blockers
A only is correct
All of the following are functions of the circulatory system EXCEPT to:
1. Transport oxygen
2. Transport waste materials of cellular metabolism
3. Propel blood through the body
4. Raise and lower HDL cholesterol
- Raise and lower HDL cholesterol
All of the following are measured on an exercise electrocardiogram EXCEPT:
1. Blood pressure
2. Exercise capacity
3. Thickness of the left ventricle
4. EKG changes
- Thickness of the left ventricle
An EBCT scan is used to:
1. Calculate exercise tolerance
2. Detect heart murmurs
3. Detect deposits of calcium in coronary arterial walls
4. Fracture plaque in an occluded coronary artery
- Detect deposits of calcium in coronary arterial walls
