Coronary Artery Disease Flashcards
Risk Factors
Pos Fam Hx - sudden death at young age or dx of CAD < 60yo Male Blood lipid abnormalities DM HTN Physical inactivity Obesity Cigarette smoking Poor dietary habits Metabolic syndrome
Smoking Cigarettes
Smoking = #1 cause of death in US
1yr after quitting smoking, risk of CAD decreases by 50%
Smokers should receive cessation info at EVERY office visit
Bood lipid abnormalities
LDL targets:
High risk for CAD: <160
Risk increases with higher LDL, declines with higher HDL
Metabolic Syndrome =
Constelation of 3 or more factors: Abdominal obesity Triglicerides >150 HDL 110 HTN
Diet
Low carbohydrate diets may improve cholesterol profiles in men and are effective diets for weight loss
Omega-3 fatty acids such as fish, may help protect against vascular disease and should be consumed 3 times a week
Inflammatory Markers
Presence of inflammatory markers are high risk factor for CAD
CRP levels useful to determine which pts are at high enough risk to warrant more intensive primary prevention
If elevated CRP, initiate statin therapy
Chronic Stable Angina Pectoris
Usually d/t CAD and occurs at site of obstructive lesion in a coronary vessel
Occurs less frequently in apparently normal coronary arteries known as Syndrome X
Syndrome X is related to inadequate flow reserve in the resistance vessels (microvasculature)
Activities that Precipitate and Relieve Angina
Occurs most commonly during activity and is relieved with rest
The amount of activity required to produce angina may be relatively constant or may vary
Threshold for angina is less after meals, during excitement or on exposure to cold
Discomfort may occur during sexual activity
Characteristics of Angina
Not really a pain, but described as: Tightness Squeezing Pressure Choking Aching "Gas" sensation Rarely sharp or localized
Locationand Radiation of Angina
Varies widely in different patients but is usually the same for each patient unless the symptoms progress to unstable angina or an acute coronary syndrome
Look for a change in a patient’s anginal pattern
Most often radiates to left shoulder or arm
May have associated symptoms of shortness of breath, nausea or diaphoresis
Duration of Angina
Generally short duration and subsides completely without residual symptoms
Usually 30min can suggest unstable angina and require further investigation
angina Dx
The diagnosis of angina is supported if nitroglycerin sublingual promptly relieves or lessens the attack
Dx Testing Angina
Baseline EKG - may be normal
Exercise EKG - ST depression
Myocardial stress imaging - reversibility
Stress echocardiography - wall motion abnormalities
Coronary Angiography - gold standard, determines types, degrees, location of blockages in coronary arteries
DD
Anterior chest wall syndrome
Cervical or thoracic disease
Reflux esophagitis, peptic ulcer disease, chronic cholecytitis, esophageal spasm
Pulmonary causes such as pneumonia, pulmonary embolism or pneumothorax
Myocarditis, pericarditis, mitral valve prolapse
Prevention of Further Angina Attacks
Cornerstone of Tx
Aggravating factors - uncontrolled HTN, LVF, arrhythmias (ST, AF), strenuous activities, cold temps, emotional states
Long-acting nitrates - NTG: subling, or spray. Take 5 min before strenuous activity. Maintain nitrate-free interval 8-10hrs q day
Beta blockers - only agents demonstrated to prolong life in CAD pts
Calcium channel blockers - not shown to reduce mortality, have been shown to increase ischemia and mortality rates
Ranolazine - 1st anti-anginal drug approved by FDA, can help with exercise tolerance
Platelet-inhibiting agents - ASA 81mg qd, plavix 75mg qd
Risk reduction
