Coronary Artery Disease

Question 1

what is arteriosclerosis

Answer 1

thickening or hardening of the
arterial wall often associated with aging

Question 2

what is atherosclerosis

Answer 2

type of arteriosclerosis that
involves the formation of plaque within
the arterial wall
Leading risk factor for cardiovascular disease

Question 3

patho atherosclerosis

Answer 3

Exact mechanism unknown – likely from chronic endothelial
injury to artery leading to inflammation
* Fatty streak appears -> cellular proliferation -> fibrous
plaque formation
* Plaques can be stable or unstable

Question 4

atherosclerosis of the coronary arteries

Answer 4

The anatomic
structure of the
coronary arteries
makes them
particularly
susceptible to
atherosclerosis

Question 5

cad is an umbrella term for

Answer 5

Chronic stable angina
◦ Acute coronary syndrome (ACS)

Question 6

risk factors of cad/acs

Answer 6

Atherosclerosis!!!
◦ Metabolic Syndrome (have 3 of
these):
◦ HTN
◦ DM/increased fasting glucose
◦ Decreased HDL (and possibly high LDL)
◦ Increased triglycerides
◦ Large waist size – central obesity

Question 7

what do statins do

Answer 7

reduce LDL

Question 8

what do fibric acid drugs do

Answer 8

refuce TG

Question 9

what do bile acid binding drugs

Answer 9

reduce ldl

Question 10

what does niacin do

Answer 10

reduceds ldls
reduces tgs
some increase hdl

Question 11

what does ezetimibe do

Answer 11

blocks absorption of cholesterol in small intestine,
decreases LDL

Question 12

what does omega 3 fatty aicds do

Answer 12

reduces mortality from MI
or stroke, reduces TG
(Total cholesterol = LDL + HDL)

Question 13

angina pectoris

Answer 13

Predictable, consistent symptoms
Likely a stable, fixed atherosclerotic plaque
Relieved with rest or nitroglycerin; medically managed
May slightly limit physical activity/exertion
4Es: Exertion, Emotional stress, Eating, Exposure to temp extremes

Question 14

common side effect of nitro

Answer 14

ha

Question 15

12 lead ekg

Answer 15

Gives varying views of the heart
◦ Can pinpoint occurrence and location
of ischemia or necrosis
◦ Done within 10 minutes of presenting
with chest pain

Question 16

troponin

Answer 16

Myocardial muscle protein that is
released with injury to myocardium
◦ Laboratory test done at the time of
presentation with chest pain
◦ Assessed at varying time intervals –
every 3-6 hours

Question 17

unstable angina

Answer 17

Occurs with rest OR exertion
◦ More severe activity limitation
◦ Less responsive to rest or nitroglycerin
◦ May have some EKG changes, but does
not affect troponin levels

Question 18

other forms/types/ters unstable angina

Answer 18

New-onset angina
◦ Vasospastic angina (r/t spasm)
[AKA variant or Prinzmetal’s]
◦ Pre-infarction angina

Question 19

nonstemi mi

Answer 19

Will have ST and T-wave changes
◦ Troponins will begin to elevate
over 3-12 hrs
st depression or t inversion

Question 20

stemi mi

Answer 20

st segment elevation
EMERGENCY

Question 21

acute mi management

Answer 21

Stabilize
* ‘MONA’ + “EBBA” (a Fetter original) 
* But not necessarily in that order…
Reperfuse
* Thrombolytics
* Percutaneous Coronary Intervention
* Coronary Artery Bypass Grafting
Recover
* Maintenance pharmacotherapy
* Education & Cardiac Rehab
* Lifestyle modification
“Begin a new normal”
“Re-establish the flow”
“Minutes Matter”

Question 22

what ti stabilize with

Answer 22

E: ECG/VS
N: Nitroglycerin** unless hypotensive
A: Aspirin (chewable)/Anti-platelets
M: Morphine (reduce stress and decrease bp)
O: Oxygen PRN
A: Anxiety Reduction
BB: Beta Blockade- unless hypotensive (decrease contractility to help perfusion)
heparin maybe

Question 23

thrombylitic therapy

Answer 23

Fibrinolytics dissolve thrombi
◦ Most effective w/in 6hr of onset
◦ For STEMI only
◦ Need ASA & Heparin after
◦ Numerous contraindications

Question 24

percutaneous coronary intervention

Answer 24

May use GP IIb/IIIa inhibitors with
PCI
◦ Need loading dose of clopidogrel (or
others)

Question 25

how long until cath lab

Answer 25

<60 min

Question 26

intr-procedure cardiac cath

Answer 26

mild sedative, lie still/flat,
puncture site, contrast used & fluoroscopy

Question 27

maintenance pharm after acs

Answer 27

Aspirin – lifelong
◦ Clopidogrel – with ACS/stent only
◦ Beta Blockers
◦ Long-acting Nitrates – may have
◦ ACE-I/ARB
◦ Statins/other lipid meds
◦ CCBs- more for chronic stable
angina, less for ACS

Question 28

educations and cardiac rehab

Answer 28

Progression to return of vital and productive
life within limitations of heart function
◦ Can participate in outpatient centers for
additional support, education, monitoring
◦ Gradual increase in activity while monitoring
VS, fatigue level
◦ Risk factor modification
◦ Lifestyle adjustments – stress, coping