Coronary artery disease Flashcards
(37 cards)
What is Coronary Artery Disease (CAD)?
CAD is the narrowing or blockage of coronary arteries due to atherosclerosis, reducing blood supply to the heart muscle.
Minor anatomy of heart
Circulation of blood.
https://youtu.be/YjsBtNN5N1A?si=ESEreJP6VLMgMqaJ
Longer video - https://youtu.be/VWamhZ8vTL4?si=KHGjo9AaLJHtf47d
Forms of manifestation of CAD
Stable CAD
Unstable Angina (acute coronary syndrome)
Myocardial Infarction (MI): ST-elevation MI (STEMI), Non-ST-elevation MI (NSTEMI)
Sudden death
What are the risk factors and causes of coronary artery disease?
Hypercholesterolemia
Hypertension
Diabetes
Physical inactivity
Obesity
Smoking
Diet high and carbs and fat
Sex -Male gender
Family history (genetics)
Poor dental health
Chronic kidney disease
What are the tests and diagnosis for Coronary artery disease?
12-lead ECG
Doctor’s clinical exam
Basic blood tests
Chest X-ray
Clinical stress ECG
Coronary artery CT scan
Coronary angiography
Echocardiography
FINNRISKI risk score calculator
What are the symptoms of coronary artery disease?
Chest pain /pressure (“stone on chest”). Chest pain radiates into left arm, neck
Pain radiating to left arm, neck, jaw, back
Shortness of breath
Nausea, sweating
Indigestion, upper abdominal pain
Symptoms may be atypical in women, elderly, diabetics
What are the treatments for coronary artery disease?
Antithrombotic agents (e.g., ASA, clopidogrel, warfarin)
Statins (for cholesterol)
ACE inhibitors / ARBs (for hypertension)
Nitrates (short GTN spray and long-acting)
Beta-blockers, calcium channel blockers
PCI (coronary angioplasty and stenting) or thrombolysis if PCI is not available.CABG (Coronary artery bypass surgery)
Rehabilitation & lifestyle changes (regular checkups, heart friendly diet)
Prevention of CAD
hypercholesterolemia, level of HDL cholesterol, diabetes management, hypertension management, physical inactivity, obesity and smoking.
What are the traditional risk factors for coronary artery disease?
Diabetes, hypertension, hyperlipidemia, smoking, obesity, inactivity, family history
What are the emerging risk factors for coronary artery disease for women?
Pregnancy complications such as developing gestational diabetes and preeclampsia.
Autoimmune diseases such as rheumatoid arthritis are at higher risk
Stress and depression
Early menopause
Smoking
Acute phase of coronary artery disease, how to recognize it on a chart and through the type of chest and body pain that happens when its present? How is the pain concentrated?
Pain Characteristics:
Pressure-like, squeezing, often central or left-sided
Ischemic pain concentrating on chest (left side) Radiates to left arm, jaw, neck, back, upper abdomen
May mimic indigestion
Accompanied by shortness of breath, sweating, nausea
Page 10 for diagrams
ECG: ST-elevation or depression, T-wave inversion, Look for dynamic changes, esp. in chest leads (V2-V6)
Acute phase of CAD – Chart recognition & chest pain (Pg. 9)
What is the general treatment for patients with cardiac chest pain?
ABCDE approach:
Semi-sitting position, calm the patient
O2 if SpO2 < 95%
ECG (including V4R from right-side and V8 from the back leads)
Labs and A&E (routine labs + TNT/TNI)
Nitrate/Dinit/GTN spray on tongue (if BP ≥ 100 mmHg syst)
Aspirin 250–500 mg unless allergic or using anticoagulants
IV access (2 lines if possible) Ringeristeril/ Normal saline
Morphine or Oxanest for pain
Beta-blockers (e.g., IV metoprolol) to slo down heart rate
Prepare for defibrillation if needed
What are the short-term, high risks factors of coronary artery disease?
Recurrent/prolonged chest pain
Elevated TNT/TNI
ECG: ST depression or bypassing elevation
Arrhythmia
Hemodynamic instability
Diabetes, kidney disease
What are the short-term, low risks factors of coronary artery disease?
No recurring chest pain
Normal Troponin (TNT/TNI) when taken twice; on admission and after 3 hours
No ischemic ECG changes
Interventions of CAD?
Hypertension – Pharmacotherapy, encourage regular BP monitoring, educate on diet, exercise, sleep and stress management.
Diabetes – regular monitoring, education on diet and exercise.
Hyperlipidemia- screening, statin therapy and non-statin options, encourage dietary modifications.
Smoking –routine assessment of smoking status, Education on consequences of smoking, nicotine replacement, pharmacotherapy and behavioral therapy
Obesity – regular BMI assessment, weight management, regular exercise, monitor diet.
Physical activity
What type of care can be given to someone with acute coronary syndrome?
Goals: Ease symptoms, Prevent MI and death
Core treatments: Antithrombotics, Anti-ischemic meds, Statins, Coronary angiography, No thrombolysis for unstable angina
What is MI Myocardial infarction/ Heart attack (sydäninfarkti)?
A heart attack (myocardial infarction or MI) is a serious medical emergency in which the supply of blood to the heart is suddenly blocked, usually by a blood clot. Heart muscle death due to blocked coronary artery.
What are the types of MI elevations?
ST-elevation MI (STEMI)
Non-ST-elevation MI (NSTEMI)
Symptoms of a heart attack
chest pain – a feeling of pressure, heaviness, tightness or squeezing across your chest
pain in other parts of the body – it can feel as if the pain is spreading from your chest to your arms (usually the left arm, but it can affect both arms), jaw, neck, back and tummy
feeling lightheaded or dizzy
sweating
shortness of breath
feeling sick (nausea) or being sick (vomiting)
an overwhelming feeling of anxiety (similar to a panic attack)
coughing or wheezing
Risk factors for MI
Its risk factors are similar with CAD since cad causes it.
What are the causes of MI?
CAD leading cause
Primary: Atheroma plaque rupture + thrombosis formation
Secondary: Anemia, arrhythmia, Takotsubo syndrome
What is the emergency response for someone experiencing MI?
Dial 112
Administer GTN, Aspirin
Monitor vitals
Prepare ECG, IV access, oxygen
Transfer to CCU if needed
