Coronary Artery Disease (CAD)

Question 1

Hyperlipidemia

Answer 1

Excessive lipids in the blood

Question 2

Hypercholesterolemia

Answer 2

• Elevated levels of blood cholesterol

- Implicated in the development of atherosclerosis

Question 3

Lipoprotein

Answer 3

Insoluble cholesterol and triglycerides encapsulated in water-soluble phospholipids and protein (called apoprotein)

Question 4

Lipoprotein Functions

Answer 4

• Transport cholesterol and triglycerides to various tissues for energy utilization
• Lipid deposition
• Steroid hormone production
• Bile formation

Question 5

List the 5 types of lipoproteins

Answer 5

• Chylomicron
• Very Low Density Lipoprotein (VDL)
• Low Density Lipoprotein (LDL
• Intermediate Density Lipoprotein (IDL)
• High Density Lipoprotein ( HDL)

Question 6

Chylomicrons

Answer 6

• Apparent in blood about 1 hour after a meal

- Carry primarily dietary triglycerides and some cholesterol to adipose cells and skeletal muscle tissue

Question 7

VLDL

Answer 7

• Synthesized from residual cholesterol in liver
• Secreted in bile
• Main source of energy
• Carries large amounts of triglycerides that have a lower density than cholesterol

Question 8

LDL

Answer 8

• Main carrier of cholesterol

- Sometimes called the bad cholesterol

Question 9

HDL

Answer 9

• “Good cholesterol”
• Synthesized in the liver
• Low in cholesterol
• Participates in the reverse transport of cholesterol by carrying it away from peripheral tissues back to the liver for excretion

Question 10

Two sites of Lipoprotein synthesis

Answer 10

Small intestines

Liver

Question 11

Factors that raise blood lipid levels

Answer 11

• Nutrition
• Genetics
• Medications
• Comorbid conditions
• Metabolic diseases

Question 12

Primary hypercholesterolemia

Answer 12

Increase in cholesterol that develops because of health problems or lifestyle behaviors

Question 13

Secondary hypercholesterolemia

Answer 13

Associated with other health problems and behaviors

Question 14

Dyslipidemia

Answer 14

• Condition seen in diabetes mellitus and metabolic syndrome
• imbalance of lipids such as cholesterol, LDL, triglycerides and HDL

Question 15

Blood values for LDL cholesterol (mg/dL)

Answer 15

Optimal: below 100

Borderline high: 120 - 159

High: 160 - 189

Very high: Above 190

Question 16

Blood values for HDL cholesterol (mg/dL)

Answer 16

Low: Below 40

High: Above 60

Question 17

Blood values for total cholesterol (mg/dL)

Answer 17

Desirable: below 200

Borderline high: 200 - 239

High: above 240

Question 18

Atherosclerosis

Answer 18

• Hardening of the arteries
• Refers to accumulation of fatty substance and
  fibrous tissue in the arterial walls
• Results in narrowed lumen and decreased blood flow

Question 19

Pathophysiology of Atherosclerosis

Answer 19

• • Fatty lipid streak deposited on the arterial wall

• Injury of the endothelial wall by – smoking
hypertension - diabetes

• The inflammatory
response is initiated

• Macrophages enter the area and form a
substance called “ foam deposit” which is
deposited on the arterial wall and secrete biochemicals that further damage artery lining

• Smooth muscle cells within the cell multiply
and form atherosclerotic plaque

• Plaque may be stable (withstand blood flow) or unstable (vulnerable to force of blood flow)
• If lesion ruptures becomes thrombus

Question 20

Risk factors for Atherosclerosis

Answer 20

• Genetics
• Increasing age
• Gender
• Race
• Hyperlipidemia
• Cigarette smoking
• Diabetes Mellitus
• Obesity
• Physical inactivity

Question 21

Signs & Symptoms of Atherosclerosis

Answer 21

• Chest pain
• SoB
• Nausea
• Weakness
• Ischemia
• Aneurysm formation -> stroke or heart attack

Question 22

Coronary Heart Disease/ Chronic Ischemic Disease

Answer 22

The coronary arteries that deliver constant supply of blood to the heart muscle begin to develop fatty plaques that can lead to restriction of blood flow to the heart

Question 23

Angina

Answer 23

A clinical syndrome characterized by pain or pressure in the chest as a result of decreased blood flow and oxygen to the heart.
This results in ischemia

• Stable or Unstable

Question 24

Stable angina

Answer 24

• Associated with specific activity levels relieves with rest and nitroglycerin

Question 25

Unstable angina

Answer 25

- increasing frequency of chest pain not particularly associated with any activity not relieved by rest or nitroglycerin

Question 26

Intractable or Refractory angina

Answer 26

– severe unrelieved chest pain.

Question 27

Variant Angina

Answer 27

- pain at rest with (Reversible ST segment) also called Prinzmetal’s angina

Question 28

Silent Angina

Answer 28

- client reports no pain but ST changes are seen on ECG

Question 29

Precipitating factors of Angina

Answer 29

* Physical exertion * Exposure to cold * Eating a heavy meal * Stress

Question 30

Signs and Symptoms of Angina

Answer 30

* Chest pain radiating * Dizziness * Weakness * SOB * Pallor * diaphoresis * Nausea vomiting * Anxiety – a feeling of impending doo

Question 31

Treatment of CAD

Answer 31

``` Aspirin Plavix Nitrates Cholesterol lowering medication e.g., statins Beta blockers ACE Inhibitors ```

Question 32

Treatment of Angina

Answer 32

Acute Angina Means Nasty Artery Blockages And Cardiac Complications - Antithrombotic agents - Antiplatelet - Morphine - Nitrates e.g., Nitroglycerin - ACE inhibitors end in "pril" - Beta blockers end in "lol" - ARBS Angiotension II receptor blockers "end in sartan" - Cholesterol lowering medication e.g., statins - Calcium channel blockers

Question 33

Diagnosis & Labs of CAD

Answer 33

Blood tests EKG (Electrocardiogram) Echo cardiogram Stress test

Question 34

EKG for CAD

Answer 34

ST segment depression: irreversible ischemia ST segment elevation: infarction where there is injury to heart muscle

Question 35

Proteins found on the myocardium which help with contractility and are released in the blood when the heart is injured

Answer 35

Major - Troponin T - Troponin I - Troponin II Minor - Troponin C

Question 36

Main arteries that supply the heart muscle

Answer 36

Left coronary artery | Right coronary artery

Question 37

Left coronary artery branches off into the:

Answer 37

Left circumflex artery - Provides blood to left atrium, side and back of left ventricle Left anterior descending artery - provides blood to front and bottom of left ventricle up and front of the septum

Question 38

Right coronary artery branches into

Answer 38

- Right marginal - Right posterior descending artery Provides blood to right atrium and ventricle

Question 39

Balloon Angioplasty

Answer 39

Inflates a balloon in the blocked artery to compress the plaque against the artery wall and a stent is placed to allow blood to flow back through the artery Sometimes arteries can not to stunted and so patients must have CABG

Question 40

CABG

Answer 40

Coronary Arterty Bypass Grafting

Question 41

Stress test

Answer 41

Monitor the heart rhythm during exercise and see if there are any EKG changes

Question 42

Antiplatelets

Answer 42

Prevent the formation of clots which decreases the chances of ischemia

Question 43

When giving plavix you should monitor for

Answer 43

Thrombotic Thrombocytopenia Purpura

Question 44

Nitroglycerin

Answer 44

Dilates vessels to allow more blood to get to the heart muscle

Question 45

Beta blockers

Answer 45

Lowers heart rate and blood pressure which reduces workload on heart Don't take with grapefruit juice

Question 46

ACE inhibitors

Answer 46

Blocks the conversion of angiotensin I and II which cause Vasodilation Side effect: Dry, nagging cough

Question 47

Myoglobin

Answer 47

* Lacks specificity * rises in 1- 4 hours * returns to normal within 24 hours

Question 48

CK-MB

Answer 48

* rises in 4 - 12 hours * returns to normal within 36 - 48 hours