Week 3A: Definitions and risk factors Flashcards
Coronary Artery Disease and Acute Coronary Syndrome
Coronary Artery Disease
Progressive athleroscleroitc disorder of the coronary arteries that narrows or occludes 1+ arteries
Atherosclerosis affects..
medium sized arteries that perfuse the heart and other organs. Plaque build up
Explain what happens when there is no oxygen to the heart?
Lactic acid builds up and this irritates the heart muscle and can cause pain and lead to cell death
How does CAD exist?
On a spectrum. It can be asymptomatic and then reach angina, unstable angina, and sudden coronary death
What are the most common signs of a heart attack?
Pt has midsteranl chest pain, sweating and short of breath
What are the 3 conditions under the umbrella of acute coronary syndrome?
Unstable angina, myocardial infarction, and sudden coronary death
How does cocaine use interfere with the oxygen in one’s body?
Increases the O2 demand
Describe the stages in development of athersclersosis (4)
Damaged Endothelium – Injury to the artery’s inner lining (due to smoking, high blood pressure, or diabetes) makes it prone to plaque buildup.
Fatty Streak – LDL (“bad” cholesterol) enters the damaged area, white blood cells try to remove it, but instead form foam cells, creating a yellow streak.
Fibrous Plaque – The fatty streak grows as smooth muscle cells form a hard cap over it, narrowing the artery and reducing blood flow.
Complicated Lesion – The plaque can rupture, causing a blood clot (thrombus) that can fully block the artery, leading to a heart attack or stroke.
What does the endothelium (in blood vessels) regulate?
-Dilation, constriction
-Thromboisis
-Transportation
-Growth/apoptosis
Thrombosis
Formation of blood clots
What are some conditions that would lead us to believe that the endothelium has become dysfunctional?
Inadequate vasodilation, prothrombotic, altered permeability, increased secretion of growth factor, increased oxidation of LDL
What does it mean if there is a higher concentration of LDL in a patient’s body?
This is bad and we are worried about endothelial dysfunction
Describe collateral circulation
-a long term solution to occluded and restricted blood flow in the patient’s arteries
-Body adaptation
-The capillary network around the arteries connect to each other to get around the block
With occlusion, will there always be no oxygen?
No because of collateral circulation
How does menopause related to collateral circulation?
This is along term adaptation and the pre menopause hormones protect against CAD. With menopause, hormone levels change but the rapid nature of the CAD is too fast for the patient’s body to adjust. Collateral circulation develops over time and is more common in men.
What hormone is cardioprotective in women?
Estrogen. This is why we have CAD issues after menopause
Does CAD present with gendered differences?
Yes.
How might CAD present in women compared to men?
Women don’t present with chest pain, radiation, but they do have heavy arms, light-headed, epigastric burning, N/V/. diaphoresis, flushed as well as prodromal symptoms
What are the prodromal symptoms?
Sleep disturbances, unusual fatigue, shortness of breath, indigestion, anxiety
List the challenges of care for women
Failure to recognize, prodromal symptoms, ECG & stress test less sensitive, plaque is diffuse, less likely to be evaluate for risk factors
How does a stress test work in women?
Go on treadmill, put leads on, run, mimic straining on the heart and see what the response is. Women don’t always have the same definitive changes that men do.
Explain atypical presentation in the elderly
MI: SOB, fatigue, tummy
Pre-existing conditions: HTN, CHF, AMI
Likely to delay seeking treatment
Why is there atypical presentation in patients with diabetes?
Atypical due to autonomic dysfunction
S&S with DM and CAD
Generalized weakness, not feeling well, syncope, lightheadedness, change in mental status
What type of obesity is a major risk factor for CAD
Abdominal
What are some contributing RF for CAD
Psychosocial, elevated homocysteine levels, DM, metabolic syndrome
Moderate CAD RF(non-smoker, no DM)
Chol: 4.8-5.1
BP (Untreated): 120-139/80-89
Low risk factors for CAD (non-smoker, no DM)
Chol: 4.7
BP (Untreated):<120/<80
Elevated RF CAD(non-smoker, no DM)
Chol: 5.2-6.1
BP (Untreated):140-159/90-99
How often should those with low risk factors be assessed and those with high?
3-5yr, every year
What are the major risk factors for CAD
-Treated hyperlipidemia
-Chol= 6.2
-Treated HTN
-160/100++ untreated
-Current smoker
-Diabetes
How old are men and women we screen for CAD?
M40, F50
Regardless of age, who are we screening for CAD
Smoker, HTN, elevated chol, Diabetic, family Hx, EDys, obesity, inflammatory disease, COPD, HIV
