Coronary Atherosclerotic Disease Flashcards
coronary atherosclerotic disease is foundation for what?
chest pain and MI
what can feel like a heart attack?
bad acid reflux
angina is commonly seen in pts who do what drug?
crack cocaine
what is the founding cause of coronary atherosclerotic disease?
atherosclerosis
atherosclerosis
inflammation - plaque - stenosis
cause of atherosclerosis
exact cause unknown but is multifactorial
contributing factors of heart disease:
- hypertension
- type 2 diabetes
- abnormal blood lipid levels
- tobacco
- physical inactivity
- obesity
what is a significant contributing factor to heart disease?
hypertension
atherosclerotic disease starts out what?
asymptomatic but as plaque grows and stenosis worsens, will result in clinical symptoms (ischemic heart disease)
symptoms of coronary atherosclerotic disease
- oxygen demand > supply
- chest discomfort = ischemia
the most important symptom of someone that has had coronary atherosclerotic disease and #1 way to determine if treatable?
angina
stable angina
- precipitated by physical effort
- transient
how is stable angina relieved?
- rest
- nitroglycerin
what is the prognosis of stable angina?
good
unstable angina
- precipitated by effort or rest
- changing character
- difficult resolution
what is the prognosis of unstable angina?
poor
is stable angina reversible?
yes
when does stable angina occur?
when there is an increased demand on the heart
unstable angina may be associate with what?
heart attack
medical treatment of ischemic heart disease
- reduce risk factors
- treat contributing conditions
- lifestyle mods
- pharmacologic management
- revascularization
pharmacologic management of ischemic heart disease
- nitrates (nitroglycerin)
- beta blockers
- dual antiplatelet therapy
mechanism of nitrates
venodilator used for acute management of chest discomfort
mechanism of beta blockers
decrease risk of MI by decreasing HR and contractility
mechanism of antiplatelet therapy
make platelets less sticky so less likely to cause clots
dual anti-platelet therapy for managing ischemic heart disease
aspirin +/- clopidogrel
re-stenosis rate of balloon angioplasty
re-stenosis and return of symptoms in 6 mos for 10-50% of pts
re-stenosis rate of ballon angioplasty with stent placement
re-stenosis rate reduced to 20-30%
types of coronary artery stents
- bare metal
- drug- eluting
- bioresorbable
which type of stent has an increased rate of thrombosis for 1 yr after placement?
drug-eluting stent
how is the increased risk of thrombosis treated?
with dual antiplatelet therapy
coronary artery bypass grafting (CABG)
- more invasive than placing stent
- reconnect area of myocardium that wasn’t getting enough O2 to a good source
road to myocardial infarction starts with what?
plaque rupture
*if plaque becomes unstable and ruptures, thrombosis starts inside artery. as thrombosis continues, blood supply to heart m. reduced and m. tissue can start to die
myocardial infarction
irreversible ischemic damage to myocardium
*dead cardiac m. tissue present
acute management of MI
- keep pt alive
- immediate hospitalization and determination of ST segment changes
- may receive thrombolytic therapy and/or revascularization
chronic management of MI
- nitrates
- anti-platelet, anti-coagulant
- cardiac drugs to decrease HR, contractility (Beta blockers)
- statins (lowers cholesterol)
- internal cardiac defibrillator, pacer
type of risk imposed by unstable coronary syndromes
MAJOR
type of risk imposed by history of ischemic disease
intermediate
should you provide elective dental care to pt with history of a MI?
- timing important so 1 mo after MI, pts are considered intermediate risk
- <1 mo = pt considered unstable coronary syms so major risk
pts who had an MI <1 mo ago are severely at risk for what?
having lethal arrythmia
should you treat pts with stable angina?
yes, but elective care with mods
should you treat pts with past MI (>1 mo)
yes, but elective care with mods and consultation with treating cardiologist
mods for pts with stable disease
- profound LA for procedure (0.036 mg epi)
- manage stress/anxiety (shorter or morning appointments)
- do not discontinue anti-platelet drugs
- comfortable chair position, no rapid changes
- avoid epi impregnated retraction cord
- prepare for emergency
should you txt pts with unstable coronary syndromes?
- no, defer elective care
- emergency care only in conjunction with cardiologist consultation
what should you do when your pt has chest pain while in your chair?
- stop procedure, let pt position themselves
- ask if similar to their normal angina
- take vitals
- nitroglycerin
how often should you give a pt with chest pain nitroglycerin?
- 1 tablet/sublingual spray Q5 minutes
- relief within 1-2 min
should you give nitroglycerin to pts who has a systolic BP <90?
NO!
pt already has a low BO and if give nitroglycerin, will even lower BP more and pt will pass out
what do you do when chest pain is not resolving with normal intervention?
- activate EMS
- pain not responding to nitroglycerin so tell pt to chew and swallow 325 MG aspirin
- O2 via nasal cannula at 4L/min
- BLS
how can you prepare for/prevent emergency?
- know pt’s syndromes
- you and staff prepared to recognize symptoms
- have O2 equipment, nitroglycerin option, and aspirin ready
- determine threshold and plan for calling EMS
