Coronary Artery Disease Flashcards
what is arteriosclerosis
thickening or hardening of the
arterial wall often associated with aging
what is atherosclerosis
type of arteriosclerosis that
involves the formation of plaque within
the arterial wall
Leading risk factor for cardiovascular disease
patho atherosclerosis
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
atherosclerosis of the coronary arteries
The anatomic
structure of the
coronary arteries
makes them
particularly
susceptible to
atherosclerosis
cad is an umbrella term for
Chronic stable angina
◦ Acute coronary syndrome (ACS)
risk factors of cad/acs
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
what do statins do
reduce LDL
what do fibric acid drugs do
refuce TG
what do bile acid binding drugs
reduce ldl
what does niacin do
reduceds ldls
reduces tgs
some increase hdl
what does ezetimibe do
blocks absorption of cholesterol in small intestine,
decreases LDL
what does omega 3 fatty aicds do
reduces mortality from MI
or stroke, reduces TG
(Total cholesterol = LDL + HDL)
angina pectoris
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
common side effect of nitro
ha
12 lead ekg
Gives varying views of the heart
◦ Can pinpoint occurrence and location
of ischemia or necrosis
◦ Done within 10 minutes of presenting
with chest pain
troponin
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
unstable angina
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
other forms/types/ters unstable angina
New-onset angina
◦ Vasospastic angina (r/t spasm)
[AKA variant or Prinzmetal’s]
◦ Pre-infarction angina
nonstemi mi
Will have ST and T-wave changes
◦ Troponins will begin to elevate
over 3-12 hrs
st depression or t inversion
stemi mi
st segment elevation
EMERGENCY
acute mi management
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”
what ti stabilize with
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
thrombylitic therapy
Fibrinolytics dissolve thrombi
◦ Most effective w/in 6hr of onset
◦ For STEMI only
◦ Need ASA & Heparin after
◦ Numerous contraindications
percutaneous coronary intervention
May use GP IIb/IIIa inhibitors with
PCI
◦ Need loading dose of clopidogrel (or
others)
how long until cath lab
<60 min
intr-procedure cardiac cath
mild sedative, lie still/flat,
puncture site, contrast used & fluoroscopy
maintenance pharm after acs
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
educations and cardiac rehab
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
