Chapt 34/ CAD & ACS Flashcards
What is the most common type of Cardiovascular Disease?
Coronary Artery Disease (CAD)
What is CAD?
Blood vessel disoorder caused by atherosclerosis. Takes a long time to develope. This is why it is important to catch it early and detect high risk patients.
What is ACS?
Acute Coronary Syndrome. It has the same s/s (full or almost complete blockage of artery) of CAD but includes unstable angina (UA) and mycardial infarction (MI).
How prevelant is an MI in ACS?
70-80% because of thrombus formation.
When in angina seen in CAD?
Not until approx 75% the the vessel is occluded. Turbulent flow is what breaks off the occlusion= thrombous
During an MI how long does it take the heart to have full necrotic damage with Collateral circulation?
6 hours
What is collateral circulation
Angiogenesis and the presence of chronic ischemia. Promotes blood flow to comprised areas
Is collateral damange good or bad?
good
If a patient has a rapid onset of CAD will they have collatreral circulation?
No, because there is no time for development of angiogenesis.
Dose Angiogenesis prevent MI’s?
No, but it does lessen the severity.
What is the value for HTN
140/90
What does Pre HTN DX/CKD stand for?
A modifable risk factor for CAD. Prehypertension (130/80) with DM2 or Chronic Kideny Disease.
What is metabolic syndrome?
A modifable risk factor for CAD. Your body becomes insulin resistent and damages nerves and vessels.
In what way are homocysteine levels related to CAD?
The break down our vasculature system
What are the leveds for serum Lipids?
High Cholesterol (>200) Fasting triglycerides (>150)
Why is tobacco a modiable risk factor CAD.
Because nictoine releases catacholemines (Epi, NorEpi) which decreases blood flow and constricts the plaqy vessels.
FITT
Risk Prevention for CAD/ Physical Activity/Promoting weight loss and a decrease in insuline resistance. F=Frequency (at least 5X/week) I=Intensity (moderate) T-Type (Isotonic) T=Time (30 minutes) ~ Add resistance 2days/week.
If you are at a high risk for CAD what should your overall nutrition look like?
Decrease in saturated fats
Increase in Fiber
30% of calories come from mono/poly unsaturated fats
Reduce or eliminate alcohol/simple sugars
Increase omega 3 fatty acids
What age should you start complete lipid profiles?
20 years old and then every 5 years
How do you lower your cholesterol?
- Diet and Exercise (Diet therapy first!) (Reassess after 6 weeks if no change then move to medications)
- Medication
What are the 5 groups of Cholesterol Lowering Drugs
- Statins
- Niacin
- Fibric Acid Derivative
- Bile Acid Sequesterants
- Cholesterol ABsorption Inhibitors
What is the mechanism of Action for Statin Drugs
Simvastatin, Atorvastatin, Rosuvastatin
Inhibit cholesterol synthesis in the liver You haev to take them at night Serious side effects -rhabdomyolysis (muscle breakdown) -Liver damage ~ Monitor SLT,ALT -No grapefruit Juice, dig toxicity.
What is the mechanism of Action for Niacin?
Inhibits Cholesterol Synthesis Many adverse side effects -Severe flushing (take tylenol) -Itching -GI problems -orthostatic hypotension
What is the mechanism of Action for Fibric Acid Derivatives ( Gemibrozil, Fenofibrate) ?
- Do not effects LDL’s, Target VLDL’s
- Take 2 hours before all other medications becuase this drug competes for binding sites. Medication is active when not bound. Therfore can cause toxicities.
What is the mechanism Actions for Bile Acid Sequesterants (chlestyramine, Colesevelam) ?
Increases conversion of cholesterol to bile acid
Needs to be given 2 hours apart from other medication
what is the mechanism of action for Cholesteral Absorption Inhibitor (Ezetimibe) ?
Inhibits absorption of dietary and billary cholesterol.
Often used with diet changes for primary hypercholesterolemia.
Works really well when combined with statins.
What two cholesterol lowerind drugs need to be taken two hours before any other medications?
Fibric Acids Derivatives
Bile Acid Sequesterants
What two cholesterl lowering drugs work really well when combined?
Statins and Cholesteral Absorption Inhibitors
What is the standart antiplatelet therapy for CAD?
Low dose ASA (81 mg)
-baby ASA lowers the risk of GI bleeds
What are symptoms of a GI bleed?
Dark Tary stools
Change in LOC
How do you treat the gerontologic community with CAD?
Aggressively treat HTN and hyperlipidemia
Stop smoking
Planned physical activity.
What is prinzmetals’s Angina?
Chest pain at rest
Pt with migranes and Raynaud’s
What is angina?
Temporary imblalance between oxygen supply and the hearts demand. Anaeroblic metabolism=lactic acid irritates nerves.
What are the usual causes of angina?
Stable, atherosclertoic plaque.
Precipitating Factors of Angina
Physical Exertion (Supply and demant) Temp extremes (cold, vasoconstrict) Strong emotions (catacholamines) Eating a heavy meal (shunting blood flow to gut) Tobacco Use (catacholamines) Sexual Activity Stimulants Disrupt in circadian rhythm (early morning)
Can Nitrates be taken prophylactically?
Yes
Describe Chronic Stable Angina
- Plaque build up in the coronary a.
- Chest pain occurs intermittently over a long period witht he same patter of onset, duration, and intensity.
- Pain lasts 5-15 minutes
- Usu controlled with rest or meds to provide peak effects when angina occurs.
What are Holter Monitors?
Heart monitors what go home with the pt and monitor for 24 hours.
Silent ischemia
ischemai without symptoms. Often seen in pt’s with diabetes because of nerve damage.