Coronary Artery Disease & Acute Coronary Syndromes
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Questions and Answers

What are the two major disease processes classified under Coronary Artery Disease (CAD)?

  • Myocardial infarction and stroke
  • Hypertension and dyslipidemia
  • Peripheral artery disease and deep vein thrombosis
  • Chronic stable angina and acute coronary syndromes (correct)

    • The incidence of Coronary Artery Disease (CAD) is increasing in the United States.

    False (B)

    What is the most common type of angina, characterized by predictable pain that occurs with exertion and subsides with rest?

    Stable angina

    A heart attack, also known as ______, is a serious condition where blood flow to the heart muscle is blocked, causing damage or death to the tissue.

    <p>myocardial infarction</p> Signup and view all the answers

    Match the following terms with their corresponding definitions:

    <p>Coronary Artery Disease (CAD) = Disease of the coronary arteries Acute Coronary Syndromes = A group of conditions including unstable angina, new-onset angina, and myocardial infarction Stable Angina = Chest pain that occurs predictably with exertion and subsides with rest Unstable Angina = Chest pain that is new or worsening, occurring at rest or with minimal exertion</p> Signup and view all the answers

    Which of the following are indicators of ST-Elevation Myocardial Infarction (STEMI)?

    <p>ST segment elevation on EKG (A), Chest pain unrelieved by rest (C)</p> Signup and view all the answers

    Unstable angina is characterized by chest pain that can occur at rest.

    <p>True (A)</p> Signup and view all the answers

    What is the primary difference between STEMI and NSTEMI?

    <p>STEMI is associated with ST segment elevation and significant troponin elevation, while NSTEMI shows ST segment depression and initially normal troponin levels.</p> Signup and view all the answers

    The primary treatment used within 6-12 hours after onset of a STEMI is __________.

    <p>thrombolytics</p> Signup and view all the answers

    Match the myocardial infarction types with their characteristics:

    <p>ST-Elevation MI = Causes significant ST segment elevation Non-ST Elevation MI = May initially show normal troponin levels Unstable Angina = Can cause severe limitations of activity Stable Angina = Chest pain with predictable pattern</p> Signup and view all the answers

    What is a common manifestation of myocardial infarction?

    <p>Chest pain radiating to the left arm (C)</p> Signup and view all the answers

    Troponin T levels above 0.1 ng/mL indicate normal heart function.

    <p>False (B)</p> Signup and view all the answers

    What are the emergency interventions known as 'MONA'?

    <p>Morphine, Oxygen, Nitroglycerin, Aspirin</p> Signup and view all the answers

    Patients undergoing cardiac catheterization should have their __________ monitored for complications.

    <p>vital signs</p> Signup and view all the answers

    Match the coronary intervention with its purpose:

    <p>Percutaneous Coronary Intervention (PCI) = To open blocked coronary arteries Coronary Artery Bypass Graft (CABG) = Surgical intervention to improve blood flow Thrombolytics = To dissolve blood clots Heart Catheterization = To diagnose and assess coronary artery disease</p> Signup and view all the answers

    Which of the following is NOT an indication for heart catheterization?

    <p>Stable angina responsive to medication (B)</p> Signup and view all the answers

    Reocclusion or restenosis of the artery can occur after a cardiac catheterization.

    <p>True (A)</p> Signup and view all the answers

    What role do ACE inhibitors play in the treatment of myocardial infarction?

    <p>They help lower blood pressure and decrease strain on the heart.</p> Signup and view all the answers

    The use of __________ is critical within 4-6 hours of symptom onset in STEMI to reduce heart damage.

    <p>medical intervention</p> Signup and view all the answers

    Flashcards

    Coronary Artery Disease (CAD)

    A disease affecting the coronary arteries, leading to reduced blood flow to the heart.

    Acute Coronary Syndromes (ACS)

    A spectrum of conditions associated with sudden reduced blood flow to the heart, including unstable angina and myocardial infarction.

    Chronic Stable Angina

    Chest pain or discomfort that occurs with exertion and is relieved by rest.

    Unstable Angina

    A type of chest pain that occurs unexpectedly and may signal a heart attack is near.

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    Myocardial Infarction (MI)

    Commonly known as a heart attack, it occurs when blood flow to the heart is blocked.

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    Atherosclerosis

    A buildup of plaque in the coronary arteries, reducing blood flow.

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    Angina

    Chest pain caused by decreased blood flow to heart muscle.

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    STEMI

    A type of MI associated with ST segment elevation on an EKG, considered a medical emergency.

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    NSTEMI

    Non-ST elevation myocardial infarction, differs on EKG from STEMI but still indicates heart damage.

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    Troponin Levels

    Cardiac enzymes that indicate heart muscle damage; normal levels are Troponin T < 0.1 ng/mL.

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    Heart Catheterization

    A procedure to diagnose or treat coronary artery disease by observing blood flow.

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    MONA Protocol

    Emergency treatment steps for chest pain: Morphine, Oxygen, Nitrates, Aspirin.

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    Thrombolytics

    Medications known as 'clot busters' used during STEMI to dissolve blood clots.

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    Symptoms of MI

    Common manifestations include severe chest pain, radiating pain, nausea, and dyspnea.

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    Coronary Artery Bypass Graft (CABG)

    A surgical procedure that improves blood flow to the heart by bypassing blocked arteries.

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    Cardiac Enzymes

    Proteins released into the blood when the heart is damaged; key for diagnosing MI.

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    Emergency Interventions

    Measures taken to address acute heart issues, including monitoring and medication.

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    Study Notes

    Coronary Artery Disease & Acute Coronary Syndromes

    • Coronary Artery Disease (CAD) is a disease of the coronary arteries, classified as chronic stable angina, acute coronary syndromes (unstable angina, new-onset angina, vasospastic angina, myocardial infarction), and the leading cause of death in men and women in the US.
    • Incidence is declining due to improved identification and treatment of hypertension and dyslipidemia, enhanced education on early signs of MI, and better management of metabolic diseases (e.g., diabetes).
    • Almost half of non-Hispanic, black adults have some form of CAD/CVD. Metabolic syndrome is a contributing factor.
    • CAD involves atherosclerosis in coronary arteries, with plaque buildup decreasing blood flow to heart muscle (angina) or rupturing and blocking arteries (ischemia, infarction).
    • Acute Coronary Syndromes (ACS) include unstable angina, new-onset angina, vasospastic angina, and myocardial infarction (MI).

    Acute Coronary Syndromes—Unstable Angina

    • Unstable angina results in chest pain during rest or exertion which severely limits activity, increasing in frequency, intensity, and duration (> 15 minutes). Pain may be poorly relieved by nitroglycerin or rest.

    Acute Coronary Syndromes—Myocardial Infarction (MI)

    • MI, the most severe ACS, occurs when myocardial tissue is severely deprived of oxygen, resulting in ischemia, leading to tissue injury and necrosis.
    • Two types of MI:
      • ST-Elevation Myocardial Infarction (STEMI): A medical emergency characterized by ST segment elevation on a 12-lead ECG (in two areas), elevated troponins (infarct), and requiring intervention within 4-6 hours (TIME=MUSCLE). Plaque rupture, platelet aggregation, thrombus formation are the causes.
      • Non-ST Elevation Myocardial Infarction (NSTEMI): Characterized by ST segment depression and/or T-wave inversion on a 12-lead ECG (2 areas), with initially normal but later elevated troponins. Causes include coronary vasospasm, spontaneous coronary artery dissection, and sluggish blood flow.

    Manifestations of MI

    • Chest pain: Sudden, severe, crushing pressure mid-sternal or sub-sternal (described as an "elephant sitting on my chest"). Pain may radiate to the back, jaw, left or right arm.
    • Symptoms may also include dyspnea, indigestion, nausea/vomiting, diaphoresis, and denial.

    Cardiac Diagnostics

    • Labs: Coagulation studies (PT/INR, aPTT/PTT), cardiac enzymes (troponin T or I). Normal troponin T levels < 0.1ng/mL; troponin I normal.
    • Cardiac diagnostics: 12-lead EKG, chest x-ray, and CBC, Coagulation studies, BMP (renal function). Multiple IV sites should be readily available for administering fluids, medications, and anesthesia.
    • Cardiac catheterization to determine location and extent of CAD: Left or right sided approach are possible.
    • Percutaneous Coronary Intervention (PCI)/Percutaneous Transluminal Coronary Angioplasty (PTCA): Used to diagnose and treat coronary artery obstructions.

    Emergency Interventions

    • "MONA" protocol (Monitoring of 12-lead EKG and telemetry, Oxygen, Nitrates, Morphine)
    • Immediate transport for emergency cardiac catheterization or surgery if nitrates are not relieving.

    Pharmacology for MI

    • Oxygen
    • Nitrates
    • Morphine (emergent)
    • Beta-blockers
    • ACE inhibitors
    • Antiplatelets
    • Anticoagulants (for PCI)
    • Thrombolytic agents (for STEMI): Tissue plasminogen activator (tPA), reteplase, tenecteplase. (Must be given within 6-12 hours of STEMI)
    • Cholesterol-lowering agents

    Post-Catheterization Complications & Care

    • Complications: Hematoma, retroperitoneal bleed, loss of pulse, pseudoaneurysm, allergic reactions, arrhythmias, reocclusion/restenosis.
    • Care: Bedrest 2-6 hours, supine position, protect groin site, monitor vitals frequently (q15 min to q4), assess pulses and skin, monitor urine output.

    AMI Core Measures (Joint Commission)

    • Aspirin at arrival or within 24 hours, with continued use at discharge.
    • Beta-blockers within 24 hours and at discharge unless contraindicated.
    • STEMI/new LBBB patients—PCI within 90 minutes (goal is 60 minutes), fibrinolytics within 30 minutes if PCI is not possible.
    • LDL measured, cholesterol-lowering prescribed for LDL > 100.
    • Left ventricular (LV) function assessed, ACE inhibitor prescribed for patients with reduced ejection fraction after MI.

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    Description

    This quiz focuses on Coronary Artery Disease (CAD) and Acute Coronary Syndromes (ACS), exploring their definitions, risk factors, and the impact on public health. Learn about the various forms of CAD and the significance of early detection and management strategies to reduce mortality rates.

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