Coronary Artery Disease Flashcards
True or false: CAD disease is not a major cause of death
False
What is the main cause of CAD?
Atherosclerosis
What types of ACS are there?
Unstable angina, MI, and sudden cardiac death
What types of chronic ischemic heart disease are there?
Stable angina and congestive heart failure
What is a manifestation of coronary artery disease?
Angina
What causes angina pectoris?
Atherosclerosis mainly, vasospasms, and thrombosis
What is the patho physiology of angina?
Inadequate perfusion leads to ischemia which leads to chest pain
What are manifestations of angina?
Chest pain which is triggered on exertion
What are the characteristics of stable angina?
It deals with a fixed plaque which impedes perfusion and causes transient pain from the ischemia
What is transient pain?
Pain that can be relieved when the trigger is taken away
True or false: stable angina is triggered by exertion
True
What are the characteristics of unstable angina?
Deals with an unstable plaque that can burst, and if it bursts a thrombus will form as platelets aggregate.
What do platelets release when the aggregate on the atherosclerotic plaque and what results from it?
Prostaglandins which causes a vasospasm
True or false: pain in unstable angina occurs only on exertion.
False. Pain can occur nocturnally and at rest too
What is variant/vasospastic angina?
No atherosclerosis is present, however vasospasm occurs in the artery causing ischemia and chest pain
When does variant/vasospastic angina occur?
Nocturnally and at rest
What are manifestations of angina?
Squeezing or burning chest pain, sometimes accidentally thought to be heart burn or indigestion
What subcategories of CAD are there?
Acute coronary syndromes (CAS) and chronic ischemic heart disease
What is the treatment for angina?
Decrease activity, nitro-glycerin
What can be prevented if you treat angina?
MI
What is a myocardial infarction based on an ECG?
S-T Elevated MI STEMI
Define the characteristics of a MI
It is the end point of CAD, it is life threatening and it has an acute onset
What is the etiology of a MI?
Mainly atherosclerosis, a hemorrhage or a coronary artery spasm (any artery in the coronary circuit)
What is the Patho of a MI?
Atherosclerosis leads to a complicated lesion which results in ischemia, wish ischemia anaerobic respiration happens and then metabolic acidosis which causes arrhythmias leaving the heart unable to pump properly
What five factors determine how large an infarct is?
Affected vessel (how much tissue is affected)
Extent of occlusion
Duration of ischemia
Metabolic status of the heart (HR, BP, rhythm)
Collateral circulation
What two types of MIs are there?
Subendocardial infarct (NSTEMI) and a transmural infarct (STEMI)
What part of the heart is affected in a subendocardial infarct?
Inner 1/2 to 1/3 of the ventricle wall
What part of the heart is affected in a transmural infarct?
Entire ventricle wall
Which type of MI is more serious?
Transmural
Which vessels are occluded to cause a subendocardial infarct?
Distal vessels, not a main artery
Which vessels are occluded to cause a transmural infarct?
One main artery, it is a proximal occlusion
What are manifestations of an MI?
Severe chest pain that radiates into the jaw, neck or left arm
Anxiety
Tachycardia
Nausea and vomiting
How can you diagnose an MI?
ECG
Angiogram
Blood work
What do you look for in blood work to diagnose an MI?
Troponin I and T
Myoglobin (carries O2 in heart muscle)
CKmb
Treatment of an MI (STAT tx)
STAT medical attention
Thrombolytic & anti coag & anti arrhythmic used at same time
O2 for hypoxia
Opioids for pain
Once stabilized what are the treatments for an MI?
IV diuretic
Negative inotrope
Vasodilator
ALL DEC STRESS ON HEART
Revascularization surgery (angioplasty if minimal or bypass if angioplasty is not possible)
