Term
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Definition
| The most common type of cardiovascular disease caused by atherosclerosis |
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Term
| What are the more serious manifestations of CAD? |
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Definition
| Unstable angina and Myocardial Infarction |
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Term
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Definition
| atherosclerosis is characterized by focal deposit of cholesterol and lipids within the intima of the wall of the artery |
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Term
| What plays a central role in the development of atherosclerosis? |
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Definition
| the genesis of plaque formation, inflammation and endothelial injury |
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Term
| What can cause endothelial injury? |
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Definition
| Tobacco use, hyperlipidemia, hypertension, diabetes, hyperhomocysteinemia and infection (herpes) |
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Term
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Definition
| C-reactive protein is a marker of inflammation that is increased with pt. with CAD |
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Term
Chronic elevated CRP level have what effect on the patient?
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Definition
| Can trigger a rupture of the plaques and promote oxidation of LDL, cholesterol leading to uptake of macrophages in the endothelial lining |
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Term
| What are the stages of CAD development? |
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Definition
1) Fatty streak: it is believed that treatment to lower LDL can reverse this stage
2) Fibrous plaque
3)Complicated Lesion |
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Term
What constitutes a "complicated lesion"
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Definition
| as the fibrous plaque grows, continued inflammation can result in plaque instability,ulceration and rupture. The vessel becomes comproimsed causing platelets to accumulate leading to thrombus. Further platelet aggregation and adhesion enlarges the thrombus leading to a "complicated lesion" |
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Term
| The growth and extent of collateral circulation is attributed to what? |
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Definition
1) inherited predispostion to develop new blood vessels
2) the presence of ischemia |
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Term
| What are modifiable risk factors for CAD? |
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Definition
Elevated serum levels-- low HDL and high LDL, cholesterol serum >200
Hypertension
Tobacco use
Physical inactivity
Obesity |
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Term
| How is HTN a modifiable risk factor for CAD? |
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Definition
| The shearing stress that causes endothelial injury, when atherosclerosis is present, there is increased pressure needed to push blood through the narrow lumen. Increased BP can cause injury |
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Term
| How is tobacco a modifiable risk factor? |
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Definition
| Tobacco smoke causes catecholemines to be released, which ^ HR and BP. Also increases platelet adhesion and risk for emboli formation. CO is a byproduct that affects the amount of O2 carried in hemoglobin. Decrease in HMG causes increase cardiac workload |
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Term
| What are the modifiable contributing risk factors? |
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Definition
| Diabetes, Metabolic Syndrome, Stress, Elevated Homocysteine levels |
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Term
| Why does DM cause a increased risk for CAD? |
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Definition
| DM manifests an increased tendency toward connective tissue degeneration and endothelial dysfunction. Diabetics also have alterations in lipid metabolism and tend to have high cholesterol. |
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Term
| What is metabolic syndrome, what are the risk factors for Met. Syn.? |
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Definition
| It refers to a cluster of risk factors for CAD which is though to be related to insulin resistance. Risk factors are; obesity, HTN, ab. serum levels, elevated fasting blood glucose levels |
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Term
How does stress become a modifiable contributing risk factor for CAD?
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Definition
| stress causes SNS and it effects on the heart (through release of catecholemines) work load and myocardial oxygen demand. |
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Term
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Definition
| ^ levels of homocyst. are linked to ^ risk for CAD. Homocyst is a amino acid in dietary protein that contribute athersclerosis by damaging inner lining of vessels and promoting clot build up. |
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Term
| What are some cholesterol lowering therapy, what are their side effects? |
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Definition
"statin" drugs
rare side effects include liver damange, rhabdomyolosis and myopathy. Liver enzymes and creatine levels must be monitored |
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Term
What are some forms of risk management for CAD?
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Definition
physical activity
nutritional therapy (^EPA & DHA)
cholesterol lowering agents
anti platelet therapy |
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Term
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Definition
| When the demand of myocardial oxygen exceeds the ability of the coronary arteries to supply the heart with oxygen, which lead to myocardial ischemia |
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Term
| what is the primary reason for insufficient blood flow and decrease oxygen delivery to the heart? |
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Definition
narrowed lumens due to athersclerosis
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Term
| What causes the angina/chest pain during myocardial ischemia? |
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Definition
| myocardial fibers are irritated by a buildup of lactic acid and transmit a pain message through the cardiac nerves and upper thoracic posterior nerve roots |
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Term
Cardiac cells are viable for how long during ischemic conditons?
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Definition
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Term
What is chronic stable angina?
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Definition
| when chest pain occurs intermittently over a long period of time with the same pattern of onset, duration and intensity of symptoms. |
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Term
What is silent ischemia?
Nocturnal angina?
Angina Decubitus?
Preinzmetals angina? |
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Definition
1) angina that occurs in the absence of symptoms
2)occurs during night, despite if person is sleeping or awake
3) occurs when lying down and resolved when standing
4) occurs at rest, response to a spasm, rare form that is seen in pt. with history of migraine or raynaulds |
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Term
| what are some kinds of drug therapy for angina? |
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Definition
short acting nitrates
long acting nitrates
beta andrenergic blockers
calcium channel blockers
ACE inhibitors
RANOLAZINE |
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Term
| What is the goal for treatment for chronic stable angina? |
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Definition
| aimed at decreasing oxygen demand and or/ increasing oxygen supply |
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Term
| How do short acting nitrates work? |
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Definition
| they dilate peripheral blood vessels, coronary arteries and collateral vessels |
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Term
| When giving nitrates such as nitroglycerin, what are some side effects? |
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Definition
| pt. should be warned about HR increase, pounding headache, dizziness, flushing. Pt. needs to be aware of hypotension when standing |
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Term
| How do Beta Blockers effect the heart? |
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Definition
| decreases myocardial contractility, HR, SVR and BP which reduce the need for oxygen demand |
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Term
| What are the S/E of beta blockers? |
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Definition
| bradycardia, hypotension, wheezing, GI compaints. Pt. may also complain about weight gain, depression and sexual dysfunction |
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Term
| What should you consider when a diabetic pt. is prescribed beta blockers? |
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Definition
| Beta blockers can mimic the symptoms of hypoglycemia |
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Term
| What do calcium channel blockers do? |
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Definition
1)systemic vasodilation with decreased SVR
2) decreased myocardial contractility
3) coronary vasodilation |
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Term
| How do calcium channel blockers work? |
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Definition
| Block movement of calcium into cells |
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Term
What type of class of drugs are:
propranolol
metoprolol
cogard
atenolol |
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Definition
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Term
What type of class of drugs are:
diltiazem
amlodipine
nifedipine |
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Definition
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Term
What class of drugs are:
lisinopril
captopril |
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Definition
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Term
| What is Ranolazine? When is it used? |
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Definition
| It is used to treat chronic angina, based on it anti-anginal and anti-ischemia effects. Ranolazine prolongs QT interval and should only be used as a last result when pt. hasn't responded to any the anti-anginal drugs. |
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Term
| What are the side effects of Ranolazine? |
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Definition
| dizziness, headache, constipation and nausea |
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Term
| What is acute coronary syndrome? |
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Definition
| when ischemia is prolonged and not immediately reversed |
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Term
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Definition
unstable angina
non ST segment elevation in MI
ST segment elevation in MI
association with deterioration of a once stable plaque |
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Term
| If a unstable plaque grows, creates a thrombus that partially occludes, what would you see on an EKG? |
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Definition
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Term
| If the lesion is unstable, and fully occludes, what would you see on the EKG? |
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Definition
|
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Term
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Definition
| when stable angina becomes unstable angina |
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Term
| Whats the difference between unstable and stable angina? |
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Definition
| when angina changes from stable to unstable, it changes its patter, frequency, and it is easily provoked by little to no exertion. |
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Term
| When does myocardial infarction occur? |
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Definition
| it occurs as a result of sustained ischemia causing irreversible myocardial cell death |
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Term
| How long does it take for the entire thickness of the heart to become necrotic? |
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Definition
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Term
| What are the clinical manifestations of an MI? |
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Definition
Pain (severe and immobilizing)
quality of chest pain
SNS activation --> diaphoresis, vasoconstriction of peripheral blood vessels
CV changes
GI changes; nausea & vomiting
Fever due to inflammation causing increased metabolic demand |
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Term
What are the CV manifestations?
Which are specific to LV dysfunction?
Which are specific to RV dysfunction?
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Definition
1) elevation of BP and HR initially (due to SNS, then a drop due to decrease cardiac output)
2)decrease in CO= decrease renal perfusion and decrease urine output
3)crackles in lungs indicating LV dysfuntion
4)JVD, hepatic engorgment and peripheral edema indicating RV dysfunction |
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Term
What are complications of an MI?
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Definition
1) dysrhythmias
2)heart failure
3)cardiogenic shock |
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Term
| What are the symptoms of HF? |
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Definition
| restlessness, mild dyspnea, agitation, slight tachycardia, crackles, JVD, S3 S4 heart sounds |
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Term
| What drug interventions are taken when a patient presents to the ER with a MI? |
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Definition
1) IV Nitro -- increase 1 ml increments by titrating till relief
2) morphine sulfate -- can be given with Nitro when chest pain is not relieved
3) ACE inhibitors, anti dysrhytmias, cholesterol lowering agents and stool softners |
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Term
| What are the criteria for CABG? |
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Definition
failed medical mangment
have left main coronary artery for 3 vessel disease
not a canidate or angioplasty or stent
failed stenting or angioplasty accompanied by chest pain |
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Term
What are the donor sites for CABG
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Definition
RIMA
LIMA
R/L saphenous vein |
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