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Pathophysiology > Coronary Artery Disease (CAD) > Flashcards

Coronary Artery Disease (CAD) Flashcards

- Atherosclerosis - Angina

1
Q

Hyperlipidemia

A

Excessive lipids in the blood

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2
Q

Hypercholesterolemia

A
  • Elevated levels of blood cholesterol

- Implicated in the development of atherosclerosis

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3
Q

Lipoprotein

A

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

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4
Q

Lipoprotein Functions

A
  • Transport cholesterol and triglycerides to various tissues for energy utilization
  • Lipid deposition
  • Steroid hormone production
  • Bile formation
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5
Q

List the 5 types of lipoproteins

A
  • Chylomicron
  • Very Low Density Lipoprotein (VDL)
  • Low Density Lipoprotein (LDL
  • Intermediate Density Lipoprotein (IDL)
  • High Density Lipoprotein ( HDL)
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6
Q

Chylomicrons

A
  • Apparent in blood about 1 hour after a meal

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

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7
Q

VLDL

A
  • 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
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8
Q

LDL

A
  • Main carrier of cholesterol

- Sometimes called the bad cholesterol

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9
Q

HDL

A
  • “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
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10
Q

Two sites of Lipoprotein synthesis

A

Small intestines

Liver

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11
Q

Factors that raise blood lipid levels

A
  • Nutrition
  • Genetics
  • Medications
  • Comorbid conditions
  • Metabolic diseases
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12
Q

Primary hypercholesterolemia

A

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

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13
Q

Secondary hypercholesterolemia

A

Associated with other health problems and behaviors

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14
Q

Dyslipidemia

A
  • Condition seen in diabetes mellitus and metabolic syndrome
  • imbalance of lipids such as cholesterol, LDL, triglycerides and HDL
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15
Q

Blood values for LDL cholesterol (mg/dL)

A

Optimal: below 100

Borderline high: 120 - 159

High: 160 - 189

Very high: Above 190

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16
Q

Blood values for HDL cholesterol (mg/dL)

A

Low: Below 40

High: Above 60

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17
Q

Blood values for total cholesterol (mg/dL)

A

Desirable: below 200

Borderline high: 200 - 239

High: above 240

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18
Q

Atherosclerosis

A
  • 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
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19
Q

Pathophysiology of Atherosclerosis

A
  • • 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
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20
Q

Risk factors for Atherosclerosis

A
  • Genetics
  • Increasing age
  • Gender
  • Race
  • Hyperlipidemia
  • Cigarette smoking
  • Diabetes Mellitus
  • Obesity
  • Physical inactivity
21
Q

Signs & Symptoms of Atherosclerosis

A
  • Chest pain
  • SoB
  • Nausea
  • Weakness
  • Ischemia
  • Aneurysm formation -> stroke or heart attack
22
Q

Coronary Heart Disease/ Chronic Ischemic Disease

A

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

23
Q

Angina

A

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
24
Q

Stable angina

A
  • Associated with specific activity levels relieves with rest and nitroglycerin
25
Q

Unstable angina

A
  • increasing frequency of chest pain not particularly associated with any activity not relieved by rest or nitroglycerin
26
Q

Intractable or Refractory angina

A

– severe unrelieved chest pain.

27
Q

Variant Angina

A
  • pain at rest with (Reversible ST segment) also called Prinzmetal’s angina
28
Q

Silent Angina

A
  • client reports no pain but ST changes are seen on ECG
29
Q

Precipitating factors of Angina

A
  • Physical exertion
  • Exposure to cold
  • Eating a heavy meal
  • Stress
30
Q

Signs and Symptoms of Angina

A
  • Chest pain radiating
  • Dizziness
  • Weakness
  • SOB
  • Pallor
  • diaphoresis
  • Nausea vomiting
  • Anxiety – a feeling of impending doo
31
Q

Treatment of CAD

A 
Aspirin 
Plavix 
Nitrates
Cholesterol lowering medication e.g., statins
Beta blockers
ACE Inhibitors
32
Q

Treatment of Angina

A

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
33
Q

Diagnosis & Labs of CAD

A

Blood tests
EKG (Electrocardiogram)
Echo cardiogram
Stress test

34
Q

EKG for CAD

A

ST segment depression: irreversible ischemia

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

35
Q

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

A

Major

  • Troponin T
  • Troponin I
  • Troponin II

Minor
- Troponin C

36
Q

Main arteries that supply the heart muscle

A

Left coronary artery

Right coronary artery

37
Q

Left coronary artery branches off into the:

A

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

38
Q

Right coronary artery branches into

A
  • Right marginal
  • Right posterior descending artery

Provides blood to right atrium and ventricle

39
Q

Balloon Angioplasty

A

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

40
Q

CABG

A

Coronary Arterty Bypass Grafting

41
Q

Stress test

A

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

42
Q

Antiplatelets

A

Prevent the formation of clots which decreases the chances of ischemia

43
Q

When giving plavix you should monitor for

A

Thrombotic Thrombocytopenia Purpura

44
Q

Nitroglycerin

A

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

45
Q

Beta blockers

A

Lowers heart rate and blood pressure which reduces workload on heart

Don’t take with grapefruit juice

46
Q

ACE inhibitors

A

Blocks the conversion of angiotensin I and II which cause Vasodilation

Side effect: Dry, nagging cough

47
Q

Myoglobin

A
  • Lacks specificity
  • rises in 1- 4 hours
  • returns to normal within 24 hours
48
Q

CK-MB

A
  • rises in 4 - 12 hours
  • returns to normal within 36 - 48 hours
49
Q
A

Pathophysiology (15 decks)

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