Coronary Artery Disease (CAD) Flashcards
- Atherosclerosis - Angina
Hyperlipidemia
Excessive lipids in the blood
Hypercholesterolemia
- Elevated levels of blood cholesterol
- Implicated in the development of atherosclerosis
Lipoprotein
Insoluble cholesterol and triglycerides encapsulated in water-soluble phospholipids and protein (called apoprotein)
Lipoprotein Functions
- Transport cholesterol and triglycerides to various tissues for energy utilization
- Lipid deposition
- Steroid hormone production
- Bile formation
List the 5 types of lipoproteins
- Chylomicron
- Very Low Density Lipoprotein (VDL)
- Low Density Lipoprotein (LDL
- Intermediate Density Lipoprotein (IDL)
- High Density Lipoprotein ( HDL)
Chylomicrons
- Apparent in blood about 1 hour after a meal
- Carry primarily dietary triglycerides and some cholesterol to adipose cells and skeletal muscle tissue
VLDL
- 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
LDL
- Main carrier of cholesterol
- Sometimes called the bad cholesterol
HDL
- “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
Two sites of Lipoprotein synthesis
Small intestines
Liver
Factors that raise blood lipid levels
- Nutrition
- Genetics
- Medications
- Comorbid conditions
- Metabolic diseases
Primary hypercholesterolemia
Increase in cholesterol that develops because of health problems or lifestyle behaviors
Secondary hypercholesterolemia
Associated with other health problems and behaviors
Dyslipidemia
- Condition seen in diabetes mellitus and metabolic syndrome
- imbalance of lipids such as cholesterol, LDL, triglycerides and HDL
Blood values for LDL cholesterol (mg/dL)
Optimal: below 100
Borderline high: 120 - 159
High: 160 - 189
Very high: Above 190
Blood values for HDL cholesterol (mg/dL)
Low: Below 40
High: Above 60
Blood values for total cholesterol (mg/dL)
Desirable: below 200
Borderline high: 200 - 239
High: above 240
Atherosclerosis
- 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
Pathophysiology of Atherosclerosis
- • 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
Risk factors for Atherosclerosis
- Genetics
- Increasing age
- Gender
- Race
- Hyperlipidemia
- Cigarette smoking
- Diabetes Mellitus
- Obesity
- Physical inactivity
Signs & Symptoms of Atherosclerosis
- Chest pain
- SoB
- Nausea
- Weakness
- Ischemia
- Aneurysm formation -> stroke or heart attack
Coronary Heart Disease/ Chronic Ischemic Disease
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
Angina
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
Stable angina
- Associated with specific activity levels relieves with rest and nitroglycerin
Unstable angina
- increasing frequency of chest pain not particularly associated with any activity not relieved by rest or nitroglycerin
Intractable or Refractory angina
– severe unrelieved chest pain.
Variant Angina
- pain at rest with (Reversible ST segment) also called Prinzmetal’s angina
Silent Angina
- client reports no pain but ST changes are seen on ECG
Precipitating factors of Angina
- Physical exertion
- Exposure to cold
- Eating a heavy meal
- Stress
Signs and Symptoms of Angina
- Chest pain radiating
- Dizziness
- Weakness
- SOB
- Pallor
- diaphoresis
- Nausea vomiting
- Anxiety – a feeling of impending doo
Treatment of CAD
Aspirin Plavix Nitrates Cholesterol lowering medication e.g., statins Beta blockers ACE Inhibitors
Treatment of Angina
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
Diagnosis & Labs of CAD
Blood tests
EKG (Electrocardiogram)
Echo cardiogram
Stress test
EKG for CAD
ST segment depression: irreversible ischemia
ST segment elevation: infarction where there is injury to heart muscle
Proteins found on the myocardium which help with contractility and are released in the blood when the heart is injured
Major
- Troponin T
- Troponin I
- Troponin II
Minor
- Troponin C
Main arteries that supply the heart muscle
Left coronary artery
Right coronary artery
Left coronary artery branches off into the:
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
Right coronary artery branches into
- Right marginal
- Right posterior descending artery
Provides blood to right atrium and ventricle
Balloon Angioplasty
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
CABG
Coronary Arterty Bypass Grafting
Stress test
Monitor the heart rhythm during exercise and see if there are any EKG changes
Antiplatelets
Prevent the formation of clots which decreases the chances of ischemia
When giving plavix you should monitor for
Thrombotic Thrombocytopenia Purpura
Nitroglycerin
Dilates vessels to allow more blood to get to the heart muscle
Beta blockers
Lowers heart rate and blood pressure which reduces workload on heart
Don’t take with grapefruit juice
ACE inhibitors
Blocks the conversion of angiotensin I and II which cause Vasodilation
Side effect: Dry, nagging cough
Myoglobin
- Lacks specificity
- rises in 1- 4 hours
- returns to normal within 24 hours
CK-MB
- rises in 4 - 12 hours
- returns to normal within 36 - 48 hours
