Coronary artery disease

Question 1

most common cause of cardiovascular disease in canada is

Answer 1

atherosclerosis

Question 2

risk factors for CAD (atherosclerosis)

Answer 2

-

Question 3

Coronary artery diagnosis

Answer 3

Labs:-troponin and troponin (HS)
-CPK-MB

Medical imaging: 
-ECG 
chest x-ray 
coronary angiogram 
echocardiogram 
cardiac stress test

Question 4

what labs do you want to monitor during treatment of CAD

Answer 4

PTT: for heparin

CBC

Question 5

what does an electrocardiogram do

Answer 5

• measures the electrical activity of the heart, not the mechanical
• looks at the rythm of the heart, can give info on areas of heart that are damaged
• used to help diagnose actue coronary artery syndrome

Question 6

what does a coronary angiogram do

Answer 6

allows x-ray visualization of the coronary arteries following the injection of a contrast medium (shows if there is a blockage)

Question 7

what does an echocardiogram do

Answer 7

-sound waves create an image of the heart in moition
(can evaluate heart wall motion, ventricular function,identify valvular disease, evaluate the heart under stress, identify and quantify if pericardial fluid, ejection fraction)

Question 8

what is the ejection fraction

Answer 8

amount of blood pumped out of ventricle

Question 9

management of ischemia

Answer 9

Morphine
Oxygen
Nitrates
Activity stop
but stop activity then nitrates then 02 then morphine

Question 10

what do nitrates do

Answer 10

ex. nitroglycerin tabs
relax smooth muscle ie. arteries (including coronary arteries) but particularly veins, reducing preload and consequently reducing cardiac workload

Question 11

what is the worst thing that can happen if someone takes too much nitrates

Answer 11

-vessels dilate too much and blood pools in periphery, reducing co, headache

Question 12

what does morphine do for coronary artery disease

Answer 12

• reduces pain and anxiety which reduces SNS activity

- relaxes vascular smooth muscle, reducing preload and afterload (watch out for respiratory depression and hypotension)

Question 13

Aspirin for CAD

Answer 13

• anti-platelet
• anti-inflammatory
• reduces mortality by 23%
  ex. for ischemia 160-325mg chewed asap non-enteric coating

Question 14

beta blockers for coronary artery disease what do these drugs do?

Answer 14

reduction in cardiac output (stroke volume) by blocking beta receptors
ex. metoprolol

Question 15

ischemia

Answer 15

impediment of blood flow causing an inadequate blood supply that deprives the cardiac muscle cells of oxygen required for survival

Question 16

most common mnfts of myocardial ischemia is

Answer 16

chest pain

Question 17

pts with myocardial ischemia may present with

Answer 17

• chest pain
• SOB, dyspnea
• weakness, lightheadness pain
• dizziness, nausea, vomiting, hearburn
• feeling of panic or impending doom
• skin cool, clammy, diaphoretic

Question 18

non modifiable risk factors for CAD

Answer 18

• family history of coronary artery disease
• increasing age
• gender (men)
• family history

Question 19

modifiable risk factor for CAD

Answer 19

• hyperlipidemia
• smoking
• hypertension
• diabetes mellitus
• obesity
• physical inactivity

Question 20

stable angina

Answer 20

predictable and consistent pain that occurs on exertion and is relieved by rest or medication

Question 21

unstable angina

Answer 21

persistent and severe pain that occurs at rest, is of new onset or more severe and prolonged than previously experienced

Question 22

several factors associated with typical angina pain:

Answer 22

• physical exertion, can precipitate an attack
• exposure to cold, can cause vasoconstriction and elevated bp with increased oxygen demand
• eating a heavy meal which increases blood flow to mesentric area
• stress or emotional provoking situation

Question 23

unstable angina characterized by

Answer 23

attacks that increase in frequency and severity and are not relived by rest and nitroglycerin. pts with unstable angina require medical intervention as it indicates unstable plaque and platelet aggregation

Question 24

objectives of medical managment of angina are

Answer 24

decrease oxygen demand of myocardium and to increase oxygen supply