CORONARY ARTERY DISEASE (CAD) Flashcards
MI symptoms and location
dull, aching, pressure or tightness/squeezing
- location: retrosternal or left precordial
CAD- locations of referred pain
throat, lower jaw, shoulders, inner arms, upper abdomen, or back
MI ischemic symptoms are first noted when?
with exercise or cardiac stress from cold exposure, meals, or combo of factors that resolve after event is over
unstable angina
progressive SS at REST due to coronary plaque rupture and thrombosis
more frequent, lasts longer, occurs with less exertion
stable angina
reproducible chest pain, relieved WITH REST
chest pain with exercise, stops at rest
protracted/prolonged episodes of chest pain can indicate?
an MI
although some pts with Acute MI have NO CP
do men or women have higher frequency of atypical angina?
women
CAD definition
atherosclerosis of intima of coronary arteries
(PAD, Carotid AD, Cerebral AD- CVA or TIA, CAD- ischemic heart ds
CAD RFs
- tobacco use
- DM
- HTN, HLD
- Metabolic Syndrome
- Fam Hx of CAD
- obesity
what is metabolic syndrome?
a group of conditions that inc the risk of developing CAD, stroke, and type 2 DM
Metabolic syndrome requires 3 or more of the following:
- triglycerides >150
- HDL <40 men, <50 women
- fasting blood glucose >110
- abdominal obesity
HTN
high TG, high glucose, high BP, obesity, LOW HDL
CAD Dx
Cardiac CATH/angio- DEFINITIVE DX
EKG- nl or ST depression, non specific changes (t-wave changesin lead 3 can be diaphragmatic)
stress test- ST depressions of 1mm in 2 leads=pos test
- more specific with SPECT (nuclear stress testing to see location of ds)
ECHO- wall motion abnormalities, dec LVEF
CAD Tx- RF mods
- HTN, HLD, DM, exercise/dietary mods, smoking cessation, wt loss
CAD Tx- medical therapy
3 classes of ANTIANGINALS
Beta blockers- FIRST LINE FOR STABLE ANGINA PT
- inc oxygenation by dec HR/prolong diastole
- prevents reinfarction
CCB (central)- SECOND line if BB fail/CI
- vasodilate
NITRATES (nitroglycerin, isosorbide, hydralazine)- inc o2 by vasodiation
- for angina that persists with monotherapy
- sublingual nitro IMMEDIATELY EFFECTIVE
- long acting- iso and hydral.
additional- ranolazine, late sodium channel blocker
what medication do you NEVER use for vasospastic angina?
beta blockers
what is the first line med for pts with stable angina?
beta blockers
first line for prinzmetal’s angina?
CCBs (central- diltiazem and verapamil)
Nitrates- side effects
headache, facial flushing, orthostat hypotension, syncope
CAD tx- revascularization
Percutaneous coronary intervention
- balloon angioplasty
- drug eluting stents–> dual antiplatelet therapy for 12 months (aspirin + clopidogrel/plavix, ticagrelor, prasugrel)
- bare metal stents–> 1 month dual antiplatelet therapy (min 1 month, up to 12 months)
drug eluting- stent coated in medication
bare metal- metal mesh stents
CAD Tx- Coronary Artery bypass grafting (CABG)
Indicated with:
- triple-vessel ds with >70-% stenosis of each vessel
- L main coronary ds >50% stenosis
