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CAD Flashcards

1
Q

supplies oxygenated blood to the (posterior portion) back portion of the left atrium & ventricle

A

Left Circumflex Artery (LCA)

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2
Q

supplies oxygenated to the front portion of the ventricle to the septum of the heart

A

Left Anterior Descending Artery (LDA)

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3
Q

— supply oxygenated blood to the front portion of the right atrium

A

Right Marginal Artery (RMA)

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4
Q

supply oxygenated blood to the back poriton of the right ventricle

A

Posterior Descending Artery

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5
Q

form re-route when there is blockage so that the blood can reach other parts of the artery

A

collateral circulation

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6
Q

Vascular supply to the heart is impended by

A

Atheroma
Thrombosis
Spasm of the coronary artery

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7
Q

Accumulated fatty deposits and scar tissues

A

Atheroma

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8
Q

Atheroma leads to ________ and risk of ________

A

restriction in blood flow; thrombosis

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9
Q

patchy deposit of plaque

A

atheromas or atherosclerotic plaque

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10
Q

condition in which patchy deposit of plaque
(atheromas or atherosclerotic plaque) develop in the
wall of the medium and large sized arteries, leading to
reduced or blocked blood flow

A

Atherosclerosis

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11
Q

Atherosclerosis is a condition in which patchy deposit of plaque
(atheromas or atherosclerotic plaque) develop in the
wall of the medium and large sized arteries, leading to

A

reduced or blocked blood flow

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12
Q

T/F: Atherosclerosis can lead to stroke (in brain)

A

T

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13
Q

rupture, causing thrombosis

A

Unstable plaque

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14
Q

What do you give to patients with unstable plaque?

A

give antiplatelet medication just in case of rupturee (lead to coagulation/platelet adhesion)

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15
Q

T/F: Plaque rupture can cause MI

A

T

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16
Q

Blood clot

A

Thrombus

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17
Q

Fragment of blood clot travelling through vein

A

Emboli

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18
Q

Risk factors for CAD

A

atherosclerosis, htn, high cholesterol, diabetes, obesity, smoking + alcohol consumption

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19
Q

Etiology of CAD: Decrease blood flow to the myocardium

A

*Atherosclerosis
*Coronary spasm
*Traumatic Injury
*Embolic event

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20
Q

Etiology of CAD: Increased oxygen demand

A

*Diastole
*Systole
*Contractile state of the heart
*Increase in systolic wall tension
* Lengthening of ejection time
*Change in the heart rate

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21
Q

unbalanced oxygen supply and oxygen demand

A

Myocardial Ischemia

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22
Q

T/F: during MI, px can experience angina pectoris (chest pain)

A

T

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23
Q

Oxygen demand exceeds myocardial oxygen
supply

A

Myocardial Ischemia

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24
Q

Myocardial Ischemia may be silent if

A

the length is insufficient
* Afferent cardiac nerves are damages
* Inhibition of pain at the spinal or
supraspinal

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25
Occurs when oxygen demand exceeds the oxygen supply
Myocardial Ischemia
26
T/F: during Myocardial infarction, heart muscles already died due lack of oxygenated blood for a long time
T
27
Transient chest discomfort that are attributed to insufficient myocardial oxygen
Angina
28
Ordinary activity does not cause angina, such as walking and climbing stairs
Class I
29
Slight limitation of ordinary activity
Class II
30
Marked limitation of ordinary physical activity
Class III
31
Inability to carry on any physical activity without discomfort
Class IV
32
T/F: not all chest pain is classified as angina
T
33
Characterized by chest pain and breathlessness on exertion, symptoms are relieved promptly with rest
Stable Angina
34
Patient has a reproducible pattern of pain or other symptoms
Stable Angina
35
Components to Consider in Anginal Pain
1.Quality of pain (suffocating type of pain) 2.Location of pain (chest pain) 3.Duration of pain (0.5 to 30 minutes) 4.Factor provoking pain 5.Factors that relieve pain
36
Symptoms of Stable Angina
Pressure over the sternum but not always radiating Pain usually lasting for 0.5 to 30 minutes Precipitating factors include exercise, cold weather, emotional stress Relief occurs with rest and nitroglycerin
37
>20 minutes occurring within a week of presentation
Rest Angina
38
Previously diagnosed angina with distinctly more frequency, longer duration or lower threshold
Increasing angina
39
-Rest Angina -Increasing Angina -decrease response to NTG
Unstable Angina
40
Nocturnal angina
Angina Decubitus
41
Angina Decubitus occurs when patient is in a
recumbent position
42
Coronary artery spasm that reduces blood flow
Prinzmetal Angina
43
Prinzmetal Angina is due to a
thrombi or plaque formation
44
Prinzmetal Angina occurs at
rest rather than exertion
45
ECG shows ST-elevation
Prinzmetal Angina
46
only occurs when patient is lying down; upright position, relieved
nocturnal
47
chest pain even if px is in upright position
prinzmetal
48
Diagnostic Test
*Resting ECG *Exercise test * Myocardial scintigraphy * Stress Echocardiography *Coronary Angiography (gold standard)
49
Treatment Goals for Angina
Prevent MI and death, thereby improving the patient’s quality of life Reduce symptomatology Remove or reduce risk factors
50
Chronic Stable Angina treatment
*A – Aspirin and Antianginal Therapy *B – Beta blocker and BP *C – Cigarette smoking and Cholesterol *D – Diet and Diabetes *E – Education and Exercise
51
Recommendations
* Weight reduction/ maintenance * Physical activity for 30 - 60 minutes/day x 7 day * LDL-C <100mg/dL *BP < 130mmHg *No smoking and no environmental exposure to smoke *Reduce intake of saturated fats *If Diabetic HbA1c <7%
52
recommended physical activity for Chronic Stable angina
30 - 60 minutes/day x 7 day
53
recommended LDL-C for Chronic Stable angina
<100mg/dL
54
recommended BP for Chronic Stable angina
130mmHg
55
recommended Diabetic HbA1c for Chronic Stable angina
<7%
56
Management for Chronic Stable angina
*Anti-platelets/Anti-thrombotic *ACEI’s and ARBS *Statins *Beta-blocker *Calcium Channel Blocker *Nitrates
57
Anti-Thrombotic Agents
Aspirin Clopidogrel COX- 2 Inhibitor
58
Acts via irreversible inhibition of platelet COX-1 and thus thromboxane production
Aspirin
59
Aspirin's Antiplatelet action is apparent within an hour of taking _________
300mg
60
Effect on platelet last for the lifetime of the platelet
Aspirin
61
Optimal maintenance dose for aspirin
75 -150mg/day
62
Lower dose of Aspirin have _________
limited cardiac risk protection
63
Higher dose of aspirin _______
increase risk for GI side effect
64
Inhibits ADP activation of platelet
Clopidogrel
65
Useful alternative to aspirin in patients who are allergic or cannot tolerate aspirin
Clopidogrel
66
As effective as aspirin in patients with stable coronary disease
Clopidogrel
67
Usual dose is 300mg once then 75 mg daily
Clopidogrel
68
Less likely to cause gastric erosion and ulceration
Clopidogrel
69
Reduces the production of Prostacyclin
COX- 2 Inhibitor
70
More traditional non-selective NSAIDs increase cardiovascular risk
COX- 2 Inhibitor
71
NSAID with high _______ specificity increase the risk of MI
COX-2
72
SHOULD BE AVOIDED IN CHRONIC STABLE ANGINA
COX- 2 Inhibitor
73
Proven beneficial for post MI
ACE Inhibitor
74
Vasodilatory effect caused by the inhibition of the production of Angiotensin II
ACE Inhibitor
75
Anti-inflammatory, anti-thrombotic and anti-proliferative property
ACE Inhibitor
76
Reduces ROS production
ACE Inhibitor
77
Demonstrate the benefit of reducing cholesterol, especially LDL-C, in patients with CHD
Statin
78
Earlier studies focused on patients with “elevated” cholesterol, but all patients with coronary risk factors benefit from reduction of their serum cholesterol level
Statin
79
T/F: all patients with coronary risk factors that is treated with statin benefit from reduction of their serum cholesterol level
T
80
statins reduce cardiovascular risk by
* Shift LDL cholesterol particle size to a larger particle, lesser atherogenic * Improve endothelial function * Prevention of pro-inflammatory mediators * Possibly improve atherosclerotic plaque stability
81
No safe level for cholesterol for patients with CAD and there is a continuum of risk down to very low cholesterol level
Statins
82
Level of LDL-C of __________ and total cholesterol__________ are recommended for patients with established CVD
<2mmol/L; <4mmol/L
83
Considered first line agent in angina
Beta-Blocker
84
Reduce mortality both in patients who suffered from previous MI and patients with HF
Beta-Blocker
85
Beta-Blocker reduce myocardial oxygen demand by blocking β- adrenergic receptor, there by ___________ (increasing/decreasing) the heart rate and force of left ventricular contraction and lowering blood pressure
decreasing
86
Beta Blockers are useful in
exertional angina
87
Patients treated optimally with B blockers should have a resting heart rate of around
60 beats/minute
88
B blockers are used in caution in patients with _________
diabetes
89
Tendency to cause bronchospasm and peripheral vascular spasm
Beta Blockers
90
Should not be stopped abruptly
Beta Blocker
91
Contraindicated in the rare Prinzmetal’s angina where coronary spasm is a major factor
Beta Blocker
92
Acts on a variety of smooth muscle and cardiac tissue
Calcium Channel Blocker
93
______ have been implicated in the exacerbation of angina
Calcium Channel Blocker
94
valuable in angina
Organic nitrates
95
Dilate vein → decrease preload
Nitrates
96
Dilate arteries to a lesser extent → decrease afterload
Nitrates
97
Promote flow in collateral coronary vessel, diverting blood from the epicardium to the endocardium
Nitrates
98
Relax vascular smooth muscle by releasing nitric oxide
Nitrates
99
Tolerance is one of the main limitation
Nitrates
100
Nitrate preparation
*IV infusion *Tablet / capsule *Transdermal patch * Sublingual tablet * Spray
101
Exhibits the properties as nitrate
Nicorandil
102
Also activates ATP dependent potassium channel
Nicorandil
103
main benefit of nicorandil
Reduction in unplanned admission to hospital with chest pain
104
Anti-ischemic agent
Ranolazine
105
T/F:Ranolazinen is not commonly used in the management of chronic stable angina
T
106
Inhibit inward sodium current during plata
Ranolazine

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