Coronary Atherosclerotic Disease

Question 1

coronary atherosclerotic disease is foundation for what?

Answer 1

chest pain and MI

Question 2

what can feel like a heart attack?

Answer 2

bad acid reflux

Question 3

angina is commonly seen in pts who do what drug?

Answer 3

crack cocaine

Question 4

what is the founding cause of coronary atherosclerotic disease?

Answer 4

atherosclerosis

Question 5

atherosclerosis

Answer 5

inflammation - plaque - stenosis

Question 6

cause of atherosclerosis

Answer 6

exact cause unknown but is multifactorial

contributing factors of heart disease:

• hypertension
• type 2 diabetes
• abnormal blood lipid levels
• tobacco
• physical inactivity
• obesity

Question 7

what is a significant contributing factor to heart disease?

Answer 7

hypertension

Question 8

atherosclerotic disease starts out what?

Answer 8

asymptomatic but as plaque grows and stenosis worsens, will result in clinical symptoms (ischemic heart disease)

Question 9

symptoms of coronary atherosclerotic disease

Answer 9

• oxygen demand > supply

- chest discomfort = ischemia

Question 10

the most important symptom of someone that has had coronary atherosclerotic disease and #1 way to determine if treatable?

Answer 10

angina

Question 11

stable angina

Answer 11

• precipitated by physical effort

- transient

Question 12

how is stable angina relieved?

Answer 12

• rest

- nitroglycerin

Question 13

what is the prognosis of stable angina?

Answer 13

good

Question 14

unstable angina

Answer 14

• precipitated by effort or rest
• changing character
• difficult resolution

Question 15

what is the prognosis of unstable angina?

Answer 15

poor

Question 16

is stable angina reversible?

Answer 16

yes

Question 17

when does stable angina occur?

Answer 17

when there is an increased demand on the heart

Question 18

unstable angina may be associate with what?

Answer 18

heart attack

Question 19

medical treatment of ischemic heart disease

Answer 19

• reduce risk factors
• treat contributing conditions
• lifestyle mods
• pharmacologic management
• revascularization

Question 20

pharmacologic management of ischemic heart disease

Answer 20

• nitrates (nitroglycerin)
• beta blockers
• dual antiplatelet therapy

Question 21

mechanism of nitrates

Answer 21

venodilator used for acute management of chest discomfort

Question 22

mechanism of beta blockers

Answer 22

decrease risk of MI by decreasing HR and contractility

Question 23

mechanism of antiplatelet therapy

Answer 23

make platelets less sticky so less likely to cause clots

Question 24

dual anti-platelet therapy for managing ischemic heart disease

Answer 24

aspirin +/- clopidogrel

Question 25

re-stenosis rate of balloon angioplasty

Answer 25

re-stenosis and return of symptoms in 6 mos for 10-50% of pts

Question 26

re-stenosis rate of ballon angioplasty with stent placement

Answer 26

re-stenosis rate reduced to 20-30%

Question 27

types of coronary artery stents

Answer 27

• bare metal
• drug- eluting
• bioresorbable

Question 28

which type of stent has an increased rate of thrombosis for 1 yr after placement?

Answer 28

drug-eluting stent

Question 29

how is the increased risk of thrombosis treated?

Answer 29

with dual antiplatelet therapy

Question 30

coronary artery bypass grafting (CABG)

Answer 30

• more invasive than placing stent

- reconnect area of myocardium that wasn’t getting enough O2 to a good source

Question 31

road to myocardial infarction starts with what?

Answer 31

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

Question 32

myocardial infarction

Answer 32

irreversible ischemic damage to myocardium

*dead cardiac m. tissue present

Question 33

acute management of MI

Answer 33

• keep pt alive
• immediate hospitalization and determination of ST segment changes
• may receive thrombolytic therapy and/or revascularization

Question 34

chronic management of MI

Answer 34

• nitrates
• anti-platelet, anti-coagulant
• cardiac drugs to decrease HR, contractility (Beta blockers)
• statins (lowers cholesterol)
• internal cardiac defibrillator, pacer

Question 35

type of risk imposed by unstable coronary syndromes

Answer 35

MAJOR

Question 36

type of risk imposed by history of ischemic disease

Answer 36

intermediate

Question 37

should you provide elective dental care to pt with history of a MI?

Answer 37

• timing important so 1 mo after MI, pts are considered intermediate risk
• <1 mo = pt considered unstable coronary syms so major risk

Question 38

pts who had an MI <1 mo ago are severely at risk for what?

Answer 38

having lethal arrythmia

Question 39

should you treat pts with stable angina?

Answer 39

yes, but elective care with mods

Question 40

should you treat pts with past MI (>1 mo)

Answer 40

yes, but elective care with mods and consultation with treating cardiologist

Question 41

mods for pts with stable disease

Answer 41

• 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

Question 42

should you txt pts with unstable coronary syndromes?

Answer 42

• no, defer elective care

- emergency care only in conjunction with cardiologist consultation

Question 43

what should you do when your pt has chest pain while in your chair?

Answer 43

• stop procedure, let pt position themselves
• ask if similar to their normal angina
• take vitals
• nitroglycerin

Question 44

how often should you give a pt with chest pain nitroglycerin?

Answer 44

• 1 tablet/sublingual spray Q5 minutes

- relief within 1-2 min

Question 45

should you give nitroglycerin to pts who has a systolic BP <90?

Answer 45

NO!

pt already has a low BO and if give nitroglycerin, will even lower BP more and pt will pass out

Question 46

what do you do when chest pain is not resolving with normal intervention?

Answer 46

• 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

Question 47

how can you prepare for/prevent emergency?

Answer 47

• 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