CAD Flashcards by Lux Smith

greatest risk factors for CAD

a.     Prior coronary event
B.	Non-cardiac atherosclerosis
C.	Diabetes mellitus
D.	Dyslipidemia
E.	Hypertension
F.	Family History
G.	Cigarette smoking
H.	Sedentary lifestyle
I.	Obesity
J.	Age

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strongest familial predictor of CAD

sibling

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what is the correlation b/w DM and CAD

Small vessel dz

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how does dyslipidemia

increase deposition of LDL into intima space –> reducing endothelial fxn

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what age is a greater predictor of CAD than cigarette smopke

> 70

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MCC of CAD

atherosclerosis

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common underlying physiological process that leads to CAD

endothelial dysfunction of the vessels

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lipid deposition in the wbc leads to smooth muscle proliferation known as

fatty streak

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precipitated angina, caused by exertion and external factors

stable angina

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acute coronary syndromes

ST elevation MI
Non ST elevation MI
Unstable angina
noncardiac chest pain

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any condition brought on by a sudden reduction or blockage of blood flow to the heart - most often caused by plaque rupture or clot formation in the coronary arteries

Acute Coronary Syndrome

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Endothelial dysfunction results in lipid (cholesterol) deposition btwn INTIMA and MEDIA. Dysfunction results from…

"	HTN
"	↑ LDL
"	Smoking
"	DM
"	Stress factors
"	Sedentary lifestyle

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Endothelial dysfunction results in lipid (cholesterol) deposition btwn _____ and ____.

Endothelial dysfunction results in lipid (cholesterol) deposition btwn INTIMA and MEDIA.

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precipitating external factors of stable angina

exercise
eating
anxiety or stress
cold environment

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etiology of unstable angina

1) Atherosclerosis - MCC of MI –> caused by plaque rupture
2) Coronary artery spasm
3) REDUCTION in flow in the coronary artery
* acute coronary syndrome that is defined by the ABSENCE of biochemical evidence of myocardial damage

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pathophysiology of unstable angina

TRANSIENT occlusion

Abrupt ↓ in coronary BF w/o ↑ in myocardial O2 demand.

Results from coronary thrombus 2˚ atherosclerosis

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New onset chest pain w/i 2 wks is a classic manifestation of

stable angina

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long term DOC for prevention of the progression of stable angina

Long term tx

DOC: Aspirin

reduces incidence of stroke and MI

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classic outpatient regimen of stable chronic angina

aspirin, sublingual nitroglycerin as needed, and daily beta blocker and stain

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cardioselective B1 beta blockers

metoprolol

atenolol

nonselective beta blockers

propranalol

nadolol

these three drugs have been show to reduce the risk of adverse cardiovascular events

Statins, ezetimibe, and PCSK9 inhibitors have been shown to reduce the risk of adverse cardiovascular events.

for pts with established atherosclerotic CVD what is the go to platelet tx

For patients with established and stable atherosclerotic CVD, we recommend long-term aspirin therapy. Long-term antiplatelet therapy with aspirin reduces the risk of subsequent myocardial infarction (MI), stroke, and cardiovascular death among patients with a wide range of manifestations of occlusive CVD.

for pts that can’t take aspirin b/c of risk of GIB what is the go to for anti platelet tx of CVD

ADP inhibitors: Clopidogrel (Plavix) for 1yr íASA allergies

if you have chest pain for more than 30 minutes what diagnostic marker would you expect to see

traponin diagnostic tests to evaluate: " ECG: ST depression &/or T wave inversion " Neg cardiac enzymes

_____ are effective at reducing the severity and frequency of anginal attacks in patients with stable ischemic heart disease and should be used for this purpose.

Beta blockers are effective at reducing the severity and frequency of anginal attacks in patients with stable ischemic heart disease and should be used for this purpose.

80% of pts benefit from this form of CVD tx that can be indicated for lowering bp or tx of acute myocardial infarction, hf, or EF <40

About 80 percent of patients with established cardiovascular disease will benefit from angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARBs) therapy. The most common indications range from attainment of goal blood pressure to the treatment of acute myocardial infarction, heart failure or left ventricular ejection fraction below 40 percent, diabetes, and proteinuric kidney disease.

Certain focal areas under the___ become sites of LIPID POOLS

intima full of fatty material that become covered in fibrous caps

Body wants to "clean up" lipid pools ---> WBC leave circulation, the dissolve the fibrous cap via enzymes which can have what complication...

Body wants to "clean up" lipid pools --> WBC leave circulation & enter pool "eating" the lipids can lead to rupture

following the rupture of fibrous caps what occurs

exposes the thrombogenic lipid pool to the circulation triggering clotting factors Circulating platelets aggregate & a platelet thrombus is formed - aka white thrombus

difference between white thrombus and red thrombus

first Circulating platelets aggregate & a platelet thrombus is formed --> white thrombus Fibrin thrombus then forms trapping RBC in the large fibrin clot (red thrombus) & partially or totally occludes the coronary artery

acute tx of unstable angina

Acute tx " Stress test " Cardiac cath: angio if indicated

long term tx of unstable angina

Long term tx " DOC: Aspirin " ADP inhibitors: Clopidogrel (Plavix) for 1yr -->ASA allergies " Adj tx: B-blockers, NTG, CCB " Lifestyle changes (↓ wt, daily exercise) " HTN, lipid control (consider Statins) " Low MW heparin " Unfractionated heparin: given w/ ACS, EKG changes, + cardiac marker

STEMI and non STEMI what distinguishes them from people with MI

troponin

how to dx MI

MI dx: 1) Chest pain 2) Troponin * Do serial troponin Positive cardiac enzymes: " CK/CK-MB: appears 4-6 hr, peaks 12-24 hr and returns to baseline 3-4 d " Troponin I&T: appears 4-8hr, peaks 12-24 hr, returns to baseline 7-10day " MOST SENSITIVE & SPECIFIC ECG: " STdepression, +/- T wave inversion = can be normal looking

what is the immediate tx goal of NSTEMI

" Urgent angioplasty 1-3d after admisssion

what is the immediate tx goal of a STEMI

the goal is a door to balloon time (angioplasty) of less than an hour and half Reperfusion! Percutaneous coronary intervention - best w/i 3 hrs of sx onset May need CABG if 3 vessel dz TPA

anti-throm tx and adj tx following STEMI

Anti-throm tx: ASA, heparin, GP IIB/IIIA inhibitor Adj tx: Bblockers, ACE-I, NTG, Morphine, Statin

ASA dose that prolongs like for individuals with ACS

75-100MG decreases GIB without decreasing thrombotic risk

PTCA what is it and when is it indicated

percutaneous transluminal coronary angioplasty indicated with 1 or 2 vessel dz not involving LAD in whom ventricular function is near normal restoneosis can be reduced with stents

calcium scores, CAC (coronary artery calcium)

seen in almost everyone over 65 so really only indicated in pts under 50

pain under the left axilla

is virtually never cardiac pain

pain under the left breast that doesn't start at the sternum is _____ to be cardiac

unlikely

diagnostic gold for stable angina

coronary angiogram

medical tx for stable angina

BB statin ASA nitro for acute sublingual NTG PRN

tx for unstable angina

agioplasty if indicated anti-platlets : ASA anticoagulants: heparin maybe CCB of BB

NSTEMI tx

angiplasty 1-3 days after admission

STEMI

emergency angio