Exam 3- Coronary Artery Disease

Question 1

What are Modifiable risk factors for CAD

Answer 1

Diet
Exercise
Glucose control
Smoking
Weight management

Question 2

The types of angina and a brief description of each

Answer 2

Stable
Unstable
Variant (Prinzmetal’s)
Nocturnal
Atypical

Question 3

Symptoms of angina

Answer 3

Squeezing, grip-like pressure
Heavy feeling on chest
Substernal, radiates to jaw or neck pain
dyspnea
n/v
May be relieved with rest and NTG

Question 4

A list and description of the diagnostic tests and procedures commonly ordered for a patient experiencing chest pain

Answer 4

EKG- 12 Lead: identify which part of heart
Serial Troponins= if elevated= cardiac muscle damage
Stress Test: Exercise or Chemical (Thalium)
Echo: Assess heart ability to contract and relax. External
TEE: Invasive: Probe down esophagus at pt of heart
Muga Scan: inject w/ radioactive die. differ color where able to infiltrate the tissue “cold spots”
Angiogram: Cardiac Cath; invasive, sedation, most reliable
CABG: Coronary Artery bypass Graft x 3 arteries
Percutaneous Coronary Intervention (PCI)

Question 5

The immediate interventions ordered for a patient experiencing angina

Answer 5

MONA (not necessarily in this order)
Bedrest (decrease demand)
Start IV access
Monitor BP, pulse, pulse oximetry, ECG rhythm
Obtain 12-lead EKG

Question 6

Atherosclerosis

Answer 6

1 form of CAD

Plaque arteries/hardening of artery
- injury or buildup of cholesterol
- characterized by thickening of portion of vessel wall with: abnormal small muscle cells, macrophages, lymphocytes, cholesterol and other fatty substances, connective tissue matrix.

Question 7

LDL vs HDL

Answer 7

LDL: (lousy) delivers cholesterol to cells
HDL: (healthy) removes excess cholesterol from blood and tissues. Exercise raises HDL, Smoking decreases it.
Best indicator of cardiac disease is not total cholesterol by ratio.

Question 8

4 Statin Benefit Groups

Answer 8

1. Person with clinical ASCVD
2. Person with primary elevations of LDL-C>= 190 mg/dl
3. Person with diabetes age 40-75 with LDL 70-189 and w/o clinical ASCVD
4. Person w/o ASCVD or diabestes w/ LDL 70-189 and est 10 yr ASCVD risk >= 7.5%

Question 9

Chronic, Stable Angina

Answer 9

Stable fixed atherosclerotic plaque; predictable degree of exertion; stable pattern, onset, duration, severity; relieved with rest/NTG/both

• Not at night
• Rest and nitroglycerin relieves symptoms

Question 10

Unstable Angina

Answer 10

Ischemia persists in duration, severity, occurances and may progress to STEMI or NSTEMI
Nitro does not help

Question 11

Variant (Prinzmetals) Angina

Answer 11

Associated with spasm, same time of day; often at night

Typically have clear coronary arteries.

Question 12

Nocturnal Angina

Answer 12

At night

Question 13

STEMI / NSTEMI

Answer 13

ST segment Elevation MI (emergency)
Non ST segment Elevation MI (not as emergent)
They look at ST segment because of the area of heart that gets impacted by ischemia in that area of heart.

Question 14

Collateral circulation

Answer 14

As an artery is about to be blocked, the body forms additional arteries to supply the body. Happens only with a gradual onset of a blocked artery.

Question 15

MONA

Answer 15

Immediate Interventions for chest pain
Morphine
O2
Nitrates
Aspirin

Question 16

Angina vs Non Angina

Answer 16

Angina: squeezing, grip-like, pressure, suffocating, heavy. Lasts minutes. Pain is substernal; radiation to neck, jaw, epigastrim. Triggers are exertion, emotional stress, exposure to cold, sex, eating lrg meal, emotional stress. Relief: rest, NTG.
NON Angina: sharp, stabbing, changes w/ position. Lasts for hours. Pain occurs above mandible or below the epigastrium. Relief by changing positions, antacids, eating, burping, coughing.

Question 17

Angioplasty

Answer 17

Inflate balloon; push plaque to sides; deflate

Risk: reocclusion

Question 18

Stent

Answer 18

Balloon inflate; netting to hold artery to open

Risk: infection, lifetime anti-coag (Plavex)

Question 19

Atherectomy

Answer 19

Scrape out; “ Rottar Rooter”

thread past occlusion, spin, then remove.

Question 20

Nitrates

Answer 20

Dilate coronary arteries, improve collateral blood flow, decrease cardiac O2 demand, decrease preload and afterload.
Isorbide - long acting
Nitroglycerine - short acting
Side effects: drop BP from vasodilation
Fall risk

Question 21

Antiplatelet Meds

Answer 21

Inhibit aggregation of platelets and clotting process for lifespan of platelets
ASA, ticlopidine (Ticlid), clopidolgrel (Plavex), Aggrenox

Question 22

Beta Blockers

Answer 22

Inhibit beta adrenergic stimulation, decreasing HR, BP and cardiac output, resulting in decreased cardiac workload and O2 demands. Helps w/ O2 conservation
Risk: Bradycardia

Question 23

Ca Channel Blockers

Answer 23

Inhibit influx of Xa ions thru cell membrane, resulting in decreased cardiac contractility. Relaxes smooth muscle.
Risk: bradycardia; disrhythmias
Amlodipine, Verapamil, nifedipine, diltiazem, procardia.

Question 24

Lipid Lowering Therapy

Answer 24

Statins: lowers blood lipids, LDL, Tgl and total cholesterol, raises HDL and possibly decreases inflammation.
Simvastatin (Zocor); atorvastatin (Lipitor); rosuvastatin (Crestor)