Coronary Artery Disease Flashcards
Coronary Artery Disease
Blocked area of HE, narrowing of artery, blocked of blood flow to the heart
what does coronary artery disease cause
Causes Heart attack - myocardium infarction, angina, chest pain
what causes coronary artery disease
• Due to plaque build up in wall of coronary or blockage - Atherosclerosis plaque / Atheroma, - cause atherosclerosis
Angina
• Angina is not a heart attack - excess stress, physical effort, too much food, temperature.
atherosclerosis,
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
What causes atherosclerosis
It occurs when fat, cholesterol, and other substances build up in the walls of arteries and form hard structures called plaques.
What are the symptoms of atherosclerosis
pain
effects brain kidneys and legs
Plaques form primarily where
aorta, carotid, coronary, iliac arteries
at points of bifurcation, where turbulent blood flow may encourage the development of these plaques
During inflammation, how does an atherosclerosis form?
Monocytes conglomerate through the lining of the endothelium, collect CHO & fatty material. the artery wall thickens and bulges into artery
List some risk factors of developing athersclerosis
smoking, elivated CHO, High BP, Diabetes, Obesity, inactivity, diet, alchohol, high homocysteine levels
•High-Density Lipoprotein (HDL)
- 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
•Low-Density Lipoprotein (LDL)
- 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
What can an athersclerosis develop into
thrombus, embolus, or aneurysm
angina, myocardial infarction
________ of aortic aneurysm develop in the abdomen Abdominal aortic anerysm’s
75%
•Besides formation of thrombus and embolus the plaque also damages the arterial wall, weakening the structure and may lead to _____________
an aneurysm
What are non-modifiable risk factors that will increase the likeliness of an atheroscerosis?
Age, more common after 40 yrs
Males more likely
Genetic - familial hypercholesterolemia
What are modifiable risk factors that will increase the likeliness of an atheroscerosis?
obesity Diet Exercise smoking diabeties hypertension
how does smoking increase the risk of atherosclerosis
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
How does one check for atherosclerosis
ECG - can identify cardiac blockages
CBD’s - blood levels of CHO - ratio
CRP - C reative protein - inflammation marker
Exercise stress test
Treatments for atherosclerosis
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)
Coronary Artery Bypass Graft (CABG)
surgical procedure to relieve angina and decrease the risk of death from CAD. Graft to reroute the blockage through the new graft.
Percutaneous transluminal coronary angioplasty (PTCA)
minimally invasive procedure to open up blocked coronary arteries, allowing blood to circulate unobstructed to the heart.
Angina Pectoris
Angina, or chest pain, occurs when there is a deficit of oxygen to the heart muscle
• Relieved by rest
cause of angina pectoris
blood or oxygen supply to the myocardium is impaired,
the heart is working harder than usual (needs more oxygen) or a combination of both
cause of angina
Spasm in artery, drugs, cold exposure, smoking, stress, partial blockage
Classic or exertional angina
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
Variant angina
(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
Unstable angina
(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 -
signs and symptoms of angina
- 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
treatment of angina
- 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,
what is the most common cause of myocardial infarction
The most common cause is atherosclerosis with thrombus
In which three ways may an infarction develop?
- The thrombus may build up to obstruct the artery
- Vasospasm may occur in the presence of a partial occlusion by a plaque leading to total obstruction
- 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
• 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
creatinine phosphokinase (CPK) and troponin
____________ is the most specific indication for cardiac muscle damage
Troponin
signs and symptoms of myocardial infarction
- 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
Diagnostic tests for myocardial infarction
ECG
serum enzymes CPK, Troponin
Electrolytes abnormal
Leukocytosis
Treatment for myocardial infarction
- 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
