Coronary Artery Disease Flashcards
Risk Factors
- Family history of coronary heart disease; the younger the first-degree relative, the greater the risk
- Male gender
- Hypercholesterolemia
- Low HDL cholesterol (<40 mg/dl)
- Hypertriglyceridemia (>200 mg/dl)
- Diabetes mellitus
- Hypertension
- Abdominal obesity
- Metabolic Syndrome
- African American Race
- Physical Inactivity
- Cigarette smoking; #1 preventable cause and One year after quitting, the risk of CAD decreases by 50%
- Consumption of too few fruits and vegetables
- Consumption of too much alcohol
- High blood markers for inflammation
- Systemic Lupus Erythematosus
- Rheumatoid Arthritis
- Psychosocial factors (i.e. Depression)
- Hypoalphalipoproteinemia
- Chronic kidney disease
Characterized by:
endothelial dysfunction, vascular inflammation, build-up of lipids, cholesterol, calcium, and cellular debris within the intima of the vessel wall
Atheroslcerotic Build-up Results in:
plaque formation, vascular remodeling, acute and chronic luminal obstruction, abromalities of blood flow, diminished oxygen supply to target organs
When should you assess risk?
• assess clinical risk factors for 20-79 year old patients who do not have existing ASCVD every 4-6 years
assess 30-year or lifetime risk for patients with low (<7.5) 10-year risk
Primary Prevention of Coronary Artery Disease
o reduces the risk of myocardial infarction and heart failure, decreases the need for coronary revascularization procedures, and extends and improves quality of life
o Smoking cessation
o Regular exercise
o Diet high in fruits, vegetables, fish, whole grains, & low in saturated/trans fats and sugars
o Limit alcohol consumption
o Blood pressure control
o Hypercholesterolemia/Hyperlipidemia control
o Weight management
o Diabetes control
o Daily low dose aspirin
Secondary Prevention of Coronary Artery Disease
statin therapy is appropriate for the following individuals:
o elevations of LDL-C of 190 mg/dL or greater
o aged 40-75 years with diabetes and LDL levels of 70-189 mg/dL without clinical CAD
o those without clinical CAD or diabetes aged 40-75 years who have LDL levels of 70-189 mg/dL as well as an estimated 10-year CAD risk of 7.5% or higher.
o any patient at significant risk for vascular events
Goals of Therapy
High intensity Statin therapy: goal is to reach LDL levels below 100 mg/dL; if triglyceride levels are 200 mg/dL or above, non-HDL levels should be below 130 mg/dL.
BP control: Below 140/90 mmHg, or below 130/80 mmHg if the patient has diabetes or chronic kidney disease
Diabetes management: Maintain a glycosylated hemoglobin (HbA1c) concentration below 7%.
Antiplatelet Agents and Anticoagulants
Aspirin
Clopidogrel
Warfarin, if indicated
ACE Inhibitors/ARB
initiate and continue therapy indefinitely in all patients with an LV ejection fraction of 40% or below; in those with hypertension, diabetes, or chronic kidney disease; and consider for all other patients
Beta-Blockers
start and continue indefinitely in all patients who have had MI, ACS, or LV dysfunction, unless contraindicated.
the only medication that has demonstrated to prolong life in patients with CAD
initial procedure for low risk patients
exercise stress test
confirms diagnosis of angina
determines severity of limitation of activity due to angina
assesses prognosis in patients with known coronary disease
evaluates responses to therapy
Laboratory Tests
CBC, CMP, CK-MB, Troponin, TSH, Lipid Profile, Serial Cardiac Enzyme, Magnesium (Prinzmetal)
Myoglobin
elevates in first 1–3 hrs peaks at 6–7 hours and normal by 24 hr
CK-MB
less sensitive test
elevate within 4-8 hours, peaks around 24 hours and normalizes by 48-72 hours
Troponin
most important marker for cardiac myocyte necrosis
released only when mycardial necrosis occurs
elevate within 2–12 hours and peak around 24 hours; remains elevated for 7-10 days
