Coronary Artery Disease

Question 1

What are non-modifiable risk factors for CAD?

Answer 1

• family history (men under 55, women under 65)
• age (men over 45, women over 55)
• sex (men)
• ethnicity

Question 2

What are modifiable risk factors for CAD?

Answer 2

• hyperlipidemia (especially high LDL or low HDL)
• smoking
• hypertension
• diabetes mellitus
• obesity
• physical inactivity
• stress
• decreased estrogen in women

Question 3

What is angina?

Answer 3

chest pain from ischemia

Question 4

What is the difference between stable and unstable angina?

Answer 4

• stable angina precipitated by exertion, cold, is relieved by rest
• unstable angina can occur at rest, is unpredictable

Question 5

What normally causes angina?

Answer 5

• atherosclerosis

Question 6

What are signs and symptoms of angina?

Answer 6

• chest pain (can radiate to neck, jaw, arms, may feel “vice-like” or be mistaken for “indigestion”)
• sense of impending doom

Question 7

What diagnostics would be helpful to diagnose angina?

Answer 7

• CK-MB would indicate cardiac muscle damage
• myoglobin indicative of cardiac OR skeletal muscle damage
• troponin I and T indicative of cardiac muscle damage
• ECG
• stress test
• echocardiogram
• angiogram

Question 8

What are the two goals when treating angina?

Answer 8

1) increase oxygen supply

2) decrease oxygen demand

Question 9

How is angina managed?

Answer 9

• rest
• apply oxygen
• nitrates (can repeat up to 3 doses in 15 minutes)
• aspirin (160-325 mg chewed)

then:
- fibrinolytics OR percutaneous coronary interventions (stents etc.) OR coronary artery bypass

then:

• heparin or low molecular weight heparin
• antiplatelet
• statin
• beta blocker
• calcium channel blocker

Question 10

What is myocardial infarction?

Answer 10

• death of myocardial cells due to ischemia

Question 11

What causes myocardial infarction?

Answer 11

• atherosclerosis

- vasospasm

Question 12

What are signs and symptoms of myocardial infarction?

Answer 12

• chest pain
• SOB
• nausea and vomiting
• anxiety
• increased respiratory rate and heart rate
• cool, pale, moist skin

Question 13

What tests will help diagnose MI?

Answer 13

• ECG
• echocardiogram
• troponin I and T
• CK-MB
• myoglobin (could be from skeletal muscle though)
• angiogram

Question 14

How is an MI managed?

Answer 14

immediate priorities:

• rest
• oxygen
• nitrates
• morphine
• ASA

monitor vitals and get the ECG

then:

• beta blocker
• ACEI within 24 hours of signs and symptoms
• evaluate if PCI or fibrinolytics can be done

Question 15

What is the patient at risk for after an angiogram?

Answer 15

bleeding - catheter is inserted into an artery