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M6 13-005
Exam 4: Coronary Artery Disease
| Term | Definition |
|---|---|
| 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... |
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jtzuetrong
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