Coronary heart disease Flashcards
arteriosclerosis
thickening and hardening of arteries causing stiffness and lack of elasticity
Greek meaning of atherosclerosis
athero- paste or gruel
sclerosis- hardeness
atherosclerosis is characterized by
endothelial dysfunction
vascular inflammation
buildup of cholesterol, waste material, fibrin, lipids, and calcium within the intima of the vessel wall
atherosclerosis buildup results in
plaque formation
vascular remodeling
acute and chronic luminal obstruction
abnormalities of blood flow
decreased 02 supply to target organs
causes of CAD
physical inactivity- increased HDL
smoking- endothelial injury and platelet adhesion
DM- increased cholesterol, plaque, and platelet aggregation
Cholesterol- decreased HDL increased LDL and hypertriglyceridemia
Obesity- HTN, DM, elevated triglycerides, elevated cholesterol
prevention of CAD
no smoking
exercise
treat hyperlipidemia aggressively
prevent HTN
baby aspirin–81 mg
diagnostic test of CAD
stress test
coronary angiography
angina pectoris
oxygen demand is greater than oxygen supply
mismatch between coronary perfusion and myocardial oxygen demand
angina causes
CAD
cocaine
precipitating factors: anemia, fever, cold temperature, catecholamines, tachyarrhythmias, post prandial, stress, hyperthyroidism
unstable angina
new onset
unpredictable
worsening symptoms
occurs at rest
often due to complex coronary stenosis
stable angina
predictable symptoms
characteristics of angina
substernal chest discomfort
Levine’s sign
aching, tightening, indigestion
angina time of day
early morning
angina location
left shoulder
jaw
down inner aspect of arm between 4th and 5th fingers
left back
interscapular area
why is precise localization of pain due to cardiac ischemia difficult
the heart lack somatic innervation
who presents with atypical sx of angina
women, elderly, and DM pts
how do atypical presentations present
dyspnea or GI upset
duration of angina discomfort
1-5 mins
relieved with nitroglycerin take 1 3-5 mins take another if sx don’t relieve and call 911
dx tests for angina
CBC
electrolytes
cardiac enzymes
HBA1C
Lipid Panel
EKG
Echo
EKG stress test
coronary angiography
EKG reading between episodes and during episodes
normal; inverted T waves
EKG stress test
best noninvasive procedure to induce ischemia
exercise testing
pharmacological stress testing
coronary angiography
definitive dx
shows both structure and function of coronary vessels
narrowing of >50% of lumen diameter
collateral perfusion
secondary pathway perfusion
acute management of angina
sublingual nitroglycerin as soon as angina starts
MOA of nitroglycerin
decreased arterial and vessel tone
reduced myocardial oxygen demand
reduced preload and afterload
tx of angina
avoid aggravating factors
sublingual nitroglycerin
long acting nitrates
beta blocker
calcium channel blockers
asa
lipid lowering agents
aggravating factors of angina
cold temperatures
HTN
strenuous activity
emotional stress
long-acting nitrates
isosorbide dinitrate 10-40mg po TID
isosorbide mononitrate 10-40mg pa BID
side effect: headaches
limitation: development of tolerance
beta blockers
first line therapy
Beta blockers reduce anginal symptoms by decreasing both heart rate and contractility. Since beta blockers reduce the heart rate, the onset of angina or the ischemic threshold during exercise is delayed or avoided.
metoprolol
calcium channel blockers
cause arterial vasodilation, decreased myocardial oxygen demand, and improved coronary blood flow
nifedipine and amlodipine
asa
antiplatelet drug
81-325 mg daily for all pts with angina
lipid lowering agents
for all pts with CAD
atorvastatin (Lipitor)
rosuvastatin (Crestor)
percutaneous coronary intervention
opens stenotic coronary arteries
usually involves stenting (metal or drug eluding)
reduced incidence of CABG
CABG
coronary artery bypass grafting
referred over PCI for left main coronary artery stenosis, >3 lesions, and for lesions not amenable by PCI
mortality higher with age and with prior CABG
harvest great saphenous vein, internal mammary artery, or radial artery
