Coronary Artery Disease Flashcards
Number 1 killer in world
CAD
What causes CAD to occur
Abnormal lipid metabolism, too much cholesterol and saturated fats intake, and genetics play a role
What risk factors are associated with CAD
Hypertension, hyperlipidemia, diabetes, tobacco abuse, and family history
Low risk of CAD
Atypical chest pain, minimal or no risk factors, young
Intermediate risk of CAD
AGE (more than 70), GENDER (male), DIABETES hx, PVD/CVA-peripheral vascular disease and cerebrovascular accident or stroke hx, PREVIOUS EKG changes
High risk of CAD
Ischemic discomfort, hx of CAD, hx of CHF, new EKG changes, elevated biomarkers
Tests/Labs to for diagnosis
EKG, cardiac enzymes, lipid panel, screen for diabetes, (BP history)
Stress testing in CAD
Graded exercise stress testing, pharmological stress testing, imaging with echocardiography or nuclear imaging
EKG changes in CAD
ST depression, transient ST elevation, and T wave inversion
BIomarkers released from necrotic cardiac tissue
myoglobin released in 2-4 hours, CK-MB released 4-8 hours, Troponin I and T released 6-12 hours
How long do the cardiac biomarkers stay elevated (released from necrotic tissue)
Myoglobin for 1 day, CK-MB for 2-3 days, and Troponin for 7-10 days
PE in someone with large area of myocardium in jeapordy
Hypotension, tachycardia, third and fourth heart sound, and rales
Tx of UA/Unstable Angina
Anti-Ischemic medical therapy, anti-thrombotic medical therapy, revascularization therapy, other meds- high dose statin (lipitor)
Anti-Ischemic therapy meds
Nitroglycerin, BB, Morphine sulfate
Function of nitroglycerin
Vasodilator- increases blood flow, reduces afterload (so less resistance)
How is nitroglycerin taken?
Sublingual, topical nitro, or IV nitro
How do beta blockers work?
Block adrenergic receptors to decrease HR and contractility- this decreases oxygen demand and decreases ventricular irritability
Example of beta blocker and dose
Lopressor
Heart rate goal on beta blocker
50-60/min
function of morphine sulfate in CAD
analgesic, some vasodilation
Dose of morphine sulfate
2-5 mg IV every 5-30 min for comfort
Anti-thrombotic therapy meds
ASA, ADP receptor antagonist (Plavix), GpIIb/IIIa receptor inhibitor (Effient, Integrellin), LMW Heparin (Lovenox), Unfractionated Heparin
Plavix dosing
600 mg initial dose, then 75 mg every day
If coronary artery bypass grafting likely, what should you be careful with (drug)
Plavix
Lovenox dose
LMW heparin binds to antithrombin III - inhibits thrombin and Factor X. 1 mg/kg SC every 12 hours
UFH dosing
5000 IU IV, then 1000 U/hour
PTT in UFH
1.5-2.5 times the control
Integrellin dose
180 ug/kg bolus, then 2.0 ug/kg/hr for 3-4 days
Lipitor - what is it and dosing
High dose statin for plaque stabilization and anti inflammation- 80 mg PO every day
When to initiate angiogram for revascularization
Angiogram within 2 days if NSTEMI or abnormal stress test
Percutaneous intervention with revascularization
Angioplasty and stent placement (bare metal or drug-eluting)
long term management of CAD
ASA, plavis for 9-12 months, Beta blocker, Ace-Inhibitor, Statin, Cardiac rehab
Lifestyle changes for secondary prevention
Tobacco cessation, weight control, exercise, BP control, glycemic control, lipid control
