Coronary Artery Disease

Question 1

CVD Stats

• is America’s (2)
• approx 1/__ deaths results from CVD

Answer 1

Leading health problem and cause of death

1/3

Question 2

CVD

• includes diseases of the (2)
• 3 major diseases

Answer 2

Heart and blood vessel circulation

Abnormal heart rhythm
Coronary artery disease
Heart failure

Question 3

CAD

-describe

Answer 3

Arteries that supply to heart muscle become hardened and narrow due to build-up of plaque within* their walls (atherosclerosis)

Question 4

CAD

-over time

Answer 4

Can weaken heart muscle and contribute to heart failure and arrhythmias

Question 5

CAD

-epidemiology

Answer 5

Most common type of heart disease

Leading cause of death in USA (men and women)

Question 6

CAD
-pathophysiology
—CAD
—heart attack from CAD

Answer 6

Artery narrowed by plaque, damaged inner vessel lining
WBCs in area to kill infection change into cells w/ fatty materials

Plaque breaks open and clot forms that blocks blood flow

Question 7

CAD: causes of atherosclerosis

• unmodifiable risk factors (2)
• modifiable risk factors

Answer 7

Age
Family hx (esp sibling/parent)

LDL chol.
HTN
DM2
Tobacco
Overweight/obese
Physical inactivity
Diet

Question 8

CAD

-signs and symptoms

Answer 8

Quite variable

None initially (silent ischemia)

Chest pain/angina (due to ischemia of coronary artery, usually sporadic)

Shortness of breath

Heart attack (acute, crushing pressure/pain)

Question 9

CAD diagnosis
+records electrical signal
+may reveal evidence of previous heart attack/one in progress
+can be done in-office or via portable monitor

Answer 9

ECG/EKG

Question 10

CAD diagnosis
+uses sound waves to produce images of the heart
+similar/same as B-scan

Answer 10

Echocardiogram

Question 11

CAD diagnosis

+uses catheterization and dye to image blood flow within coronary arteries

Answer 11

Cardiac angiogram

Question 12

CAD diagnosis

+use computerized tomography (CT) tech to image Ca2+ deposits within arteries

Answer 12

Heart scans

Question 13

CAD management

• main
• medications (4)

Answer 13

Lifestyle changes

Cholesterol-modifying (statins)
Aspirin
Beta blockers (also CCBs, ACE inhibitors)
Nitroglycerin

Question 14

CAD management

-surgeries (2)

Answer 14

Angioplasty and stent placement

Coronary artery bypass surgery (used to commonly use saphenous vein)

Question 15

CAD management medications:

• caution
• how nitroglycerin works and what SE

Answer 15

Beta blockers - caution with NTG pts, BP may go too low overnight

Dilates BVs
Blue-yellow color vision distortion

Question 16

Atherosclerosis elsewhere: brain

• called
• 2 types
• pathophysiology
• emergency tx (2)

Answer 16

Stroke

Ischemic vs hemorrhagic

Blockage of blood supply to part of the brain caused by a clot or debris (embolus)

Medications or procedure to break up clot(s)

Question 17

Atherosclerosis elsewhere: carotid arteries

• most common __
• symptoms systemically
• symptoms ocularly
• tx (3)

Answer 17

Source of retinal emboli

None -> TIA -> retinal vascular occlusions or stroke

Transient vision loss - lodges (loss of blood/vision) then goes on (regains vision)
Will either throw off plaques or become very narrow (severe stenosis -> hypoperfusion)
-if hypoperfusion = ocular angina

Cholesterol-lowering meds, blood thinners, surgery if severe

Question 18

Atherosclerosis elsewhere: legs, arms, etc.

• called
• pathophysiology
• symptoms
• tx (5)

Answer 18

Peripheral vascular disease (PVD)

Circulatory condn, narrowed BV reduce blood flow to limbs

Leg pain (esp when walking)

Tobacco cessation, exercise, healthy diet, medications, surgery

Question 19

Atherosclerosis implications for optometrists

• coronary AD (3)
• cerebrovascular disease (2)

Answer 19

May lead to retinal vascular occlusions (RVOs)
Meds used in tx may affect eyes
Implantable devices may preclude certain ocular procedures

Signs/symptoms of impending stroke
May lead to vision loss (temporary or permanent)

Question 20

Atherosclerosis implications for optometrists

• carotid AD (1)
• peripheral vascular disease

Answer 20

May lead to retinal vascular occlusions (RVOs) or ocular ischemic syndrome (OIS)

Ocular assoc with erectile dysfunction (vascular problem) - more at risk for NAION

Question 21

Atherosclerosis Elsewhere: carotid arteries/eye

-ways to detect (3)

Answer 21

Listen for bruit

Carotid ultrasound/B-scan
-with doppler = duplex

Invasive = catheter (gold-standard)