Coronary artery disease Flashcards
most common cause of cardiovascular disease in canada is
atherosclerosis
risk factors for CAD (atherosclerosis)
-
Coronary artery diagnosis
Labs:-troponin and troponin (HS)
-CPK-MB
Medical imaging: -ECG chest x-ray coronary angiogram echocardiogram cardiac stress test
what labs do you want to monitor during treatment of CAD
PTT: for heparin
CBC
what does an electrocardiogram do
- 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
what does a coronary angiogram do
allows x-ray visualization of the coronary arteries following the injection of a contrast medium (shows if there is a blockage)
what does an echocardiogram do
-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)
what is the ejection fraction
amount of blood pumped out of ventricle
management of ischemia
Morphine Oxygen Nitrates Activity stop but stop activity then nitrates then 02 then morphine
what do nitrates do
ex. nitroglycerin tabs
relax smooth muscle ie. arteries (including coronary arteries) but particularly veins, reducing preload and consequently reducing cardiac workload
what is the worst thing that can happen if someone takes too much nitrates
-vessels dilate too much and blood pools in periphery, reducing co, headache
what does morphine do for coronary artery disease
- reduces pain and anxiety which reduces SNS activity
- relaxes vascular smooth muscle, reducing preload and afterload (watch out for respiratory depression and hypotension)
Aspirin for CAD
- anti-platelet
- anti-inflammatory
- reduces mortality by 23%
ex. for ischemia 160-325mg chewed asap non-enteric coating
beta blockers for coronary artery disease what do these drugs do?
reduction in cardiac output (stroke volume) by blocking beta receptors
ex. metoprolol
ischemia
impediment of blood flow causing an inadequate blood supply that deprives the cardiac muscle cells of oxygen required for survival
most common mnfts of myocardial ischemia is
chest pain
pts with myocardial ischemia may present with
- chest pain
- SOB, dyspnea
- weakness, lightheadness pain
- dizziness, nausea, vomiting, hearburn
- feeling of panic or impending doom
- skin cool, clammy, diaphoretic
non modifiable risk factors for CAD
- family history of coronary artery disease
- increasing age
- gender (men)
- family history
modifiable risk factor for CAD
- hyperlipidemia
- smoking
- hypertension
- diabetes mellitus
- obesity
- physical inactivity
stable angina
predictable and consistent pain that occurs on exertion and is relieved by rest or medication
unstable angina
persistent and severe pain that occurs at rest, is of new onset or more severe and prolonged than previously experienced
several factors associated with typical angina pain:
- 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
unstable angina characterized by
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
objectives of medical managment of angina are
decrease oxygen demand of myocardium and to increase oxygen supply
