Week 3: Coronary Artery Disease Flashcards
what is coronary artery disease
progressive atherosclerotic disorder of coronary arteries that results in narrowing or complete occlusion of one or more arteries
what is atherosclerosis
progressive build up of plaque impacting medium-sized arteries that perfuse the heart and major organs
- this causes narrowing which can stop/decrease blood flow leading to heart attacks
what are the common hints of a heart attack
- chest pain - midsternal
- sweating (diaphoretic)
- shortness of breath
give the 3 aspects of coronary artery disease (presentations, syndrome)
- asymptomatic
- stable angina
- acute coronary syndrome: unstable angina, myocardial infarction, sudden coronary death
why is there angina with coronary artery disease
lack of balance of O2 supply and demand
- decreased supply of blood due to the artery size leading to anemia and hypoxia
what are the 12 things that decrease O2 supply
- anemia
- CAD
- hypoxia
- COPD, asthma, pneumonia
- arrhythmias
- CHF
- coronary spasm
- thrombosis
- valve disorders
what are the 9 things that increase O2 demand / consumption
- anxiety
- cocaine use
- hyperthermia
- hyperthyroidism
- physical exertion
- aortic stenosis
- arrhythmias - ↑ rates/work of heart
- cardiomyopathy
- hypertension
how do we decrease the risk of developing atherosclerosis
- diet
- statin medications
- exercise
- education
- stress management
- treat comorbidities
what does the endothelium regulate
- dilation and constriction of vessels
- thrombosis: formation of blood clots
- transport of substances to and from the vascular space
- growth and ‘apoptosis’ of vascular wall
what can cause endothelial dysfunction
- inadequate vasodilation (hypertension)
- prothrombotic
- altered permeability (electrolyte imbalances)
- increased secretion of growth factors (hypertrophy)
- increased oxidation of LDL (fatty plaques)
what is collateral circulation
body is creating collateral capillaries to adapt to the narrowing of arteries in order to have a different route of blood flow
which population develops CAD fast
- CAD is #1 killer of women due to hormonal changes
- women post menopausal due to low estrogen levels (decreased cardio protectiveness)
- low estrogen causes no collateral circulation development
what are some signs of a cardiac event for women
- absence or vagueness of cp
- no radiation of pain
- heaviness of arms
- lightheadedness
- epigastric burning
- nausea and vomiting
- diaphoresis
- feeling flushed
- prodromal symptoms: sleep disturbances, unusual fatigue, shortness of breath, indigestion, anxiety
what are some signs of a cardiac event for men?
- chest pain / aching / tightness / pressure / jaw pain
- shortness of breath
- pain between shoulder blades
- shoulder/arm/neck pain
- headache
- inndigestion
- palpitations
- cough
- diaphoresis
- fatigue
- nausea and vomiting
what are the challenges of care for CAD?
- failure to recognize & difficulty interpreting symptoms
- failure of HCP to recognize prodromal symptoms
- ECG & stress test less sensitive
- plaque tends to be distributed diffusely (plenty of occluded arteries)
- less likely to be evaluated for risk factors or treated aggressively
what are the atypical presentations in the elderly? (most frequent symptoms of acute MI, the pre-existing conditions, treatment)
Most common symptoms of acute MI:
- shortness of breath
- fatigue and weakness
- abdominal or epigastric discomfort
Pre-existing conditions:
- hypertension
- CHF
- previous AMI
Treatment:
- likely to delay seeking treatment
what are the atypical presentations in patients with diabetes?
- acute presentation due to autonomic dysfunction (neuropathic symptoms, do not present the same with pain)
common signs / symptoms:
- generalized weakness
- generalized feeling of not being well
- syncope
- lightheadedness
- change in mental status
what are some non-modifiable risk factors for CAD
- age
- male > female until 65
- genetics
- ethnicity
what are some modifiable risk factors for CAD? (major and contributing)
Major:
- tobacco use
- abdominal obesity
- hypertension > 140/90 mmHg
- hyperlipidemia
- physical inactivity
Contributing:
- psychosocial risk factors depression, hostility, anger, stress)
- elevated homocysteine levels
- diabetes mellitus
- metabolic syndrome
among non-smokers without diabetes what are the low risk factors (BP, Cholesterol)
BP: untreated pressure <120 / <80
Cholesterol: 4.7 mmol/L
among non-smokers without diabetes what are the moderate risk factors (BP, Cholesterol)
BP: systolic 120-130 mmHg or diastolic 80-89 mmHg
Cholesterol: 4.8 - 5.1 mmol/L
among non-smokers without diabetes what are the elevated risk factors (BP, Cholesterol)
BP: untreated systolic 140-159 mmHg or diastolic 90-99 mmHg
Cholesterol: 5.2 - 6.1 mmol/L
how often should low risk factor people be assessed? how often should high risk people be assessed?
low risk: every 3-5 years
high risk: every year
what are some major risk factors for CAD?
- treated hyperlipidemia or total cholesterol 6.2 mmol/L
- treated hypertension or untreated systolic pressure ≥160 mmHg or diastolic ≥100 mmHg