Coronary Artery Disease and Angina Pectoris
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Questions and Answers

What primarily causes coronary artery disease (CAD)?

  • Impaired blood flow to the myocardium (correct)
  • Low levels of cholesterol
  • Increased myocardial contraction rate
  • Inflammation of the heart muscle

    • Which of the following conditions can precipitate angina pectoris?

  • Stimulant abuse (correct)
  • Pre-existing heart valve disease
  • Caloric restriction
  • High fiber diet

    • What does acute myocardial infarction (AMI) signify?

  • Loss of blood flow leading to heart muscle death (correct)
  • Inflammation of coronary arteries
  • Chronic blood flow restriction to the heart
  • Temporary chest pain due to stress

    • What percentage of AMI-related deaths occur before hospital admission?

    <p>40%</p> Signup and view all the answers

    Which condition does NOT typically contribute to triggering angina?

    <p>Sedentary lifestyle</p> Signup and view all the answers

    Acute coronary syndrome (ACS) primarily results from what?

    <p>Sudden reduction of blood flow through coronary arteries</p> Signup and view all the answers

    Which of the following is a common consequence of untreated acute myocardial infarction?

    <p>Cardiogenic shock</p> Signup and view all the answers

    Approximately how many cases of acute myocardial infarction occur each year in the United States?

    <p>805,000 cases</p> Signup and view all the answers

    What is the most common cause of coronary artery disease (CAD)?

    <p>Buildup of atherosclerotic plaque</p> Signup and view all the answers

    What factors primarily regulate blood flow through the coronary arteries?

    <p>Aortic pressure and metabolic activity</p> Signup and view all the answers

    What role do HDL particles play in relation to atherosclerosis?

    <p>They transport cholesterol back to the liver.</p> Signup and view all the answers

    Which two main arteries supply blood to the heart muscle?

    <p>Left main and right coronary arteries</p> Signup and view all the answers

    What is the effect of atherosclerosis on blood vessels?

    <p>Narrowing or occlusion of the vessel</p> Signup and view all the answers

    Which process is primarily involved in the formation of atherosclerotic plaques?

    <p>Accumulation of lipoproteins and inflammation</p> Signup and view all the answers

    How does collateral circulation function in relation to coronary arteries?

    <p>It creates alternative routes for blood flow.</p> Signup and view all the answers

    What is the primary component of very low-density lipoproteins (VLDLs)?

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

    What initiates the process of atherosclerosis?

    <p>Damaged endothelial cells</p> Signup and view all the answers

    What is a characteristic feature of the early atherosclerotic lesion?

    <p>A yellowish, fatty streak</p> Signup and view all the answers

    What is the role of macrophages in atherosclerosis?

    <p>They attack LDL particles at injury sites.</p> Signup and view all the answers

    What happens to the arterial lumen as atherosclerosis progresses?

    <p>Narrowing occurs due to plaque growth</p> Signup and view all the answers

    What component of plaque is deemed hazardous during the progression of atherosclerosis?

    <p>Cholesterol and cellular debris</p> Signup and view all the answers

    What is the primary consequence of an atheroma that ulcerates or ruptures?

    <p>Thrombosis leading to rapid occlusion</p> Signup and view all the answers

    Which type of angina is characterized by unpredictability and often occurs at rest?

    <p>Unstable angina</p> Signup and view all the answers

    What factor does NOT contribute to myocardial ischemia?

    <p>Increased levels of blood glucose</p> Signup and view all the answers

    Which arteries are more likely to be affected by plaque formation in atherosclerosis?

    <p>Coronary arteries</p> Signup and view all the answers

    What is the primary purpose of treatment for cardiac ischemia injury?

    <p>To ensure timely resumption of myocardial perfusion</p> Signup and view all the answers

    What happens to the cells in response to reduced oxygen availability during myocardial ischemia?

    <p>They switch to anaerobic metabolism</p> Signup and view all the answers

    What role does plaque formation play in the development of aneurysms?

    <p>Weakens arterial walls</p> Signup and view all the answers

    Which type of angina arises unexpectedly and is often related to coronary artery spasm?

    <p>Prinzmetal angina</p> Signup and view all the answers

    What causes temporary and reversible myocardial ischemia as CAD progresses?

    <p>Decreased blood supply to cardiac tissue</p> Signup and view all the answers

    Silent myocardial ischemia is particularly associated with which group of patients?

    <p>Patients with a history of stable angina</p> Signup and view all the answers

    Which of the following is NOT a contributing factor to myocardial workload?

    <p>Blood volume</p> Signup and view all the answers

    When do manifestations of atherosclerosis typically appear?

    <p>When approximately 75% of the arterial lumen is occluded</p> Signup and view all the answers

    Which of the following describes acute coronary syndrome (ACS)?

    <p>A dynamic state of reduced coronary blood flow</p> Signup and view all the answers

    What is true about atherosclerotic plaque lesions?

    <p>Unstable lesions are prone to rupture</p> Signup and view all the answers

    What is the primary consequence of plaque rupture in unstable angina?

    <p>Platelet aggregation and thrombus formation</p> Signup and view all the answers

    Which layer of the heart is first affected during an acute myocardial infarction?

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

    What triggers plaque rupture in acute coronary syndrome (ACS)?

    <p>Hemodynamic factors such as increased heart rate and blood pressure</p> Signup and view all the answers

    What happens to myocardial cells if ischemia persists for more than 20 to 45 minutes?

    <p>Irreversible hypoxic damage and cell death</p> Signup and view all the answers

    What is a significant complication associated with a transmural myocardial infarction?

    <p>Heart failure post-event</p> Signup and view all the answers

    Which electrolyte imbalance is most likely to occur due to cellular ischemia?

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

    What major physiological change occurs in myocardial cells as a result of infarction?

    <p>Shift to anaerobic metabolism</p> Signup and view all the answers

    Which ECG change may indicate ischemia due to myocardial infarction?

    <p>Inverted T waves</p> Signup and view all the answers

    How does collateral circulation affect myocardial ischemic damage?

    <p>It decreases the extent of ischemic damage</p> Signup and view all the answers

    What type of myocardial infarction is categorized as subendocardial?

    <p>Non-Q-wave infarction</p> Signup and view all the answers

    What triggers the formation of a clot in the setting of plaque rupture?

    <p>Exposed lipid core and platelet aggregation</p> Signup and view all the answers

    What effect does sympathetic hyperactivity have on the cardiovascular system during an ACS event?

    <p>Promotes arrhythmias and increased myocardial demand</p> Signup and view all the answers

    What indicates the area of necrosis during a myocardial infarction?

    <p>The region of injury around the necrotic area</p> Signup and view all the answers

    What might be observed in myocardial tissues after successful reperfusion post-AMI?

    <p>Stunned and hibernating myocytes</p> Signup and view all the answers

    What biochemical changes occur in the myocardial cells due to ischemia?

    <p>Depletion of glycogen and ATP stores</p> Signup and view all the answers

    What is the most devastating type of myocardial infarction?

    <p>Left main coronary artery occlusion</p> Signup and view all the answers

    Which artery is primarily affected in a lateral myocardial infarction?

    <p>Left circumflex artery</p> Signup and view all the answers

    Which of the following is a modifiable risk factor for coronary artery disease (CAD)?

    <p>Cigarette smoking</p> Signup and view all the answers

    What effect does cocaine have on the sympathetic nervous system?

    <p>Increases heart rate and contractility</p> Signup and view all the answers

    What is a common presentation symptom of a patient with cocaine-induced myocardial infarction?

    <p>Seizure activity</p> Signup and view all the answers

    At what age does the risk for coronary artery disease typically begin to increase for males?

    <p>45 years</p> Signup and view all the answers

    How does gender influence the risk of CAD?

    <p>Risk is equal for males and females post-menopause</p> Signup and view all the answers

    Which study has significantly contributed to our understanding of cardiovascular disease risk factors?

    <p>Framingham Heart Study</p> Signup and view all the answers

    What lifestyle factor is strongly associated with high rates of cardiovascular disease according to research?

    <p>Unhealthy diet</p> Signup and view all the answers

    What is a key implication of the findings from the Framingham Heart Study for healthcare providers?

    <p>Emphasize lifestyle modifications and education</p> Signup and view all the answers

    What dietary components are associated with a protective effect against coronary artery disease (CAD)?

    <p>High fruits, vegetables, whole grains, and unsaturated fatty acids</p> Signup and view all the answers

    What role does genetics play in the risk of developing cardiovascular disease?

    <p>Genetic predisposition may increase risk alongside lifestyle factors.</p> Signup and view all the answers

    Which artery's occlusion primarily affects the right ventricle and inferior myocardial portions?

    <p>Right coronary artery</p> Signup and view all the answers

    How does physical inactivity affect the risk of CAD?

    <p>It decreases cardiac function leading to higher CAD risk.</p> Signup and view all the answers

    What is considered a significant risk factor for CAD in relation to body weight?

    <p>Having a BMI of 30 or greater</p> Signup and view all the answers

    What mechanism is often the cause of myocardial infarction?

    <p>Rupture or ulceration of atherosclerotic plaque</p> Signup and view all the answers

    Which waist-to-hip ratio poses an increased risk for CAD in males?

    <p>0.9</p> Signup and view all the answers

    What additional factor complicates the risk of CAD for the elderly population?

    <p>Advanced age and associated medical conditions</p> Signup and view all the answers

    What effect does tobacco smoking have on the risk of developing CAD?

    <p>It increases the risk through endothelial damage and cholesterol deposition.</p> Signup and view all the answers

    Which measurement defines hypertension as a risk factor for CAD?

    <p>Systolic BP greater than 140 mmHg or diastolic BP greater than 90 mmHg</p> Signup and view all the answers

    How does diabetes mellitus contribute to the risk of CAD?

    <p>It raises blood lipid levels and damages blood vessel endothelium.</p> Signup and view all the answers

    Which of the following describes hyperlipidemia?

    <p>Abnormally high levels of blood lipids and lipoproteins</p> Signup and view all the answers

    What is the primary role of LDL cholesterol in relation to CAD?

    <p>Deposits cholesterol on artery walls</p> Signup and view all the answers

    What HDL cholesterol level is considered protective against CAD?

    <p>60 mg/dL or greater</p> Signup and view all the answers

    What does a waist circumference measurement indicate regarding CAD risk?

    <p>Central obesity which increases CAD risk</p> Signup and view all the answers

    Which statement best summarizes the effect of regular physical activity on CAD risk?

    <p>It decreases the risk of developing CAD significantly.</p> Signup and view all the answers

    Which factor does NOT contribute to the development of CAD?

    <p>High intakes of unsaturated fatty acids</p> Signup and view all the answers

    Which group does NOT have an increased risk for coronary artery disease (CAD) due to low 25-hydroxyvitamin D concentrations?

    <p>Black populations</p> Signup and view all the answers

    What factor significantly contributes to an individual's risk of developing CAD if both parents were diagnosed by age 55?

    <p>Increased risk by as much as 50%</p> Signup and view all the answers

    Which of the following is NOT considered a component of metabolic syndrome?

    <p>Elevated serum homocysteine</p> Signup and view all the answers

    Which statement about the relationship between homocysteine levels and CAD is true?

    <p>Lower dietary folate intake raises homocysteine levels.</p> Signup and view all the answers

    What is one of the unique risk factors for females regarding CAD?

    <p>Use of oral contraceptives</p> Signup and view all the answers

    Which lifestyle change is NOT effective in preventing CAD?

    <p>Increasing dietary fat intake</p> Signup and view all the answers

    What is the role of vitamin D in the body related to CAD?

    <p>Regulates calcium and phosphate levels</p> Signup and view all the answers

    What condition is NOT directly related to an increased risk of CAD?

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

    Which factor has been recognized as an emerging risk factor for CAD?

    <p>High serum homocysteine levels</p> Signup and view all the answers

    What lifestyle factor can significantly reduce the risk of CAD?

    <p>Smoking cessation</p> Signup and view all the answers

    Which statement about dietary influences on CAD is true?

    <p>Consumption of omega-3 fatty acids reduces CAD risk.</p> Signup and view all the answers

    What is the biggest risk factor for CAD that is also a genetic component?

    <p>Family history of CAD</p> Signup and view all the answers

    What hormonal change is associated with increased CAD risk in females?

    <p>Decreased estrogen levels after menopause</p> Signup and view all the answers

    Which condition is characterized by exhibiting three or more risk factors for CAD?

    <p>Metabolic syndrome</p> Signup and view all the answers

    Which factor is thought to promote plaque formation and rupture, contributing to CAD?

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

    What is the recommended approach to screening for clot-promoting factors in relation to CAD?

    <p>Screening is not recommended due to unclear roles.</p> Signup and view all the answers

    Study Notes

    Coronary Artery Disease

    • Coronary Artery Disease (CAD) is a major cause of death in the United States.
    • It affects both males and females and accounts for approximately 370,000 deaths annually
    • CAD is caused by reduced blood flow to the myocardium, usually due to atherosclerosis
    • CAD can be asymptomatic, or it can lead to angina pectoris, acute coronary syndrome, acute myocardial infarction (heart attack), dysrhythmias, heart failure, and sudden death.

    Angina Pectoris

    • Angina Pectoris is chest pain caused by reduced blood flow to the heart
    • It results from an imbalance between myocardial oxygen supply and demand
    • Can be caused by coronary artery disease, atherosclerosis, vessel constriction, or hypermetabolic conditions
    • Increased myocardial oxygen demand can be caused by exercise, thyrotoxicosis, hyperthyroidism, and emotional stress
    • Other conditions that affect blood and oxygen supply include anemia, heart failure, ventricular hypertrophy, and pulmonary diseases.

    Acute Coronary Syndrome (ACS)

    • ACS is sudden, reduced blood flow through the coronary arteries
    • It is characterized by conditions like unstable angina and acute myocardial infarction (AMI)
    • It results from the loss of blood flow to the cardiac muscle, most commonly through blockage of coronary circulation

    Acute Myocardial Infarction (AMI)

    • AMI is the death of myocardial cells
    • It is a life-threatening condition resulting from lack of blood flow to the heart muscle
    • Most commonly caused by coronary artery blockage and can lead to cardiogenic shock and death
    • AMI deaths are more likely to occur within the first hour after the onset of symptoms
    • Approximately 805,000 cases of AMI occur yearly in the US, approximately 605,000 are first heart attacks, and 200,000 occur in individuals who have had previous heart attacks.

    Anatomy of the Coronary Arteries

    • Coronary arteries are the main arteries that supply oxygenated blood and nutrients to the myocardium
    • There are two main coronary arteries: the right coronary artery and the left coronary artery
    • The right coronary artery supplies blood to the right ventricle, right atrium, SA node, AV node, and the posterior heart
    • The left main coronary artery supplies blood to the left ventricle, left atrium, and the interventricular septum.
    • The left main coronary artery has two branches: the left anterior descending and circumflex arteries
    • The left anterior descending artery brings blood to the anterior interventricular septum and the left ventricle
    • The circumflex branch provides blood to the left atrium and the lateral wall of the left ventricle

    Factors Regulating Coronary Blood Flow

    • Aortic pressure is the main factor regulating coronary blood flow
    • Other factors include heart rate, metabolic activity of the heart, blood vessel tone, and collateral circulation

    Coronary Atherosclerosis

    • Coronary atherosclerosis is responsible for reduced coronary blood flow
    • It involves the buildup of plaques within the coronary arteries
    • The plaque accumulation narrows the arteries and reduces blood flow to the heart muscle
    • The etiology of atherosclerosis is unknown, but it is thought to be related to injury to or inflammation of the endothelial cells lining the arteries.

    Atherosclerosis Process

    • Atherosclerosis begins when LDL cholesterol reaches the damaged endothelium and WBCs attack the LDL
    • Atherogenic lipoproteins gather and appear to bind with the extracellular portion of the vessel endothelium.
    • White blood cells called macrophages migrate to the injured site as part of the inflammatory process.
    • The accumulation of fats and cholesterol causes damage to the arterial endothelium, leading to a yellowish fatty streak on the inner arterial lining.
    • Over time, the fatty streak transforms into a fibrous plaque due to the enlargement of smooth muscle cells, proliferation of collagen fibers, and further accumulation of blood lipids.
    • The fibrous plaque may eventually occlude the vessel and limit the vessel’s ability to dilate.
    • The final stage is the development of calcified lesions called atheromas.
    • Atheromas can ulcerate or rupture, leading to thrombosis, rapid occlusion by the thrombus, or embolization of the clot to occlude a distal blood vessel.

    Myocardial Ischemia

    • Myocardial ischemia is a temporary and reversible condition that occurs when the heart muscle does not receive enough oxygen
    • This happens due to a decrease in coronary blood flow or an increase in myocardial workload.
    • Increased myocardial oxygen demand can be caused by exercise, thyrotoxicosis, hyperthyroidism, and emotional stress
    • The ability of cardiac tissue to satisfy its metabolic demands largely depends on coronary perfusion and myocardial workload
    • Coronary perfusion can be affected by several mechanisms, including atherosclerosis, thrombosis, and coronary artery spasm
    • Myocardial workload can be affected by heart rate, myocardial contractility, preload, and afterload
    • The blood’s oxygen content and hematocrit levels are also contributing factors to myocardial ischemia.

    Angina Types

    • Stable angina is the most common type, usually predictable and relieved by rest and nitrates.
    • Prinzmetal (Variant) angina is atypical and occurs unpredictably, often at night, caused by coronary artery spasm.
    • Unstable angina is unpredictable and can occur at rest or with activity or stress, putting patients at risk for AMI.

    Silent Myocardial Ischemia

    • Many patients with ischemic heart disease experience silent myocardial ischemia, which does not cause chest pain
    • Silent ischemia is more common in patients with diabetes and a history of cardiac arrest, heart transplant, percutaneous coronary intervention, or cardiac bypass surgery.

    Acute Coronary Syndrome (ACS)

    • ACS describes a dynamic state where coronary blood flow is acutely reduced but not fully occluded.
    • It is often precipitated by events such as atherosclerotic plaque rupture, thrombus formation, coronary artery spasm or inflammation, or restenosis after a revascularization procedure.
    • Most people affected by ACS have significant atherosclerotic occlusion of one or more coronary arteries.
    • Atherosclerotic plaque can form stable or unstable lesions, with unstable lesions prone to rupture and thrombus formation.
    • With ACS, plaque rupture is often triggered by hemodynamic factors, such as increases in heart rate, blood flow, and BP in response to a surge of SNS activity.

    Acute Myocardial Infarction (AMI)

    • AMI is the result of complete occlusion of blood flow to a part of the heart muscle
    • It leads to myocardial ischemia and may cause cell death or infarction
    • The lack of adequate oxygen and nutrients during an AMI causes injury to myocardial cells.
    • Cellular metabolism shifts to an anaerobic process, producing hydrogen ions and lactic acid.
    • Cellular acidosis increases the cells’ vulnerability to further damage, and intracellular enzymes are released through damaged cell membranes into interstitial spaces.
    • If ischemia lasts more than 20 to 45 minutes, irreversible hypoxic damage leads to cellular death and tissue necrosis.
    • The first portion of the heart affected during an AMI is the subendocardium, usually within 20 minutes of injury.
    • If blood flow is restored at this point, the infarction is limited to this layer, and it is categorized as a subendocardial or non-Q-wave infarction.
    • Beyond 20 minutes, continued blood flow interruption leads to progressive myocardial damage, ultimately reaching the epicardium within 1 to 6 hours.
    • This progressive event is referred to as a transmural infarction, resulting in a significant Q wave on electrocardiogram.
    • The area of infarction is the area of necrosis or cell death. This area is surrounded by regions of injury and ischemia.
    • Areas of ischemic tissue are potentially viable as restoration of blood flow minimizes the amount of tissue that is lost.
    • In response to an AMI in a larger artery, collateral vessels dilate to maintain blood flow to the myocardium.
    • The extent of collateral circulation determines the magnitude of ischemic myocardial damage.
    • AMIs are commonly identified by location and the occluded coronary artery.

    Anterior Myocardial Infarction (AMI)

    • Involves occlusion of the left anterior descending artery
    • Affects blood flow to the left-ventricular wall and part of the interventricular septum

    Lateral Myocardial Infarction (AMI)

    • Characterized by occlusion of the left circumflex artery

    Right Coronary Artery and Posterior Descending Artery AMI

    • Involves blood flow to the right ventricle, inferior and posterior myocardial portions

    Left Main Coronary Artery Occlusion

    • Most serious type of AMI
    • Leads to ischemia of the entire left ventricle
    • Carries a grave prognosis

    Cocaine-Induced AMI

    • Cocaine increases SNS activity
    • Increases release of catecholamines from central and peripheral stores
    • Interferes with catecholamine reuptake
    • Increases heart rate and contractility
    • Increases automaticity of cardiac tissues
    • Increases risk of dysrhythmias
    • Causes vasoconstriction and hypertension (HTN)
    • Patients may present with altered level of consciousness (LOC), confusion, restlessness, seizures, tachycardia, hypotension, increased respiratory rate, and respiratory crackles

    Etiology of AMI

    • Underlying causes of atherosclerosis, coronary artery disease (CAD), and their resulting conditions are unknown
    • Genetic predisposition may play a role
    • Lifestyle factors such as diet, smoking, and physical activity also play a role

    Non-Modifiable Risk Factors for CAD

    • Age: Risk for men increases around age 45, risk for women increases around age 55
    • Sex: Premenopausal women less likely to develop CAD than men of the same age, but risk equalizes post-menopause
    • Race/ethnicity: African Americans, Mexican Americans, Native Americans, Alaska Natives, and some Asian Americans at higher risk

    Modifiable Risk Factors for CAD

    • Dietary factors:
      • Atherogenic diet: promotes formation of atheromas
      • Diets high in saturated and trans fats, cholesterol, and salt promote CAD
      • Diets low in fruits, vegetables, whole grains, and unsaturated fatty acids promote CAD
      • Diets high in fruits, vegetables, whole grains, and unsaturated fatty acids protect against CAD
    • Activity level:
      • Physical inactivity associated with higher risk for CAD
      • Regular physical activity decreases risk for CAD
      • Exercise increases oxygen availability to the heart muscle, decreases oxygen demand and cardiac workload, increases myocardial function and electrical stability, lowers BP, blood lipids, insulin levels, platelet aggregation, and weight
    • Obesity:
      • Defined as BMI of 30 or greater
      • Associated with higher rates of HTN, diabetes, and hyperlipidemia
      • Central obesity (large amount of intra-abdominal fat) associated with increased risk, indicated by waist circumference and waist-to-hip ratio greater than 0.8 (female) or 0.9 (male)
    • Cigarette smoking:
      • Significant risk factor for CAD
      • Dose-dependent effects, but generally male smokers have 2-3 times the risk and female smokers have 4 times the risk compared to non-smokers
      • Risk of CAD reduced by 50% within 1 year of tobacco cessation
      • Tobacco smoke damages vascular endothelium, promotes cholesterol deposition, stimulates catecholamine release (increasing BP, heart rate, and myocardial oxygen use), constricts arteries, reduces HDL levels, and increases platelet aggregation
    • Hypertension:
      • Defined as consistent systolic BP readings greater than 140 mmHg and/or diastolic BP readings greater than 90 mmHg
      • Damages endothelial cells of arteries, leading to increased risk of CAD
    • Diabetes mellitus:
      • Contributes to CAD through higher blood lipid levels, increased incidence of HTN and obesity, and effects on the endothelium of blood vessels
    • Hyperlipidemia:
      • Defined as abnormally high levels of blood lipids and lipoproteins
      • LDLs are primarily responsible for cholesterol transport and deposition
      • High LDL levels promote atherosclerosis
      • HDLs clear cholesterol from arteries and transport it to the liver for excretion, levels above 60 mg/dL are protective, levels below 40 mg/dL (male) and 50 mg/dL (female) are associated with increased risk
      • Elevated triglycerides also elevate risk for CAD

    Emerging Risk Factors for CAD

    • Homocysteine:
      • Elevated serum levels linked to CAD
      • Lower levels in females before menopause partially explain lower risk
      • Negatively correlated with folate intake, suggesting increasing folate intake lowers homocysteine levels
    • Clot-promoting factors:
      • Aspirin and antiplatelet therapies reduce risk for AMI, highlighting a possible role for clot-promoting factors in CAD
    • Inflammation:
      • May promote development of atherosclerotic plaque and its rupture, leading to clot formation at the site of rupture
      • Routine screening for these factors not currently recommended due to unclear role

    Metabolic Syndrome as a Risk Factor for CAD

    • Characterized by the presence of at least three of the following conditions:
      • Large waistline (40 in. or greater for males, 35 in. or greater for females)
      • High triglyceride levels (150 mg/dL or greater)
      • Low HDL levels (less than 40 mg/dL for males, 50 mg/dL for females)
      • Hypertension (130/85 mmHg or greater)
      • Elevated fasting blood glucose (100 mg/dL or greater)
    • Result of obesity, physical inactivity, and genetics
    • Elevates risk of insulin resistance and type 2 diabetes

    Risk Factors Unique to Females

    • Early menopause:
      • Increases risk of CAD due to changes in hormone levels, decreasing HDL and increasing LDL
      • Risk is higher with earlier menopause, whether natural or surgical
    • Use of oral contraceptives:
      • Elevates risk of CAD, particularly in smokers, obese individuals, those with HTN, and those with genetic predisposition
      • Increased risk due to elevation of LDL and reduction of HDL levels
      • Risk highest among oral contraceptive users who smoke and are older than 35

    Prevention of CAD

    • Focuses on modifiable risk factors, including lifestyle factors and pathologic conditions
    • Behavioral or lifestyle factors can be controlled or eliminated with commitment and support from the healthcare team
    • Pathologic conditions contributing to CAD are manageable through medication, weight control, diet, and exercise

    Framingham Heart Study (FHS)

    • Conducted since 1948 to identify factors contributing to cardiovascular disease
    • First cohort included 5209 participants from Framingham, Massachusetts
    • Identified significant lifestyle risk factors: unhealthy diet, physical inactivity, obesity, and cigarette smoking
    • Emphasized importance of primary preventive education
    • Provided insight into genetic influences on cardiovascular risk
    • Linked certain genes to congenital heart defects and other structural abnormalities
    • Aims to learn more about the genetics of CAD and other forms of cardiovascular disease

    Critical Thinking Application

    • Strategies for teaching cardiovascular health in elementary school settings:
      • Use interactive activities and games to engage students
      • Incorporate examples of healthy foods and physical activities
      • Use age-appropriate language and visualizations
    • Possible health implications related to genetics and increased cardiovascular risk:
      • Increased risk of premature CAD
      • Development of other heart conditions, such as valve problems or atrial fibrillation
      • More difficulty managing cardiovascular conditions
    • Lifestyle changes for heart-healthy living:
      • Adopt a healthy diet
      • Engage in regular physical activity
      • Maintain a healthy weight
      • Avoid tobacco products
      • Manage blood pressure and cholesterol levels

    Focus on Diversity and Culture

    • Vitamin D and CAD risk:
      • Studies indicate that low amounts of 25-hydroxyvitamin D are associated with an increased risk of CAD in white and Chinese populations, but not in Black or Hispanic populations
      • Important to consider cultural variability when interpreting results from studies

    Conclusion

    • Understanding the different types of AMI, their causes, and risk factors is crucial for effective prevention and treatment
    • Emphasis should be placed on lifestyle modifications and managing modifiable risk factors
    • Continued research through studies like the FHS remains vital for advancing our understanding of cardiovascular disease

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    Description

    This quiz explores the critical aspects of Coronary Artery Disease (CAD) and Angina Pectoris, including their causes, symptoms, and consequences. Learn about the impact of reduced blood flow to the heart and the conditions that contribute to these cardiovascular issues. Test your knowledge on this vital health topic.

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