Exam 2 Coronary Artery Disease Flashcards by Ngozi Omeke

Abnormal accumulation of lipid, or fatty substances, and fibrous tissue in lining of arterial blood vessel walls
Block and narrow vessels- reduce blood flow to heart muscle
Progresses over many years- build up of plaque narrowing walls
Atherosclerotic lesions most often occur where vessels branch

Atherosclerosis

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Abnormal ______________of lipid, or fatty substances, and _________tissue in lining of arterial blood vessel walls

Abnormal accumulation of lipid, or fatty substances, and fibrous tissue in lining of arterial blood vessel walls

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Block and narrow vessels- __________blood flow to heart ______

Block and narrow vessels- reduce blood flow to heart muscle

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Progresses over ______years- build up of plaque _________walls

Progresses over many years- build up of plaque narrowing walls

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Atherosclerotic ________most often occur where ________branch

Atherosclerotic lesions most often occur where vessels branch

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Lipids and fatty tissues build up and narrow and reduce blood flow to the heart this is what causes systems like angina or they don’t have an s/s and will come in and have an MI

Plaque buildup in the vessels

Most will have symptoms and take meds for angina and then have an MI

Atherosclerosis

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If thrombus forms and obstructs blood flow leads to _____ coronary syndrome which may lead to MI

If thrombus forms and obstructs blood flow leads to Acute coronary syndrome which may lead to MI

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According to site and degree of narrowing as well as obstruction of blood flow
Blood flow decrease is usually progressive causing inadequate blood supply to heart muscle- Ischemia- causes Angina Pectoris
Angina is usually caused by significant atherosclerosis
If blood supply decrease is enough and for long enough irreversible damage and cell death may occur.
Over time damaged heart tissue is replaced by scar tissue and there are levels of dysfunction.
May result in low cardiac output and heart failure may occur
Decrease in blood supply may even cause heart to abruptly stop beating (sudden cardiac death)

Clinical manifestations

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According to site and _______ of narrowing as well as __________ of blood flow

According to site and degree of narrowing as well as obstruction of blood flow

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Blood flow decrease is usually ___________causing inadequate blood supply to heart muscle- Ischemia- causes ________Pectoris

Blood flow decrease is usually progresses causing inadequate blood supply to heart muscle- Ischemia- causes Angina Pectoris

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_________is usually caused by significant atherosclerosis

Angina is usually caused by significant atherosclerosis

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If blood supply ________ enough and for long enough _____________ damage and cell death may occur.

If blood supply decrease is enough and for long enough irreversible damage and cell death may occur.

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Over time __________heart tissue is replaced by ____ tissue and there are levels of dysfunction.

Over time damaged heart tissue is replaced by scar tissue and there are levels of dysfunction.

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May result in ________cardiac output and heart failure may occur

May result in low cardiac output and heart failure may occur

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____________in blood supply may even cause heart to abruptly stop beating (sudden cardiac death)

Decrease in blood supply may even cause heart to abruptly stop beating (sudden cardiac death)

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Chest pain cuz blood flow is decreased
Angina is caused by insignificant buildup

Once tissues dies it will not work anymore

Heart failure my occur with atherosclerosis

Clinical manifestations

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Most common- chest pain
Some are totally asymptomatic
May present with varying sx other than chest pain- epigastric distress, pain in jaw, left arm
Dyspnea
Nausea, palpitations, numbness
May just have sudden cardiac event

Clinical manifestations for not getting enough oxygen to the heart

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Clinical manifestations for not getting enough oxygen to the heart

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Widow maker – no s/s and then they have a mi and ppl don’t come back

Some are asymptomatic

Elderly will have different signs

Clinical manifestations for not getting enough oxygen to the heart

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Family history- woman before 65 or man before 55
Increasing age
Gender (men earlier than women)
Race (higher in African American)

Risk factors Non modifiable:

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Risk factors

Non modifiable:
Family history- woman before 65 or man before 55
Increasing age
Gender (men earlier than women)
Race (higher in African American)

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Hyperlipidemia
Tobacco use
Diabetes
HTN
Obesity
Physical inactivity
Metabolic syndrome
Alcohol

Modifiable Risk factors

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Modifiable Risk factors

Hyperlipidemia
Tobacco use
Diabetes
HTN
Obesity
Physical inactivity
Metabolic syndrome
Alcohol

High lipids can change

Ldl – low density lipoprotein are the bad clo.

If total is elevated you are also at a higher risk

risk factors

Control cholesterol HDL good cholesterol over 40 for males/ over 50 for females LDL bad cholesterol under 100 (less than 70 for very high risk patients) Total cholesterol of less than 200 Triglycerides less than 150 Exercise and diet can help control these levels Stop the smoking affects the arteries

Prevention

Diet Weight loss Cessation of tobacco use Increased physical activity Manage HTN Before they get to the angina point start get up and walk around to help prevent

Cholesterol

cholesterol

Diet Weight loss Cessation of tobacco use Increased physical activity Manage HTN Before they get to the angina point start get up and walk around to help prevent

a wide variety of fruits and vegetables whole grains and products made up mostly of whole grains healthy sources of protein (mostly plants such as legumes and nuts; fish and seafood; low-fat or nonfat dairy; and, if you eat meat and poultry, ensuring it is lean and unprocessed) liquid non-tropical vegetable oils minimally processed foods minimized intake of added sugars foods prepared with little or no salt limited or preferably no alcohol intake

heart diet

Fish oil capsules – otc Zocor (simvastatin) Lipitor (atorvastatin)

Cholesterol lowering agents

Fish oil capsules – otc Zocor (simvastatin) Lipitor (atorvastatin)

inflammatory marker for cardiovascular risk. Liver produces this protein to stimulus such as injury. People with diabetes and those who are likely to have cardiac event may have high levels. Increase when there is inflammation somewhere in the body

crp

Troponin is a type of protein found in the muscles of your heart. Troponin isn't normally found in the blood. Elevates in 2- 6 hours – might change after labs are drawn Peaks within 12

Troponin I

troponin I

Troponin is a type of protein found in the muscles of your heart. Troponin isn't normally found in the blood. Elevates in 2- 6 hours – might change after labs are drawn Peaks within 12

Found in heart not blood but if heart function ____________ then troponin will be found in blood

Found in heart not blood but if heart function decreases then troponin will be found in blood

Other isoenzymes that are measured in blood test- elevate after MI

CK and CK-MB

Other isoenzymes that are measured in blood test- elevate after MI

_______– metabolic profile – are enterocytes CBC – will tell them if something else is going on CXR – always do a chest _______to see heart and lungs

BMP – metabolic profile – are enterocytes CBC – will tell them if something else is going on CXR – always do a chest xray to see heart and lungs

Episodes of pain or pressure in chest Need exceeds demand Discomfort- agonizing ANGINA SUBSIDES WITH NITROGLYCERIN OR REST NITRO X 3 one every 5 minutes for chest pain if unrelieved call 911

Angina

Episodes of pain or pressure in chest Need exceeds demand Discomfort- agonizing ANGINA SUBSIDES WITH NITROGLYCERIN OR REST NITRO X 3 one every 5 minutes for chest pain if unrelieved call 911

Chest pain sit down put legs up and take three times and 5 mins in-between True angina it will go away with rest and nitro Elderly don’t have same s/s might be short of breath or confusion Elderly don’t feel the same way as younger patient

Angina

May not exhibit typical pain Dyspnea may be presenting symptom Sometimes no symptoms Medications used cautiously in elderly due to increased risk of adverse reactions

Elderly

May not exhibit typical pain Dyspnea may be presenting symptom Sometimes no symptoms Medications used cautiously in elderly due to increased risk of adverse reactions

Patient history Ecg showing ischemia (t wave inversion) Stress test – stress heart and see response

Diagnosis of angina

Patient history Ecg showing ischemia (t wave inversion) Stress test – stress heart and see response

Objectives- decrease 02 demand and increase 02 supply Stents/ CABG – going in and opening back up Medications: Nitroglycerin- sl tab or spray under tongue or in cheek should ideally relieve pain in 3 minutes for PRN use. Different routes including capsules, topical patches, IV.

Medical Management of Angina/CAD

Beta blocker: metoprolol- reduce incidence of recurrent angina, infarction and mortality. Calcium channel blocker- Norvasc- used for patients not responsive to beta blockers Antiplatelets- prevention of platelet aggregation Anticoagulants- prevention of thrombus formation Aspirin: 81-325 mg daily Lovenox: LMWH- sq monitor for s/s of internal bleeding. Oxygen: to meet demands

Medical Management of Angina/CAD

_______ Obtain a 12-lead ECG within 10 minutes of report of chest pain.

ecg

Oxygen Pain assessment Vital signs, pulse ox PQRST (find out what the patient was doing when pain came on) continuous heart monitoring and pulse ox EKG (ECG) Chest xray Saline lock (often 2) NTG prior to arrival x how many and did it work? Labs (troponin, CK, CKMB, BMP, CBC, CRP

ER monitoring management/ unknown chest pain