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M6 13-005

Exam 4: Coronary Artery Disease

Arteriosclerosis Thickening (hardening) and loss of elasticity in the arteries.
Atherosclerosis The deposit of fatty substances in the arteries and fibrosis of the inner layer of the arteries
Atherosclerosis Deposits Plaque comprised of cholesterol, lipids or cellular debris which narrows the lumen of the arteries and reduces blood volume to the area.
Etiology of Atherosclerosis Over PROLONGED period of time, a LIFELONG process, severity of disease measured by degree of obstruction & # of vessels involved.
CAD Development When there is at least a 75-80% obstruction in coronary blood flow to the myocardium.
Manifestations of CAD When blood supply can no longer meet the demands of the myocardium.
Types of risk factors with CAD 1. Non-modifiable 2. Modifiable
Non-modifiable risk factors of CAD Family Hx, Age, Gender (men greater risk, women after menopause), Ethnicity (higher in white men)
Modifiable risk factors of CAD Smoking (Vasoconstriction), Hyperlipidemia, Hypertension, Physical Activity, Stress, Obesity, Diabetes
Best predictor for development of CAD Ratio of High-density lipids (HDL) to low-density lipoproteins
Lipids are comprised of... VLDL (Very low-density lipoproteins), LDLL (Low-density lipoprotein), HDL (High Density Lipoprotein
high ________ Serum cholesterol increases the chance of developing CAD
Decreased Exercise, low fat, and low cholesterol diets ______ the chance of CAD.
Angina Pectoris PAROXYSMAL, SPASMODIC thoracic pain & choking feeling caused by decreased oxygen or anoxia of the myocardium.
Angina Pectoris Symptoms of transient myocardial ischemia PERCEIVED BY THE PATIENT as chest pain or discomfort. This ischemia DOES NOT lead to cellular necrosis.
Demand and supply Any factor that causes an imbalance between the ______ and ______ of blood flow to the myocardium can cause anginal pain.
Factors that INCREASE cardiac workload HTN, Stress, Temperature Extremes, Exercise, Smoking, Atherosclerosis
Unstable Angina UNPREDICTABLE & TRANSIENT episode of sever and prolonged discomfort that AT REST has never been experienced before or is considerably WORSE than the previous episode
Pain: Characteristics of Angina Pectoris HEAVINESS or TIGHTNESS (may be confused with INDIGESTION), usually lasts 3-5 minutes. May radiate to the LEFT shoulder and arm.
Retrosternal behind the sternum
Substernal below the sternal
Precordial around the heart or epigastric area
Cardiac Enzymes Dx Test: Rule out MI
EKG DX Test: Transient Ischemic Changes
Exercise Stress Test Dx Test: Reproduce anginal episode & EKG ischemic changes
Cardiac Catheterization Dx Test: To visualize coronary arteries for atherosclerosis
Reduce Cardiac Ischemia Goal of management for Angina Pectoris is to control symptoms by
Vasodilators Beta-blockers Calcium Channel Blockers 3 Major Types of Medications for the treatment of angina pectoris
Vasodilators VASODILATES the coronary arteries so a greater amount of blood and oxygen can go to the myocardium. Example: Nitroglycerin (NTG)
Systemic Vasodilation Reduction of blood pressure, which reduces the amount of venous rerun, which therefore reduces the cardiac workload.
Vasodilator PRN 1 tablet, sublingual, every 5 minutes for 15 minutes (no more than 3)
Beta-Blocking Agents Reduces the oxygen requirements of the myocardium by SLOWING THE HEART RATE . (Examples: Inderal, Lopressor)
Beta-Blocking Agents Blocks the effect of Epinephrine on the vascular system. (Examples: Inderal, Lopressor)
Calcium Channel Blockers DECREASES cell excitability and myocardial contractility by blocking calcium exchange across the cell membrane. (Example: Cardizem)
Calcium Responsible for the MOTOR UNIT CONTRACTION
Supplemental Oxygen Should be used for patients with unstable angina
Aspirin ALL patients suspected of having unstable angina should be started on _______ therapy unless contraindicated.
Antianginal Agents Treat and prevent attacks of angina
Beta Blockers & Calcium Channel Blockers Prophylactic Management of Angina Pectoris
Anti-anginal Agents Contraindications Hypersensitivity, avoid use of Beta Blockers or Calcium Channel blockers in: Advanced Heart Block, Cardiogenic Shock, Untreated CHF
Anti-Anginal Agents Side Effects Dizziness, headache, hypotension, tachycardia, syncope, nausea, vomiting...
Fatal Hypotension Concurrent us of sildenafil, tadalafil, or vardenafil may result in significant and potentially...
Created by: jtzuetrong