Week Week 3: Acute Coronary Syndrome

Question 1

Coronary artery disease

Answer 1

A type of blood vessel disorder that is included in the general category of atheroscleoriosis (affects hearts arteries and produces various pathological effects especially reduced flor of oxygen and nutrients to the myocardium)

Question 2

What specifically does coronary artery disease do in the body?

Answer 2

starts as soft deposits of fat that harden with age “the hardening of the arteries”

Question 3

What is the major cause of CAD?

Answer 3

atherosclerosis

Question 4

What lab test is often elevated in patients with CAD?

Answer 4

C reactive protein (produced by the liver, nonspecific marker of inflammation)

Question 5

How does CAD develop?

Answer 5

over many years
when it is symptomatic usually it is well advanced

Question 6

What are the developmental stages of CAD?

Answer 6

Fatty streak
Fibrous plaque
Complicated lesion

Question 7

What occurs in stage 1: Fatty streak?

Answer 7

characterized by lipid filled smooth muscle cells
yellow tinge appears as fat fills
can be seen by age 15

Question 8

What can reverse the fatty streak stage?

Answer 8

treatment that lowers LDL cholesterol may reverse this process

Question 9

What occurs in stage 2: Fibrous plaque?

Answer 9

LDL’s and platelet growth factors stimulate smooth muscle proliferation and thicken arterial wall
collagen covers the fatty streak and forms a plaque

Question 10

What occurs in stage 3: Complicated lesion?

Answer 10

fibrous plaque continues to grow and continued inflammation can result in the plaques instability, ulceration and rupture
Can lead to a thrombus
most dangerous

Question 11

Angiogenesis

Answer 11

the inherited predisposition to develop new blood vessels

Question 12

What is collateral circulation

Answer 12

alternate routes formed by the arteries to supply oxygen and nutrients to the myocardium despite a CAD block

Question 13

What are modifiable risk factors for CAD?

Answer 13

Age
Sex
Ethnicity

Question 14

What are the 5 major modifiable risk factors in CAD?

Answer 14

Elevate serum lipid levels
HTN
Tobacco Use
Physical inactivity
Obesity

Question 15

What are modifiable contributing risk factors to CAD?

Answer 15

DM
Metabolic syndrome
Psychological states
Homocysteine
Substance use

Question 16

What is metabolic syndrome

Answer 16

A cluster of risk factors for CAD who’s underlying pathophysiology may be due to insulin resistance

Question 17

Who is at high risk for CAD?

Answer 17

immediate family history of heart disease
Elevated serum lipid levels
HTN
Tobacco use
obesity
physical inactivity
stress
metabolic syndrome
substance use

Question 18

What medication restricts lipoprotein production?

Answer 18

Statin medications

Question 19

What medication increases lipoprotein removal?

Answer 19

cholestyramine

Question 20

Examples of saturated fats

Answer 20

animal fat
butter
cream cheese
sour cream

USE SPARINGLY

Question 21

examples of monounsaturated fats

Answer 21

Fish oil
Avocado
nuts
olives

Question 22

Examples of polyunsaturated fats

Answer 22

Fish oil
shellfish
nuts
seeds
magazine
vegetable oils

USE PRIMAIRLY

Question 23

What is angina

Answer 23

chest pain that is a clinical manifestation of reversible myocardial ischemia

Question 24

What is the primary reason for angina?

Answer 24

atherosclerosis

Question 25

chronic unstable angina?

Answer 25

chest pain that occurs intermittently over a long period with the same onset, duration and intensity of symptoms due to myocardial ischemia (usually secondary to CAD)

Question 26

What is referred pain?

Answer 26

when there is an injury on one area of the body but feel pain somewhere else (eg heart is not getting oxygen but sends pain to jaw, shoulders, arms)

Question 27

How is angina often described?

Answer 27

crushing choking suffocating squeezing

Question 28

What factors can precipitate angina?

Answer 28

physical exertion temperature extremes strong emotions consumption of heavy meal tobacco use sexual activity stimulants circadian rhythm patterns

Question 29

What is the first line treatment for angina?

Answer 29

Nitrates

Question 30

How do nitrates work?

Answer 30

dilating peripheral blood vessels dilating coronary arteries

Question 31

How long does nitroglycerin take to relieve pain

Answer 31

3 minutes

Question 32

How long is nitroglycerins duration?

Answer 32

Approx 30-60 minutes

Question 33

How much nitroglycerin can be given in a period?

Answer 33

one sublingual spray under tongue (do not inhale) if symptoms do not improve repeat every 5 minutes up to three times then contact emergency services

Question 34

What are 2 predominant adverse effect of all nitrates?

Answer 34

Headache (caused by the dilation of cerebral blood vessels) Orthostatic hypotension

Question 35

What 3 MOA's do calcium channel blockers do?

Answer 35

1. Systemic vasodilation with decreased SVR 2. decreased myocardial contractility 3. coronary vasodilation

Question 36

What is an ACS?

Answer 36

when myocardial ischemia is prolonged and not immediately reversible (encompasses unstable angina, MI)

Question 37

Explain how ACS occurs

Answer 37

deterioration or atherosclerotic plaque that was once stable, the plaque ruptures exposing intimate to blood which stimulates platelets aggregation which means vasoconstriction with thrombus formation (NSTEMI or STEMI)

Question 38

Unstable angina

Answer 38

chest pain that is new in onset, occurs at rest, or has a worsening pattern

Question 39

Unstable angina S&S

Answer 39

fatigue shortness of breath indigestion anxiety

Question 40

What is a myocardial infarction?

Answer 40

occurs as a result of sustained ischemia causing irreversible myocardial death

Question 41

What is the primary cause of an MI?

Answer 41

occur secondary due to thrombus formation

Question 42

S&S of MI?

Answer 42

pain, SNS stimulation, hypotension, edema, fever, N/V, cool skin

Question 43

What are some complications with an MI that can occur?

Answer 43

Dysrhythmias Heart failure cariogenic shock papillary muscle dysfunction pericarditis dressers syndrome

Question 44

What are the medication treatments of choice for ACS?

Answer 44

IV nitro, ASA, b adrenergic blockers, systemic anticoagulation and heparin ACE inhibitors

Question 45

What is the treatment acronym for an MI?

Answer 45

MONA morphine sulphate oxygen nitroglycerin asa

Question 46

What are nonmodifable risk factors for ACS?

Answer 46

Men over 55 or postmenopausal women 1st degree relative at 55 or younger for men and 65 or younger for women

Question 47

What are differences in CV changes in women compared to men?

Answer 47

estrogen is thought to be cardioprotective women's CV events occur 10 years later than in men women may present differently

Question 48

What are modifiable factors for ACS?

Answer 48

heart healthy diet statins activity HTN management smoking cessation DM managrmrtn Stress management Drugs/alcohol cessation/limitation

Question 49

What do statins do?

Answer 49

block cholesterol synthesis lowers LDL and triglyceride levels

Question 50

What does Niacin do?

Answer 50

decrease lipoprotein synthesis lowering LDL and triglyceride levels

Question 51

What do Bile acid sequestrates do?

Answer 51

bind to cholesterol in the intestine to increase breakdown and lower LDL levels