Module Four: CAD

Question 1

What is CAD?

Answer 1

Coronary Artery Disease

Question 2

What is North America’s leading cause of death?

Answer 2

Coronary Artery Disease

Question 3

What is ASHD?

Answer 3

Atherosclerotic Heart Disease

Question 4

In what ways does ASHD affect the heart?

Answer 4

1. Narrows the lumen of the vessel. Reducing blood flow to the area supplied by the artery. 2. Reduces elasticity, making it less resilient in the face of volume or pressure changes. Increasing the risk of vasospasm. 3. Increases risk of plaque rupture & subsequent clot formation with further occlusion & potential embolization. 4. Increases risk of vasospasm.

Question 5

What are the modifiable Atherosclerosis risk-factors?

Answer 5

Smoking, Stress, Obesity, Sedentary Lifestyle, Alcohol. Medically Modifiable: HTN, Hyperlipidema, Diabetes Mellitus.

Question 6

What are the Non-modifiable Atherosclerosis risk-factors?

Answer 6

Heredity, Age, Sex, Race.

Question 7

What is a QRS complex?

Answer 7

The QRS complex is the depolaration of ventricular muscle cells

Question 8

What are examples of increased workload on the heart in the face of a fixed supply of oxygen?

Answer 8

1. Hypertension 2. Aortic Stenosis 3. Increased metabolic demand

Question 9

What are examples and reasons for reduced blood supply to the heart?

Answer 9

1. Artherosclerosis. 2. Coronary Artery Vasospasm 3. Thrombus/Embolus

Question 10

What are some examples of reduced oxygen carrying capacity of the coronary arteries?

Answer 10

1. Anemia. 2. Hemodilution 3. Acute Blood Loss

Question 11

What are the two most important steps to take when dealing with a situation of too much oxygen demand and not enough supply?

Answer 11

Reduce the O2 demand, and increase the 02 supply.

Question 12

What are effective ways to reduce the hearts oxygen demand?

Answer 12

Rest, Oxygen, Nitrates, Morphine. Beta Blockers. Ca Channel Blockers. ACE Inhibitors/ARB.

Question 13

What are effective ways to increase the oxygen supply to the heart?

Answer 13

Aspirin 160 - 325 mg chewed. Fibrinolytics. Coronary Artery Bypass. Heparins, Antiplatelets, Statins.

Question 14

What is the best way to manage ischemia?

Answer 14

MONA. Morphine, Oxygen, Nitrates, Activity/Aspirin. Not necessarily in this order.

Question 15

What do Nitrates do?

Answer 15

Relax vascular smooth muscle in arteries (including coronary arteries) but particularly veins. Reduction of preload and consequently reducing cardiac workload.

Question 16

What is the worst thing that can happen if someone takes Nitrates?

Answer 16

Vessels dilate too much and blood pools in periphery, reducing CO.

Question 17

What is an example of Nitrates?

Answer 17

Nitroglycerine. Available as sublingual tabs, nasal spray, transdermal patches, and IV.

Question 18

Check out this picture of the MOA of Angina drugs!

Answer 18

Question 19

What is the use of Morphine during a MI?

Answer 19

Morphine is an opiod narcotic analgesic. It reduces the SNS activity. Relaxation of vascular smooth muscle, particularly veins, reducing preload. Consequently, it reduces cardiac workload.

Question 20

What is the worst that can happen for someone taking Morphine for a MI?

Answer 20

The vessels could dilate too much and blood pools in the periphery, reducing the Cardiac Output. Respiratory depression can lead to arrest. Naloxone is the antidote for Morphine.

Question 21

What are Beta Blockers? What do they do?

Answer 21

Beta Blockers assist in the reduction of cardiac output (stoke volume) be blocking the beta receptors in the heart. The drugs typically end in the suffix -olol.

Question 22

What is the worst thing that can happen to someone on Beta Blockers?

Answer 22

Bradycardia, Inadequate Cardia Output, Bronchospasm.

Question 23

What are Calcium Channel Blockers? What do they Do?

Answer 23

Calcium channel blockers cause the relaxation of vessel walls through the blocking of calcium ion channels. The reduce the heart’s afterload and consequently the cardiac workload.

Question 24

What is the worst thing that can happen if someone take Calcium Channel Blockers?

Answer 24

Bradycardia (Heartblock) from too many calcium channels being blocked. Inadequate cardiac output. Heart failure.

Question 25

What is something a patient on Calcium Channel Blockers should not consume?

Answer 25

Grape fruit juice. It increases the effect of Calcium channel blockers.

Question 26

What are a few common Calcium Channel Blockers?

Answer 26

Diltiazem, Verapamil, Norvasc, Renidil.

Question 27

What do ACE Inhibitors do?

Answer 27

ACE Inhibitors block the conversion of angiotensin I to angiotension II. They reduce the afterload and consequently the cardiac workload.

Question 28

What is the worst thing that can happen from taking ACE Inhibitors?

Answer 28

ACE inhibitors can lead to inadequate cardiac output. They can also lead to a cough (angioedema) from action on vasodilator bradykinins.

Question 29

What is a common suffix for ACE Inhibitors? What are some examples?

Answer 29

-pril

Question 30

What does Asprin do?

Answer 30

Asprin is an anti-inflammatory, anti-platelet. It reduced mortality by up to 23%.

Question 31

What is the worse thing that can happen when taking aspirin?

Answer 31

You may have an allergic reaction.

Question 32

When would you want to receive a fibinolytic?

Answer 32

For STEMI MI, if it is within 12 hours of first symptom AND PCI is not available within 90 minutes of first medical contact.

Question 33

What is the percentage of reduced mortality if a fibrinolytic is delivered within 1st hour of onset?

Answer 33

47 - 75% reduction.

Question 34

What does a fibrinolytic do?

Answer 34

It dissolves all the bodies fresh fibrin clots. It is essential that the diagnosis has to be correct.

Question 35

What are percutaneous coronary interventions?

Answer 35

Stents.

Question 36

What is the purpose of Heparin?

Answer 36

Herparin lengthens clotting time, prevents thrombus formation/growth, and inhibits certain clotting factors. IV onset is immediate. SC may take up to 1 hour. Half life of Heparin is 1.5 hours.

Question 37

LMWH?

Answer 37

Low Molecular Weight Heparin Work similar to Heparin but less likely to cause thrombocytopenia. Duration is 2-4 times longer, and produces a more stable response than heparin. Less follow up lab work is needed.

Question 38

What do antiplatelets do?

Answer 38

Reduce platelet aggregation.

Question 39

During cardia maintenance, what types of lipids would you be testing for?

Answer 39

There are 3 types of lipids: Triglycerides, Phospholipids, and Steroids (Cholesterol). There are 2 types of Cholesterol: HDL (good, broken down in bile and excreted in feces), LDL (bad, contributes to plaque deposits and CAD.

Question 40

What are statins? What do they do?

Answer 40

Statins, or HMG Coenzyme A Reductase Inhibitors. Statins inhibit cholesterol production. They reduce LDL by 20-40% and raise HDL levels. They also lower triglycerides.

Question 41

What is the worst that can happen if someone takes Statins?

Answer 41

Liver dysfunction can occur. Liver function tests need to be done prior/3 months post. Muscle pain, tenderness, weakness. Monitor creatinine phosphokinase. Heartburn, Abdominal cramping and diarrhea - give CC in evening.

Question 42

What is a common example of a statin?

Answer 42

Atorvastatin (Lipitor).

Question 43

What are the common diagnositic tests to determine if your patient has ACS?

Answer 43

CK, CK-MB, Myoglobin (estimates damage from skeletal muscle injury or MI - not cariac specific), Troponin I and T (enzyme markers, detected 2-6 hrs after MR, peaks 15-24 hrs, returns to normal within 7 days).