Coronary Artery Disease

Question 1

Athersclerotic Heart Disease causes 4 things to happen..

Answer 1

1. Narrows Lumen of vessel
2. Reduces Elasticity
3. Increases risk of placque rupture & subsequent clot formation
4. Increases risk of vasospasm

Question 2

What are the Risk Factors for Athersclerosis?

1. Unalterable (4)
2. Medically Ulterable (3)
3. Ulterable (5)

Answer 2

1. Heredity, age, sex race
2. Hypertension, hyperlipidemia, DM
3. Smoking, alochol, diet, sedentary life, stress, obesity

Question 3

The amount of damage on the heart in an MI depends on what?

Answer 3

1. Degree / duration of obstruction
2. Collateral circulation
3. Time before treatment

Question 4

How much does the blood flow to the coronary arteries need to be reduced before syptoms appear?

Answer 4

75%

Question 5

02 Demand > Supply.

3 things that cause this?

Answer 5

1. Increased workload of the heart
2. Reduced blood supply to the heart
3. Reduced oxygen carrying capacity of coronoary arteries

Question 6

What would cause increased workload on the heart? (3)

Answer 6

1. HTN
2. Aortic stenosis (stiff valves)
3. Increased metabolic demand (ex. going on a run)

Question 7

What would cause reduced blood supply to the heart? (3)

Answer 7

1. atherosclerosis
2. coronary artery vasospasm
3. thrmbus / embolus

Question 8

What would cause reduced oxygen carrying capacity of coronary arteries? (3)

Answer 8

1. anemia
2. hemodilution
3. acute blood lose

Question 9

When 02 demand > 02 supply, how could you reduce the 02 demand?

Answer 9

• rest
• oxygen
• nitrates (systemic vasodilation)
• morphine (opioid analgesic to reduce pain AND relaxes vascular smooth muscle, particularily veins to reduce preload)
• beta blockers (decreases heart contractility / CO)
• Ca+ channel Blockers (affects smooth muscle causing vasodilation)
• ACEI (inhibitits ANG1 to convert to ANG 2)

Question 10

When 02 demand > 02 supply, how could you increase the 02 supply?

Answer 10

• Aspirin (160 -325 mg chewed)
• Fibrinolytics
• PCI (percutaneous coronary interventions)
• Coronary Artery Bypass
• Heparins
• Antiplatelets
• HMG Coenzyme A Redcuctase Inhibitors

Question 11

What is the acrnoynm for mangement of ischemia?

Answer 11

MONA

Question 12

What does MONA stand for?

Answer 12

M = Morphine
O = Oxygen
N = Nitrates
A = Aspirin

Question 13

Is MONA done in the order of the acronym?

Answer 13

Not necessarily!

Question 14

Nitrates:

1. What does the drug do?
2. What is the worst thing that could happen with the drug?
3. Example:

Answer 14

1. relaxes vascular smooth muscle in arteries (including arteries) AND partciularlry in veins, reducing preload… reducing cardiac workload
2. • Vessels dialate too much, blood pools in periphery (reducing CO), fill the space with isotonic volume
   • Headache
3. Nitroglycerine

Question 15

What are the forms of Nitroglycerine?

Answer 15

SL, spray, transdermal patches, IV

Question 16

Morphine:

1. What does the drug do?
2. What is the worst thing that could happen with the drug?
3. Antidote?

Answer 16

1. • Opioid analgesic (binds to opioid receptors altering te pain respsonse, be aware of LOC / RR)
   • Relaxes smooth muscle, particularily in the veins (reducuing preload, reducing cardiac workload)
2. • Vessels dialate too much, pooling of blood in periphery
   • Respiratory depression (arrest!)
3. naloxone

Question 17

Beta Blockers:
1. What do they do?
2. What is the worst thing that could happen?
Examples:

Answer 17

1. reduction in CO by blocking beta receptors (beta 1)
2. bradycardia, inadequate CO, bronchospasm
3. OLOLS! atenolol, metoprolol, propanolol

Question 18

Calcium Channel Blockers:

1. What do they do?
2. What is the worst thing that could happen?
3. Examples:

Answer 18

1. relaxation of vessel walls through blocking of calcium ion channels (reducing afterload & consequently cardiac workload)
2. bradycardia, inadeqaute CO, heart failure
3. Norsvac, Renidil, Diltiazem

Question 19

What type of juice can you not have when on a CA+ channel blocker?

Answer 19

grapefruit juice

Question 20

ACEI

1. What do they do?
2. What is the worst thing that could happen?
3. Examples:

Answer 20

1. Inhibition of the conversion of angiotensin 1 to angiotensin 11 (reduces after load and consequently cardiac workload)
2. inadequate CO, cough aka angioedema (from action of vasodilator bradykinins)
3. PRILS - Enapril, Captopril, Ramipril

Question 21

Aspirin

1. What does this drug do?
2. What is the worst that could happen?
3. Examples

Answer 21

1. • Anti ilfmm (NSAID), Anti platelet (can cause bleeding)
2. Allergic reaction&raquo_space; antihistamine / epinephrine
3. non- enteric coated ASA 160-325 mg chewed asap

Question 22

Fibrinolytics:

1. For what type of MI?
2. Within how many hours of first symptoms?
3. Given if what is not available within first 90 minutes of first medical contact?
4. What does the drug do?

Answer 22

1. STEMI
2. 12 hours
3. PCI (Percutaenous Coronary Interventions)
4. Disolves bodys fresh fibrin clots (ALL OF THEM!) must be careful because can cause to bleed out

Question 23

What is a PCI?

Answer 23

is a non-surgical procedure that uses a catheter (a thin flexible tube) to place a small structure called a stent to open up blood vessels in the heart that have been narrowed by plaque buildup, a condition known as atherosclerosis.

Question 24

What does Heparin do?

Answer 24

Lengthens clotting time, prevents thrombus formation / growth

Question 25

Heparin can be taken IV OR SC. What is the onest for IV and SC?

Answer 25

``` IV = immediate SC = up to 1 hour ```

Question 26

What are LMWH?

Answer 26

Heparin molecules that have been modified and shortened

Question 27

What is the inhibiton of LMWH specfic to?

Answer 27

Active factor x, less likely to cause thrombocytopenia

Question 28

Duration of action is 2 - 4 times longer than what?

Answer 28

Regular heparin

Question 29

Which produces a more stable response: LMWH or Heparin?

Answer 29

LMWH (hence less follow up lab tests are needed)

Question 30

Antiplatelets: 1. What do the drugs do? 2. Examples:

Answer 30

1. Reduce platelet aggregation | 2. Thienopyridines, Glycoprotein 11b / 111a inhibitors

Question 31

Maintenance - Statins aka....

Answer 31

HGA Coenzyme A Reductase Inhibitors

Question 32

HGA Coenzyme A Reductase Inhibitors: 1. What do these drugs do? 2. What is the worst that could happen? 3. Example:

Answer 32

1. Inhibit cholesterol production - 20 - 40% reduction in LDL, raise HDL levels and lower triglycerides 2. - Liver dysfunction (must monitor LFT) Muscle Pain, tenderness and weakness, monitor CPK - Heartburn, abdominal cramping, diarrhea (give with meal in evening) 3. Atrovastatin

Question 33

Testing for Atherosclerosis: | What are the Diagnostic Tests?

Answer 33

1. CK 2. CK-MB 3. Myoglobin 4. Troponin I /T

Question 34

What is myoglobin testing for?

Answer 34

Estimates damage from skeletal muscle injury or myocardial infarction (not cardiac specfic)

Question 35

What are Troponin I / T?

Answer 35

Specfic cardiac markers, enzyme detected 2-6 hrs, MI peaks 15-24 hours, returns to normal within 7 days

Question 36

What other testing can be done?

Answer 36

1. Electrocardiogram 2. Echocardiogram 3. Stress testing 4. Angiogram

Question 37

Stress testing, patients are being monitored for what 2 things during the test?

Answer 37

1. ECG | 2. BP

Question 38

ECG is measuring what?

Answer 38

Electrical Conductivity of the heart, not the mechanical function - Can give info. on areas of the heart that are damaged

Question 39

What does an echocardiogram identify?

Answer 39

1. Heart wall motion 2. Identify valvular disease 3. Evaluate heart under stress 4. Identify & Quantity of pericardial fluid

Question 40

Coronary Angiogram allows for what?

Answer 40

X ray visulization of the coronary arteries following the injection of contrast medium. Looking for blockages!