Week 10 - Metabolic syndrome and CAD Flashcards
Describe the basic pathophysiology of coronary atherosclerosis.
- Atherosclerosis begins as a tear in the endothelium (first wall of the artery), infiltrating the intima layer
- Inflammatory response occurs and macrophages ingest lipids (foam cells) making further damage by initiating clotting
- Smooth muscle cells reproduce forming a cap over the lipids and inflammation making the vessel misshapen
- Continued abnormal accumulation of lipids and tissue in the lining of the artery are called plaques
- Plaques create narrowing or blockages interrupting blood flow and, if it continues to grow, it could rupture creating a thrombus
What are the different coronary arteries? Which is the widow maker?
RCA, LCA (widow maker), LADA (left anterior descending artery), PACA (posterio ascending)
If you suspect someone has coronary atherosclerosis, what would be the next steps?
Dietary changes, exercise
Blood test for cholesterol level and maybe starting on statins
What are symptoms of angina pectoris?
Pain (can be GERD-type pain), nausea, diaphoresis, cyanosis, pallor
Who is at risk for atherosclerosis?
- Elevated blood lipid levels (cholesterol)
- Smoking
- HTN
- DM
- Obesity
- Family Hx
What are the non-modifiable risk factors for Coronary atherosclerosis?
Family hx of CAD
Increased age
Gender (men develop CAD earlier than women)
Race - higher incidence in blacks
What are the modifiable risk factors for CAD?
hyperlipidemia Smoking HTN DM Lack of estrogen in women Obesity Physical activity
Why do women have higher rates of CAD after menopause?
Lose cardioprotective effects of estrogen
A cluster of the most dangerous heart attack risk factors.
Metabolic syndrome = diabetes and raised fasting plasma glucose, abdominal obesity, high cholesterol, and high BP
__-___% of the world’s population has metabolic syndrome, and these people are __-__ times more likely to have an MI or CVA, compared to those without the syndrome
20-25%
2-3x
Metabolic syndrome is mostly related to what?
insulin resistance and central obesity
Metabolic syndrome is secondarily related to what?
physical inactivity, ageing, a pro-inflammatory state, hormonal changes
Central obesity is associated with what?
Insulin resistance, HTN, high serum cholesterol
What is central obesity in men and women?
men >102cm
women >88cm
Where does one measure to determine if a person has central obesity?
Above the iliac crest
Describe the lipid panel for dyslipidemia and what findings would be expected.
When do men typically start getting this done? Women?
Total cholesterol < 5.2 is good TGs < 1.7 is good LDL < 3.0 is good HDL > 1.0 is good (men 40; women 50)
What are some SDoH that impact dyslipedemia?
Food insecurity, poverty, unable to travel, shift work, housing, education and health literacy
What meds are often given for dyslipidemia?
Statins
What are the different risk categories for HTN?
Low risk - 120/80
medium risk - 121-139 /80-89
High risk 140+/90
Why is HTN a risk factor for CAD or atherosclerosis?
HTN causes damage to vessel walls, which get stiffer and are predisposed to injury
What role does stress play in HTN?
Stress releases catecholamines which increase BP, HR
What diet is typically useful for HTN?
DASH diet - low salt
What types of meds are given for HTN?
Beta blockers
ACEIs (e.g. sartans)
CCB (dipines)
Which is the most common diabetes type?
T2D
How has T2D contributed to death?
Major cause of premature illness and death, primarily through the increased risk for CVD (which is responsible for 80% of these deaths)
What are some meds for T2D?
Insulin, metformin, gliptins (Januvia)
In what kind of patient may a heart attack present without chest pain?
T2D patient with diabetic neuropathy - might not have chest pain.
When the need for oxygen exceeds supply flowing physical or emotional stress due to poor blood flow – caused by atherosclerosis
Angina pectoris
What is the difference between stable and unstable angina?
stable is relieved by rest/nitro
unstable is not
What are some symptoms of angina pectoris?
chest pain (may mimic gerd), cyanosis, diaphoresis, anxiety, pain radiating down arm, scapular pain
what is the MONA acronym?
Morphine, oxygen, nitro, aspirin
What tests/BW would be ordered for an MI?
12 lead ECG
Trops, CK, CBC, lytes, blood gases, CRP
vitals
What levels do we look for for trops and CK-mb?
trops >3 –> would do a second test to see if there is a change
CK-mb > 20 (muscle damage)
What is CRP?
C-reactive protein - marker for endothelial damage
What are some possible further interventions after an MI/angina?
Cath lab tele echo CABG angio
