Exam 4: Coronary Artery Disease
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| Arteriosclerosis | Thickening (hardening) and loss of elasticity in the arteries.
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| Atherosclerosis | The deposit of fatty substances in the arteries and fibrosis of the inner layer of the arteries
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| Atherosclerosis Deposits | Plaque comprised of cholesterol, lipids or cellular debris which narrows the lumen of the arteries and reduces blood volume to the area.
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| Etiology of Atherosclerosis | Over PROLONGED period of time, a LIFELONG process, severity of disease measured by degree of obstruction & # of vessels involved.
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| CAD Development | When there is at least a 75-80% obstruction in coronary blood flow to the myocardium.
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| Manifestations of CAD | When blood supply can no longer meet the demands of the myocardium.
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| Types of risk factors with CAD | 1. Non-modifiable
2. Modifiable
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| Non-modifiable risk factors of CAD | Family Hx, Age, Gender (men greater risk, women after menopause), Ethnicity (higher in white men)
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| Modifiable risk factors of CAD | Smoking (Vasoconstriction), Hyperlipidemia, Hypertension, Physical Activity, Stress, Obesity, Diabetes
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| Best predictor for development of CAD | Ratio of High-density lipids (HDL) to low-density lipoproteins
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| Lipids are comprised of... | VLDL (Very low-density lipoproteins), LDLL (Low-density lipoprotein), HDL (High Density Lipoprotein
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| high | ________ Serum cholesterol increases the chance of developing CAD
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| Decreased | Exercise, low fat, and low cholesterol diets ______ the chance of CAD.
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| Angina Pectoris | PAROXYSMAL, SPASMODIC thoracic pain & choking feeling caused by decreased oxygen or anoxia of the myocardium.
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| Angina Pectoris | Symptoms of transient myocardial ischemia PERCEIVED BY THE PATIENT as chest pain or discomfort. This ischemia DOES NOT lead to cellular necrosis.
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| Demand and supply | Any factor that causes an imbalance between the ______ and ______ of blood flow to the myocardium can cause anginal pain.
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| Factors that INCREASE cardiac workload | HTN, Stress, Temperature Extremes, Exercise, Smoking, Atherosclerosis
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| 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
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| 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.
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| Retrosternal | behind the sternum
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| Substernal | below the sternal
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| Precordial | around the heart or epigastric area
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| Cardiac Enzymes | Dx Test: Rule out MI
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| EKG | DX Test: Transient Ischemic Changes
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| Exercise Stress Test | Dx Test: Reproduce anginal episode & EKG ischemic changes
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| Cardiac Catheterization | Dx Test: To visualize coronary arteries for atherosclerosis
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| Reduce Cardiac Ischemia | Goal of management for Angina Pectoris is to control symptoms by
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| Vasodilators Beta-blockers Calcium Channel Blockers | 3 Major Types of Medications for the treatment of angina pectoris
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| Vasodilators | VASODILATES the coronary arteries so a greater amount of blood and oxygen can go to the myocardium. Example: Nitroglycerin (NTG)
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| Systemic Vasodilation | Reduction of blood pressure, which reduces the amount of venous rerun, which therefore reduces the cardiac workload.
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| Vasodilator PRN | 1 tablet, sublingual, every 5 minutes for 15 minutes (no more than 3)
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| Beta-Blocking Agents | Reduces the oxygen requirements of the myocardium by SLOWING THE HEART RATE . (Examples: Inderal, Lopressor)
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| Beta-Blocking Agents | Blocks the effect of Epinephrine on the vascular system. (Examples: Inderal, Lopressor)
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| Calcium Channel Blockers | DECREASES cell excitability and myocardial contractility by blocking calcium exchange across the cell membrane. (Example: Cardizem)
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| Calcium | Responsible for the MOTOR UNIT CONTRACTION
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| Supplemental Oxygen | Should be used for patients with unstable angina
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| Aspirin | ALL patients suspected of having unstable angina should be started on _______ therapy unless contraindicated.
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| Antianginal Agents | Treat and prevent attacks of angina
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| Beta Blockers & Calcium Channel Blockers | Prophylactic Management of Angina Pectoris
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| Anti-anginal Agents Contraindications | Hypersensitivity, avoid use of Beta Blockers or Calcium Channel blockers in: Advanced Heart Block, Cardiogenic Shock, Untreated CHF
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| Anti-Anginal Agents Side Effects | Dizziness, headache, hypotension, tachycardia, syncope, nausea, vomiting...
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| Fatal Hypotension | Concurrent us of sildenafil, tadalafil, or vardenafil may result in significant and potentially...
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