Coronary Artery Disease

Question 1

What’s the most common cardiovascular disease?

Answer 1

Coronary artery disease

Question 2

CAD can either be what? (2)

Answer 2

Asymptotic
Or
Chronic stable angina ( chest pain )

Question 3

What are the two acute coronary syndrome ?
These are more serious conditions of CAD

Answer 3

Unstable angina ( UA )
Myocardial infarction ( MI )

Question 4

Cad has a profound effect on perfusion
Which means what?

Answer 4

Perfusion depends on the hearts ability to generate enough cardiac output to distribute blood to all body tissues

So when it has an effect on perfusion in the body, it decreases cardiac output and perfusion

Question 5

What’s the major cause of CAD?

Answer 5

Atherosclerosis

Question 6

What does atherosclerosis mean
What type of dis order is it? (2)

Answer 6

Soft deposits of fat that harden with age
(Hardening of arteries)

Blood vessel disorder

Question 7

What are the fatty deposits that form in coronary arteries called?
When these fatty deposits form, this is what classifies the name for CAD

Answer 7

Atheromas

Question 8

Atheromas are characterized how?

Answer 8

By lipid deposits within intima of artery

Question 9

What is another major role that causes Atheromas? (2)

And why is it this cause?

Answer 9

Endothelial injury & inflammation

Because the blood vessel is lined with endothelial cells that protect the blood vessel but when it gets injury it’s open to many plaque to enter

Question 10

How does the inflammation come into play when creating atherosclerosis for CAD?

Answer 10

C-reactive protein (CRP) comes from the liver and will rise when detecting systemic inflammation
Such as rheumatoid arthritis & inflammatory bowel disease

Question 11

In the textbook it mentions how high LDL ( low density lipoprotein) and homocysteine also play a role in increasing CAD, how so? (3)

Answer 11

Damaging the inner lining of blood vessels

Plaque build up

Changing the clotting mechanism

Question 12

Chronic endothelial injury plays a major role in causing atherosclerosis and opening up the 3 stage development of CAD, how so ?

Answer 12

It’s opening up the endothelium lining that protects the blood vessel and allows plaque and gunk to come in and cause distruption

Question 13

What are some things that can cause this chronic endothelial injury? (7) think of like what can cause the actual INJURY, don’t confuse with the anagram!! )

Answer 13

Hypertension
Tobacco use
Hyperlipidemia
Hyperhomocysteinemia
Diabetes
Infections
Toxins

Question 14

What are the 3 stages of development of atherosclerosis?

Answer 14

Fatty streak
Fibrous plaque
Complicated lesion

Question 15

What is fatty streak stage 1 development of CAD & at what age?

Answer 15

Lipids infiltrate smooth muscle inside vessel
Usually develop in the teen years

Question 16

What is fibrous plaque in stage 2 of development of CAD & at what age? (5)

Answer 16

Fatty streaks enlarge and become covered by collagen
Vessels lumen is narrowed
Blood flow is reduced
Fissures can develop

Begin at 30s

Question 17

What is complicated lesion for stage 3 of CAD?

Answer 17

Chronic inflammation causes plaque to be unstable, increasing risk for ulceration/rupture. Platelets adhere to the lesion, creating a thrombus ( blood clot )

Question 18

Coronary artery disease etiology & pathophysiology

Normally some arterial connections called ____ existing within the coronary circulation?
Theses are also known to be what?

Answer 18

Collateral circulation
Backup blood vessels

Question 19

Two factors that contribute to the growth and extent of collateral circulation are? (2/define the terminology)

Answer 19

Inherited predisposition to develop new blood cells ( angiogenesis )

Presence of chronic ischemia
( poor blood flow )

Question 20

What does collateral circulation have the greater change to develop?

Answer 20

Slow developing blockages

Question 21

While during these slow developing blockages that increase collateral circulation, they will allow what to the heart?? But not during what? (2)

Answer 21

Blood and oxygen to heart

But not during increased workload like exercise

Question 22

When you have a rapid onset of CAD or coronary spans ; the collateral circulation doesn’t have Time to develop, however two things can happen?

Answer 22

Severe ischemia ( bad blood flow )
Infarction

Question 23

Visualize the image from the textbook of the collateral circulation
What is the first one
What is the second one
What is the third one

Answer 23

1. Open
2. Partial blockage with collateral circulation
3. Complete blockage artery with collateral circulation bypassing

Question 24

What are some nonmodifiable risk factors for CAD? (5)

Answer 24

Age
Gender
Genetics
Ethnicity
Family history

Question 25

What are the 7 major modifiable risk factors for CAD?

Answer 25

High serum lipids Hypertension Tobacco Physical inactivity Obesity Diabetes Metabolic syndrome

Question 26

What’s the anagram that can help me remember those 7 modifiable risk?

Answer 26

High Hype To Physical Obese Diary Meta !!

Question 27

The increase risk for CAD with high serum lipids are associated with? (4)

Answer 27

Total Cholesterol greater than 200 HDL less than 40 LDL greater than 130 Fasting triglycerides greater than 150

Question 28

HDL vs LDL explain And what they function as

Answer 28

HDL is happy cholesterol helps to prevent lipid accumulation in aterties LDL is bad cholesterol Increases atherosclerosis ( harden of arteries )

Question 29

Triglycerides are the most common type of what in the blood?

Answer 29

Fat

Question 30

How does hypertension work in increasing the risk for CAD? ( think about the vascular endothelial in the Bp) (4)

Answer 30

The shear stress of an elevated blood pressure causes endothelial injury And with atherosclerosis, it causes narrowing, thicken, and decrease elasticity of vessels And remember from how hypertension the endothelial cells are disrupted because of all of the pressure that’s needed to pump blood through the vessel because of how skinny the vessels become, so that’s why it effects CAD Not to mention that all this workload can cause left ventricular hypertrophy & decrease stroke volume

Question 31

How does tobacco use-even second hand effect CAD? (2)

Answer 31

Nicotine in tobacco caused catecholamines ( epinephrine & norepinephrine ) increased heart workload ; like blood pressure Increase LDLs

Question 32

How does physical inactivity effect CAD? And what’s recommended?

Answer 32

Lack of exercise To do 30-60mins brisk walking 5 days a week

Question 33

How does obesity effect CAD. BMI?? What’s the waist circumference size for men & women? What type of body shape will we see with CAD? (4)

Answer 33

Overweight >30 Men >40 Women>35 Apple figure ( fat in abdomen)

Question 34

How does diabetes effect risk factors for CAD? (2)

Answer 34

Increased endothelial dysfunction Altered lipid metabolism & increasing cholesterol & trigs

Question 35

How does metabolic syndrome effect CAD? (3)

Answer 35

Insulin resistance Abnormal serum lipids High fasting blood glucose

Question 36

What are 3 more contributing risk factors for CAD?

Answer 36

Psychological states Substance use CRP,LIPOPROTEINS,HOMOCYSYENINE

Question 37

How does psychological state effect CAD? ( don’t overthink it, it’s literal psychology 3)

Answer 37

Depression Anxiety Stress

Question 38

How does substance use effect CAD?

Answer 38

Cocaine and merhamphetamine result in coronary artery spans causing chest pain & MI

Question 39

How does CRP, LIPOPROTEIN, HOMOCYSTEINE LEVEL effect CAD? (3)

Answer 39

1. Dmg endothelium 2. Promote plaque buildup 3. Enhance clotting

Question 40

What are the 6 health promotion strategies for CAD? We’re gonna identify what? Precent what? Encourage what??

Answer 40

Identifying high risk patients Preventing control modifiable risk Encourage life style changes Education Clarify personal values Set realistic goals

Question 41

What type of physical activity program should we implement for our CAD patients? Whats the formula name and stand for

Answer 41

FITT frequency Intensity Type Time

Question 42

We want how long to be there physical activity ? And it helps with what 3 things?

Answer 42

30mins most days plus weight training 2 days Weight reduction Reduction of systolic BP Increase HDL

Question 43

What nutritional therapy will we implement on CAD patients? (4) 2 decrease 2 increase

Answer 43

Decrease saturated fats & cholesterol Decrease red meat, egg yolk, whole milk Increase complex carbohydrates & fibers Increase omega 3 fatty acids

Question 44

When your patient has elevated triglycerides we want to reduce or stop the consumption of what& manage what?

Answer 44

ETOH Blood glucose

Question 45

What type of medication are we going to give to CAD?

Answer 45

Lipid lowering medication

Question 46

Lipid lowering medication drug therapy is what?

Answer 46

Life long

Question 47

We always want to teach patients when taking lipid lowering medication about rational goals(1) and side effects(2), what are some of them?

Answer 47

Goals Lowering LDL Side effects Muscle pain & GI disturbances

Question 48

We want our patient to following a concurrent diet when taking lipid lowering medication, not to mention we want to encourage 2 other things as well?

Answer 48

Weight loss and increase physical activity

Question 49

We also want to reassess after how many weeks of taking lipid lowering medication for what?

Answer 49

6 weeks If the medication isn’t working to alternate

Question 50

When do we want to start giving out lipid lowering drug therapy?

Answer 50

When there total cholesterol remains greater than 200 in spite of diet and exercise

Question 51

What are the 6 lipid lowering drug therapy medications we can give to patients with CAD?

Answer 51

Statins Niacin Fibric acid derivatives (lopid) Bile acid sequestranrs Ezerimibe (zetia) Antiplatelet therapy

Question 52

What’s an anagram that can help me remember the medications of lipid lowering drug therapy for CAD?

Answer 52

Stop Nick Filling Bile Ez Anti

Question 53

What is statins function? Helps decrease what?(2) Increase what(1)

Answer 53

Inhibit cholesterol synthesis in the liver and Decrease CRP&LDL increase HDL

Question 54

We want to monitor stations why?

Answer 54

Because of liver damange and myopathy leading to rhabdomyolysis ( break down of skeletal muscle )

Question 55

What is niacin function? Increases what?

Answer 55

Lowers LDL and Trigs by inhibiting synthesis HDL increase

Question 56

What are some things we want to monitor for niacin ? (4)

Answer 56

Flushing Itching ( pruritus ) GI side effects Orthostatic hypotension

Question 57

What are fibric acid derivaties function? Decrease? Increase? Nothing to?

Answer 57

Decrease triglycerides and increasing HDL Does nothing to LDL

Question 58

What are important things to monitor for fibric acid derivaties ?

Answer 58

Gi side effects Increase bleeding with warfain & effects of anti hyperglycemia drugs ( repaglinide )

Question 59

What is bile acid sequestrsnts? What is the side effect?

Answer 59

Increase conversion of cholesterol to bile acids Binds with other drugs

Question 60

What is eztimibie (Zetia)?

Answer 60

Decrease absorption of dietary and biliary cholesterol

Question 61

What is antiplatelet therapy ? Side effects? Medication

Answer 61

Preventing clots GI bleed or stroke Clopidigrel (plavix)

Question 62

GERONTOLOGIC CONSIDERSATIONS CAD THEY HAVE AN INCREASE WHAT?

Answer 62

MORTAILITY & INCIDENCE

Question 63

What are strategies to help reduce risk in elderly for CAD? (2)

Answer 63

No Smoking Physical activity

Question 64

What do we want to treat in elderly for CAD?(2)

Answer 64

Hypertension Increased lipids

Question 65

Elderly patients are more willing to change when having what two things?

Answer 65

Being hospitalized or having chest pain