Exam 3- Coronary Artery Disease Flashcards
What are Modifiable risk factors for CAD
Diet Exercise Glucose control Smoking Weight management
The types of angina and a brief description of each
Stable Unstable Variant (Prinzmetal’s) Nocturnal Atypical
Symptoms of angina
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
A list and description of the diagnostic tests and procedures commonly ordered for a patient experiencing chest pain
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)
The immediate interventions ordered for a patient experiencing angina
MONA (not necessarily in this order) Bedrest (decrease demand) Start IV access Monitor BP, pulse, pulse oximetry, ECG rhythm Obtain 12-lead EKG
Atherosclerosis
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.
LDL vs HDL
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.
4 Statin Benefit Groups
- Person with clinical ASCVD
- Person with primary elevations of LDL-C>= 190 mg/dl
- Person with diabetes age 40-75 with LDL 70-189 and w/o clinical ASCVD
- Person w/o ASCVD or diabestes w/ LDL 70-189 and est 10 yr ASCVD risk >= 7.5%
Chronic, Stable Angina
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
Unstable Angina
Ischemia persists in duration, severity, occurances and may progress to STEMI or NSTEMI
Nitro does not help
Variant (Prinzmetals) Angina
Associated with spasm, same time of day; often at night
Typically have clear coronary arteries.
Nocturnal Angina
At night
STEMI / NSTEMI
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.
Collateral circulation
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.
MONA
Immediate Interventions for chest pain Morphine O2 Nitrates Aspirin
Angina vs Non Angina
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.
Angioplasty
Inflate balloon; push plaque to sides; deflate
Risk: reocclusion
Stent
Balloon inflate; netting to hold artery to open
Risk: infection, lifetime anti-coag (Plavex)
Atherectomy
Scrape out; “ Rottar Rooter”
thread past occlusion, spin, then remove.
Nitrates
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
Antiplatelet Meds
Inhibit aggregation of platelets and clotting process for lifespan of platelets
ASA, ticlopidine (Ticlid), clopidolgrel (Plavex), Aggrenox
Beta Blockers
Inhibit beta adrenergic stimulation, decreasing HR, BP and cardiac output, resulting in decreased cardiac workload and O2 demands. Helps w/ O2 conservation
Risk: Bradycardia
Ca Channel Blockers
Inhibit influx of Xa ions thru cell membrane, resulting in decreased cardiac contractility. Relaxes smooth muscle.
Risk: bradycardia; disrhythmias
Amlodipine, Verapamil, nifedipine, diltiazem, procardia.
Lipid Lowering Therapy
Statins: lowers blood lipids, LDL, Tgl and total cholesterol, raises HDL and possibly decreases inflammation.
Simvastatin (Zocor); atorvastatin (Lipitor); rosuvastatin (Crestor)
