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Cardiovascular > Coronary heart disease > Flashcards

Coronary heart disease Flashcards

1
Q

arteriosclerosis

A

thickening and hardening of arteries causing stiffness and lack of elasticity

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2
Q

Greek meaning of atherosclerosis

A

athero- paste or gruel
sclerosis- hardeness

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3
Q

atherosclerosis is characterized by

A

endothelial dysfunction
vascular inflammation
buildup of cholesterol, waste material, fibrin, lipids, and calcium within the intima of the vessel wall

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4
Q

atherosclerosis buildup results in

A

plaque formation
vascular remodeling
acute and chronic luminal obstruction
abnormalities of blood flow
decreased 02 supply to target organs

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5
Q

causes of CAD

A

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

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6
Q

prevention of CAD

A

no smoking
exercise
treat hyperlipidemia aggressively
prevent HTN
baby aspirin–81 mg

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7
Q

diagnostic test of CAD

A

stress test
coronary angiography

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8
Q

angina pectoris

A

oxygen demand is greater than oxygen supply
mismatch between coronary perfusion and myocardial oxygen demand

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9
Q

angina causes

A

CAD
cocaine
precipitating factors: anemia, fever, cold temperature, catecholamines, tachyarrhythmias, post prandial, stress, hyperthyroidism

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10
Q

unstable angina

A

new onset
unpredictable
worsening symptoms
occurs at rest
often due to complex coronary stenosis

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11
Q

stable angina

A

predictable symptoms

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12
Q

characteristics of angina

A

substernal chest discomfort
Levine’s sign
aching, tightening, indigestion

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13
Q

angina time of day

A

early morning

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14
Q

angina location

A

left shoulder
jaw
down inner aspect of arm between 4th and 5th fingers
left back
interscapular area

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15
Q

why is precise localization of pain due to cardiac ischemia difficult

A

the heart lack somatic innervation

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16
Q

who presents with atypical sx of angina

A

women, elderly, and DM pts

17
Q

how do atypical presentations present

A

dyspnea or GI upset

18
Q

duration of angina discomfort

A

1-5 mins
relieved with nitroglycerin take 1 3-5 mins take another if sx don’t relieve and call 911

19
Q

dx tests for angina

A

CBC
electrolytes
cardiac enzymes
HBA1C
Lipid Panel
EKG
Echo
EKG stress test
coronary angiography

20
Q

EKG reading between episodes and during episodes

A

normal; inverted T waves

21
Q

EKG stress test

A

best noninvasive procedure to induce ischemia
exercise testing
pharmacological stress testing

22
Q

coronary angiography

A

definitive dx
shows both structure and function of coronary vessels
narrowing of >50% of lumen diameter

23
Q

collateral perfusion

A

secondary pathway perfusion

24
Q

acute management of angina

A

sublingual nitroglycerin as soon as angina starts

25
Q

MOA of nitroglycerin

A

decreased arterial and vessel tone
reduced myocardial oxygen demand
reduced preload and afterload

26
Q

tx of angina

A

avoid aggravating factors
sublingual nitroglycerin
long acting nitrates
beta blocker
calcium channel blockers
asa
lipid lowering agents

27
Q

aggravating factors of angina

A

cold temperatures
HTN
strenuous activity
emotional stress

28
Q

long-acting nitrates

A

isosorbide dinitrate 10-40mg po TID
isosorbide mononitrate 10-40mg pa BID
side effect: headaches
limitation: development of tolerance

29
Q

beta blockers

A

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

30
Q

calcium channel blockers

A

cause arterial vasodilation, decreased myocardial oxygen demand, and improved coronary blood flow
nifedipine and amlodipine

31
Q

asa

A

antiplatelet drug
81-325 mg daily for all pts with angina

32
Q

lipid lowering agents

A

for all pts with CAD
atorvastatin (Lipitor)
rosuvastatin (Crestor)

33
Q

percutaneous coronary intervention

A

opens stenotic coronary arteries
usually involves stenting (metal or drug eluding)
reduced incidence of CABG

34
Q

CABG

A

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

Cardiovascular (10 decks)

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