CAD & angina Flashcards
(51 cards)
What is Coronary Artery Disease (CAD)?
Insufficient perfusion of the coronary arteries due to decreased supply or increased demand.
What are the mechanical causes of decreased supply in CAD?
Atheroma, thrombosis, spasm, embolus, arteritis.
What are the causes of decreased blood flow in CAD?
Anemia, carboxy Hb, hypotension.
What is the most common cause of Coronary Artery Disease?
Obstruction (coronary atherosclerosis).
What triggers atherogenesis in CAD?
Initial endothelial injury/dysfunction due to mechanical shear stress, biochemical factors, immunological factors, inflammation, and genetic alteration.
What is the role of oxidized lipoproteins in CAD?
Increased permeability of endothelium to oxidized lipoproteins leads to accumulation taken up by macrophages, forming lipid-laden foam cells.
What are the components of a plaque in CAD?
Lipid core and fibrous cap.
What may a thrombus in CAD be adherent to?
Plaque due to superficial endothelial injury, endothelial denudation, or platelet adhesion.
What classification types fall under Acute Coronary Syndrome?
Unstable angina, Non-ST-elevation MI, ST-elevation MI.
What is a hemodynamically significant stenosis?
4 luminal cross-sectional area of ~ 70%.
What are some risk factors for CAD?
- Age (above 45 in men and above 55 in women)
- Male gender
- Family history of premature CAD
- Diabetes mellitus
- Hyperlipidemia
- Hypertension
- Smoking
- Obesity
- Sedentary lifestyle
- Hypercoagulability
- Homocysteinemia
- Certain drugs
- Heavy alcohol consumption
- Cocaine use.
Fill in the blank: A family history of premature CAD is defined as a 1st degree FH in male under ______ or female under ______.
55 years; 65 years.
True or False: Hyperlipidemia, especially T LDL, is a risk factor for CAD.
True.
How much does intermittent claudication increase the risk of CAD?
2-4 times.
How much does a myocardial infarction (MI) increase the risk of cerebrovascular accident (CVA) and heart failure (HF)?
3-6 times.
What cytokines are released by monocytes, macrophages, and damaged endothelium in CAD?
- PDGF
- TGF-B.
What is the significance of the fibrous cap in a plaque?
It is composed of smooth muscle and collagen, providing structural stability to the plaque.
What is the role of smooth muscle cells in plaque formation?
They migrate and proliferate, producing collagen that contributes to plaque formation.
What is angina?
Central/substernal heavy/tight/gripping chest pain that may radiate to jaw/arms caused by myocardial ischemia due to imbalance between blood supply and oxygen demand.
Angina can be categorized into stable and unstable types based on symptoms and triggers.
What characterizes stable angina?
Chest pain on exertion/emotion/stress, tight squeezing chest pain lasting 5-15 minutes, gradual onset, no pain at rest, occurs when oxygen demand exceeds perfusion, constant effort/duration, relieved by rest or GTN within minutes.
GTN refers to glyceryl trinitrate, a medication used to relieve angina.
What defines unstable angina?
Chest pain at rest, crescendo/deterioration in previously stable angina, or angina of recent onset (<24 h), due to reduced resting coronary blood flow, lasting more than 15 minutes, not relieved by rest.
Unstable angina is part of Acute Coronary Syndrome.
What are the components of the workup for angina?
Blood tests, chest x-ray, resting ECG, Holter monitoring, stress test, echocardiography.
Specific blood tests include CBC, coagulation profile, lipid profile, fasting glucose, HbA1c, TFT, RFT, and troponin.
What does a resting ECG typically show in angina?
Usually normal; may show ST depression and T-wave inversion during attack, normal between attacks.
ST depression indicates myocardial ischemia.
What should be done if a patient has unstable angina before a stress test?
Must be stabilized with medical treatment before stress testing due to risk of adverse events.
Stress testing is typically performed one month after the episode.
