Coronary Artery Disease

Question 1

Coronary Artery Disease

Answer 1

Blocked area of HE, narrowing of artery, blocked of blood flow to the heart

Question 2

what does coronary artery disease cause

Answer 2

Causes Heart attack - myocardium infarction, angina, chest pain

Question 3

what causes coronary artery disease

Answer 3

• Due to plaque build up in wall of coronary or blockage - Atherosclerosis plaque / Atheroma, - cause atherosclerosis

Question 4

Angina

Answer 4

• Angina is not a heart attack - excess stress, physical effort, too much food, temperature.

Question 5

atherosclerosis,

Answer 5

degenerative changes in the small arterioles
artery has a very rough elevated surface with loose pieces of plaque and through the openings to ranching arteries are locked

Question 6

What causes atherosclerosis

Answer 6

It occurs when fat, cholesterol, and other substances build up in the walls of arteries and form hard structures called plaques.

Question 7

What are the symptoms of atherosclerosis

Answer 7

pain

effects brain kidneys and legs

Question 8

Plaques form primarily where

Answer 8

aorta, carotid, coronary, iliac arteries

at points of bifurcation, where turbulent blood flow may encourage the development of these plaques

Question 9

During inflammation, how does an atherosclerosis form?

Answer 9

Monocytes conglomerate through the lining of the endothelium, collect CHO & fatty material. the artery wall thickens and bulges into artery

Question 10

List some risk factors of developing athersclerosis

Answer 10

smoking, elivated CHO, High BP, Diabetes, Obesity, inactivity, diet, alchohol, high homocysteine levels

Question 11

•High-Density Lipoprotein (HDL)

Answer 11

• High-Density Lipoprotein (HDL) is the “good” lipoprotein; it has low lipid content and is used to transport cholesterol away from the peripheral cells to the liver where it undergoes catabolism and excretion
  
  • Good kind - HDL - transport CHO from tissues to LIVER to degregate

Question 12

•Low-Density Lipoprotein (LDL)

Answer 12

• Low-Density Lipoprotein (LDL) has high lipid content and transports cholesterol from the liver to cells. It is considered the “bad” lipoprotein that promotes plaque formation
  
  • CHO from Liver to cells

Question 13

What can an athersclerosis develop into

Answer 13

thrombus, embolus, or aneurysm

angina, myocardial infarction

Question 14

________ of aortic aneurysm develop in the abdomen Abdominal aortic anerysm’s

Answer 14

75%

Question 15

•Besides formation of thrombus and embolus the plaque also damages the arterial wall, weakening the structure and may lead to _____________

Answer 15

an aneurysm

Question 16

What are non-modifiable risk factors that will increase the likeliness of an atheroscerosis?

Answer 16

Age, more common after 40 yrs
Males more likely
Genetic - familial hypercholesterolemia

Question 17

What are modifiable risk factors that will increase the likeliness of an atheroscerosis?

Answer 17

obesity
Diet
Exercise
smoking
diabeties
hypertension

Question 18

how does smoking increase the risk of atherosclerosis

Answer 18

Smoking - most effect able - directly related to the amount used, decreases good CHO and increases bad. Increasing levels of arteries to narrow, vassoconstricting, clot forming

Question 19

How does one check for atherosclerosis

Answer 19

ECG - can identify cardiac blockages
CBD’s - blood levels of CHO - ratio
CRP - C reative protein - inflammation marker
Exercise stress test

Question 20

Treatments for atherosclerosis

Answer 20

Weight loss
Diet - reduce salt intake, lowering fat intake
control of diabeties and hypertension
Quit smoking
Exercise
Anticoagulant
Percutaneous transluminal coronary angioplasty (PTCA)
Coronary Artery Bypass Graft (CABG)

Question 21

Coronary Artery Bypass Graft (CABG)

Answer 21

surgical procedure to relieve angina and decrease the risk of death from CAD. Graft to reroute the blockage through the new graft.

Question 22

Percutaneous transluminal coronary angioplasty (PTCA)

Answer 22

minimally invasive procedure to open up blocked coronary arteries, allowing blood to circulate unobstructed to the heart.

Question 23

Angina Pectoris

Answer 23

Angina, or chest pain, occurs when there is a deficit of oxygen to the heart muscle
• Relieved by rest

Question 24

cause of angina pectoris

Answer 24

blood or oxygen supply to the myocardium is impaired,

the heart is working harder than usual (needs more oxygen) or a combination of both

Question 25

cause of angina

Answer 25

Spasm in artery, drugs, cold exposure, smoking, stress, partial blockage

Question 26

Classic or exertional angina 

Answer 26

Pain on Exertion Also called stable angina. Episodes of pain or discomfort are provoked by similar or consistent amounts of activity or stress. Heavy meals, smoking, emotional ○ Develops when HE is working harder - predictable, similar to previous, less than 5 min, disappears with rest / time or medication

Question 27

Variant angina

Answer 27

(occurs at rest). Results from a  spasm of one of the large coronary arteries on the surface of the heart. ○ Caused by a spasm of HE vessels ○ Happens when Resting, ○ Can be relieved by medication

Question 28

Unstable angina

Answer 28

 (refers to prolonged pain at rest and of recent onset). ○ Unstable Angina is a more serious form. This may precede a myocardial infarction  ○ Variable cause - more severe and long lasting 30 min, may not reduce due to ○ Not relieved by rest, nor medication ○ Gets worse - impending Heart attack -

Question 29

signs and symptoms of angina

Answer 29

* Angina occurs as recurrent, intermittent brief episodes of substernal chest pain * Pain is described as a tightness or pressure in the chest and may radiate to the neck and left arm * Pallor, diaphoresis and nausea are present Attacks vary in severity and last a few seconds or minutes

Question 30

treatment of angina

Answer 30

* Usually relieved by rest and administration of coronary vasodilators such as nitroglycerin * Nitroglycerin is give sublingually - vasodilator, * Asprin - reduces clotting factors * If chest pain persists, it is important to seek hospital care * Avoidance of sudden physical exertion * Anxiety and stress reduction * Angioplasty, lifestyle,

Question 31

what is the most common cause of myocardial infarction

Answer 31

The most common cause is atherosclerosis with thrombus

Question 32

In which three ways may an infarction develop?

Answer 32

1. The thrombus may build up to obstruct the artery 2. Vasospasm may occur in the presence of a partial occlusion by a plaque leading to total obstruction 3. Part of the thrombus may break away, forming an embolus that flows freely until it gets lodged in a smaller vessel ○ The size and location of the infarct determine the severity of the damage  

Question 33

• With cell destruction, specific enzymes are released from the myocardium into tissue fluid and blood- ___________________________________ - used as cardiac markers to see if there has been damage, elevated several hours after the attack

Answer 33

creatinine phosphokinase (CPK) and troponin

Question 34

____________ is the most specific indication for cardiac muscle damage

Answer 34

Troponin

Question 35

signs and symptoms of myocardial infarction

Answer 35

* Hallmark: acute onset, substernal chestpain of crushing or squeezing nature * Pallor and diaphoresis  * Nausea, dizziness, weakness and dyspnea * Hypotension * Pulse is rapid and weak * Low grade fever * Can experience no symptoms at all! 25% silent - diabeties patients more prevalent

Question 36

Diagnostic tests for myocardial infarction

Answer 36

ECG serum enzymes CPK, Troponin Electrolytes abnormal Leukocytosis

Question 37

Treatment for myocardial infarction

Answer 37

* Analgesics (morphine) * Oxygen via mask * Nitroglycerine * Anticoagulants (thrombolytic agents such as streptokinase, urokinase or tissue plasminogen activator may be administered immediately to reduce the clot in the first few hours) * Depending on the individual circumstances: medication to reduce arrythmias, defibrillation or a pacemaker * Drugs, such as Digoxin, support the heart function * Specific measures may be required if shock or congestive heart failure develops Bypass surgery may be performed