Coronary Artery Disease Flashcards
Blood vessel disorder included in the general category of atherosclerosis; Progressive
Coronary Artery Disease (CAD)
Atherosclerosis
Soft deposits of fat that harden with age; hardening of the arteries; seen often in coronary arteries
What is the main problem with atherosclerosis and CAD
Increases afterload = increased BP
CAD Epidemiology
Leading cause of sudden death in both men and women
Most common type of heart disease
Increased among: adults >/= 65; lower Educational level, more men than women
Stages of development of Atherosclerosis
- Fatty Streaks - lipids in smooth muscle cells
- Fibrous plaque - r/t endothelial injury & plaque formation
- Complicated Lesion - most dangerous; fibrous plaque grows -> platelet accumulation -> thrombus formation
Arterial connections that exist in the coronary circulation; AKA “rerouting”
Collateral circulation
Factors contributing to the growth of collateral circulation (2)
- Inherited predisposition
2. Chronic Ischemia (decreased blood flow increases collat. Circ)
Non-Modifiable risk factors for CAD
Age
Gender
Ethnicity
Family History
Modifiable Risk Factors CAD
Elevated blood lipid levels (>200 = serum cholesterol; >150 triglycerides)
Hypertension
Tobacco Use
Lack of Exercise; Obesity; Diabetes; Stress
How does stress contribute to development of CAD?
Increased release of catecholamines = increases HR = increases workload on the heart
Primary reason for insufficient blood flow is
Narrowing of the coronary arteries
Ischemia is an issue with oxygen
Supply and demand
Chronic stable angina characteristics
Intermittent
Predictable pattern of onset
“Pressure” or “ache” in chest that lasts only a few minutes
Stops when precipitating event stops
Treatment Goals for Stable Angina (ABCDEF)
Antiplatelets/Antianginals; Beta blockers and BP control
Cholesterol lowering, Cig cessation, Calcium Channel Blockers
Diet and Diabetes mgt; Education and Exercise
Flu Vaccination
Silent Ischemia
No Subjective symptoms
Seen in pts w/ diabetes - r/t autonomic neuropathy
Angina usually caused by coronary artery spasm that often occurs at rest and relieved by moderate exercise
Prinzmetal’s Angina (Variant Angina)
How is Prinzmetal’s treated
Ca channel blockers and/or nitrates
Ex. Amlodopine or diltazem
What is Acute Coronary Syndrome an umbrella term for?
Unstable Anginna
Myocardial infarction
Unstable angina is
Rupture of athlerosclerotic plaque which results in the heart not getting enough oxygen.
Can lead to MI
Symptoms of Unstable Angina
New in onset; Occurs at REST with a worsening pattern;
Chest pain can be aching, burning, pressure, heavy, suffocating, radiates to jaw, shoulders, back, arm
Medication to treat Unstable Angina
Nitroglycerin - decrease pain by helping blood flow to area
Caused by sustained ischemia which causes irreversible cell death in the cardiac muscle.
Myocardial Infarction
Describe the process of ischemia leading to MI
Plaque rupture = clot formation = total blockage of artery = heart cell death as result of sustained ischemia
Pain Assessment for Angina (PQRST)
Precipitating Event
Quality of pain
Radiation of pain
Severity of pain; Timing of pain
