Coronary Artery Disease/ Acute Coronary Syndrome

Question 1

Characteristics of Atherosclerosis

Answer 1

1. disease of lipid-laden plaques affecting moderate and large -size arteries
2. thickening and narrowing of the intimal layer of the blood vessel wall from focal accumulation of lipids, platelets, monocytes, plaque, and other debris

Question 2

Non-Modifiable risk factors of Cardiovascular Disease

Answer 2

• Age: men >45 and women >55
• Family history: cardiac event in 1st degree male relative <55 or 1st degree female relative <65
• Race: African American
• gender: men > pre-menopausal women (equal after menopause)

Question 3

Modifiable risk factor: cholesterol

Answer 3

Total: <200
- LDL: <160 for people w/ low risk, <130 pts w/ intermediate risk, <100 pts w/ high risk
- HDL: >40 (men) and >50 (women)
- Triglycerides: <150

Question 4

Modifiable risk factor: diabetes

Answer 4

A1c <7%

Question 5

Modifiable risk factor: Diet

Answer 5

low fat, low salt, balance of veggies, fruits, grains, meats

Question 6

Modifiable risk factor: hypertension

Answer 6

keep it normal

Question 7

modifiable risk factor: Obesity

Answer 7

• BMI: 18.5 - 24.9 (healthy)
• Waist: <40 in (men), <35 in (women)

Question 8

Modifiable risk factor: physical inactivity

Answer 8

• at least 30 mins a day
• 5-7 days/week

Question 9

Modifiable risk factor: Tobacco

Answer 9

stop smoking

Question 10

Characteristics of ACS/CAD

Answer 10

• involves a spectrum of clinical entities ranging from angina to infarction to sudden cardiac death
• an imbalance of myocardial oxygen supply and demand resulting in schema chest pain

Question 11

Symptoms of ACS/CAD present when…

Answer 11

lumen is at least 70% occluded
- new ST changes (>1mm) or T wave inversion in multiple leads

Question 12

What is angina pectoris

Answer 12

• chest pain or pressure due to ischemia
• may be first accompanied by Levine’s sign (patient clenches fist over sternum)

Question 13

what does angina pectoris represent

Answer 13

• imbalance in myocardial oxygen supple and demand brought on by:
• increased demands on heart (exertion, emotional stress, smoking, extremes of temp/cold, overeating, tachyarrhythmias
• vasospasm: symptoms first present at rest

Question 14

Three major types of angina

Answer 14

• stable
• unstable
• variant

Question 15

Stable angina

Answer 15

• classic exertion angina occurring during exercise or activity
• occurs at a predictable rate-pressure product, RPP (HR X BP), relieved with rest and.or nitroglycerin

Question 16

Unstable angina

Answer 16

• pre infarction, crescendo angina
• coronary insufficiency at any time without any precipitating factors or exertion
• chest pain increases in severity, frequency, and duration
• refractory to treatment
• increases risk for MI or lethal arrhythmia
• pain is difficult to control

Question 17

Variant angina

Answer 17

• Prinzmetal’s angina
• caused by vasospasm of coronary arteries in the absence of occlusive disease
• responds well to nitroglycerin or calcium channel clocker in long term

Question 18

Description of angina in women

Answer 18

• discomfort, crushing, pressing, and bad ache

Question 19

Older adults symptoms of ACS

Answer 19

• dyspnea, diaphoresis, nausea, vomitting, syncope