Podcast
Questions and Answers
Which of the following is a modifiable risk factor for coronary artery disease (CAD)?
Which of the following is a modifiable risk factor for coronary artery disease (CAD)?
- Family history of CAD
- Elevated LDL cholesterol (correct)
- Age greater than 65 years
- Native American ethnicity
A patient presents with chest pain that is relieved by rest. Which type of angina is the patient most likely experiencing?
A patient presents with chest pain that is relieved by rest. Which type of angina is the patient most likely experiencing?
- Prinzmetal's angina
- Stable angina (correct)
- Unstable angina
- Silent ischemia
Which of the following is a key characteristic of unstable angina?
Which of the following is a key characteristic of unstable angina?
- New onset chest pain that is unpredictable (correct)
- Predictable pattern of chest pain
- Relief with rest or nitroglycerin
- Absence of symptoms
In the pathophysiology of CAD, what is the initial trigger that starts the cascade of events leading to atherosclerosis?
In the pathophysiology of CAD, what is the initial trigger that starts the cascade of events leading to atherosclerosis?
A patient is diagnosed with Prinzmetal's angina. What is the underlying cause of this condition?
A patient is diagnosed with Prinzmetal's angina. What is the underlying cause of this condition?
A patient with a history of CAD presents to the emergency department. Which symptom is most indicative of myocardial ischemia?
A patient with a history of CAD presents to the emergency department. Which symptom is most indicative of myocardial ischemia?
In the progression of atherosclerosis, what forms over the area of inflammation and a fatty streak in an artery?
In the progression of atherosclerosis, what forms over the area of inflammation and a fatty streak in an artery?
A patient who is postmenopausal is at increased risk for MI due to what physiological change?
A patient who is postmenopausal is at increased risk for MI due to what physiological change?
What is the significance of systemic inflammation in the context of cardiovascular disease?
What is the significance of systemic inflammation in the context of cardiovascular disease?
What is a potential outcome of lesions in coronary arteries that calcify or rupture?
What is a potential outcome of lesions in coronary arteries that calcify or rupture?
A patient with an acute myocardial infarction is being treated with 'MONA'. What does 'MONA' refer to in the initial treatment?
A patient with an acute myocardial infarction is being treated with 'MONA'. What does 'MONA' refer to in the initial treatment?
Which statement accurately describes the difference between NSTEMI and STEMI?
Which statement accurately describes the difference between NSTEMI and STEMI?
A patient presents with chest pain. An EKG shows ST depression, but cardiac enzymes are normal. What type of angina is the patient most likely experiencing?
A patient presents with chest pain. An EKG shows ST depression, but cardiac enzymes are normal. What type of angina is the patient most likely experiencing?
Which of the following is a goal of secondary prevention for a patient with known CAD?
Which of the following is a goal of secondary prevention for a patient with known CAD?
What type of angina involves myocardial ischemia that occurs without any symptoms?
What type of angina involves myocardial ischemia that occurs without any symptoms?
Which of the following is true regarding gender differences in the presentation and outcomes of myocardial infarction (MI)?
Which of the following is true regarding gender differences in the presentation and outcomes of myocardial infarction (MI)?
Which of the following is NOT typically a clinical manifestation of myocardial infarction?
Which of the following is NOT typically a clinical manifestation of myocardial infarction?
What is a potential complication of myocardial infarction?
What is a potential complication of myocardial infarction?
What is the first priority when a patient arrives at the hospital with a suspected myocardial infarction?
What is the first priority when a patient arrives at the hospital with a suspected myocardial infarction?
For a patient being discharged after a myocardial infarction, which lifestyle change is most important to emphasize?
For a patient being discharged after a myocardial infarction, which lifestyle change is most important to emphasize?
Flashcards
What is CAD?
What is CAD?
Leading cause of death in the U.S., characterized by plaque buildup in the arteries.
Inflammatory response
Inflammatory response
The body's initial defense mechanism that, when prolonged, can initiate the atherosclerosis process in arteries.
Atherosclerosis
Atherosclerosis
The accumulation of fats, cholesterol, and other substances in the artery walls, leading to plaque formation.
Fibrous cap
Fibrous cap
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Angina
Angina
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Myocardial Ischemia
Myocardial Ischemia
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SOB
SOB
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Myocardial Infarction (MI)
Myocardial Infarction (MI)
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Unstable Angina
Unstable Angina
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Silent Ischemia
Silent Ischemia
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Prinzmetal's Angina
Prinzmetal's Angina
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Acute Coronary Syndrome
Acute Coronary Syndrome
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NSTEMI
NSTEMI
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STEMI
STEMI
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Study Notes
- Coronary Artery Disease (CAD) is the leading cause of death in the U.S.
Pathophysiology of CAD
- Begins with an inflammatory response.
- Lipids are transported to the arterial wall, leading to lipid accumulation.
- Atherosclerosis progresses as plaque forms over areas of inflammation and fatty streaks.
- A fibrous cap protrudes into the vessel lumen, narrowing the blood vessel.
- The fibrous cap continues to propagate due to the body's inflammatory response, creating lesions.
- Lesions calcify or rupture, leading to thrombi formation that obstructs blood flow, potentially resulting in Myocardial Infarction (MI).
Clinical Manifestations of CAD
- Angina (chest pain)
- Shortness of Breath (SOB)
- Fatigue
- Nausea, indigestion
- Diaphoresis, lightheadedness
- Sometimes no symptoms are present
Modifiable Risk Factors for CAD
- Obesity
- Obstructive Sleep Apnea (OSA)
- Smoking
- Metabolic Syndrome, Diabetes Mellitus (DM)
- Physical Inactivity
- Hypertension (HTN)
- Abnormal Lipid Levels
- Excessive alcohol consumption
- Poor diet
- Illicit drug use
- Stress
Non-Modifiable Risk Factors for CAD
- Age > 65 years old
- Heredity and race: First-degree relatives with CAD; African Americans, Mexican Americans, Native Americans, Native Hawaiians, and Asian Americans are at higher risk
- Sex: Men have a greater risk for MI at a younger age but lower mortality rates compared to women; Women's risk increases after menopause due to decreased estrogen (cardioprotective) and changes in cholesterol levels, leading to increased LDL, decreased HDL, and higher mortality rates from MI
Other Risk Factors
- Systemic Inflammation: Evidenced by specific markers in lab work
- Periodontal disease
Prevention
- Maintain cholesterol and triglycerides within goal ranges
- Balanced Diet
- Regular Exercise
- Medications
- Smoking Cessation
- Manage Hypertension (HTN)
- Control diabetes
- Follow Healthy People Initiatives
Angina Types
- All types of Angina are caused by CAD until proven otherwise
Stable Angina (caused by CAD)
- Predictable and reversible
- Caused by increased heart demand, such as during exercise
- Alleviated with rest
- Pain resolves within 3-5 minutes
- EKG changes may occur during an acute episode, but the EKG returns to normal after the episode resolves
Unstable Angina (caused by CAD)
- Unpredictable and irreversible
- New onset chest pain
- Pain can occur at rest
- Pain lasts longer than 5 minutes
- Always considered an emergency
- ST-segment depression on EKG
Silent Ischemia (usually caused by CAD)
- Myocardial ischemia occurs without symptoms
- Associated with diabetes and elderly patients, who may present with weakness and shortness of breath instead of chest pain
Prinzmetal's or Variant Angina (not caused by CAD)
- Occurs because of spasm of coronary arteries
- Common in patients with a history of migraines/Raynaud's
Acute Coronary Syndrome
- Occurs when ischemia is prolonged and irreversible
Unstable Angina
- EKG changes occur
- Cardiac enzymes are normal
NSTEMI (Non-ST-Elevation Myocardial Infarction)
- EKG changes occur
- Cardiac enzymes are elevated
- There is a partial coronary artery occlusion
STEMI (ST-Elevation Myocardial Infarction)
- EKG changes occur
- Cardiac enzymes are elevated
- There is a full coronary artery occlusion
- Immediate thrombolytic intervention and transfer to the cardiac catheterization lab is required
Myocardial Infarction (MI) Clinical Manifestations
- Pain
- Sympathetic nervous system activation
- Cardiovascular symptoms
- Respiratory symptoms
- Gastrointestinal symptoms
- Neurological/Psychological symptoms
- Immunological symptoms
Collaborative Care: Myocardial Infarction (MI)
- Initial treatment includes MONA (Morphine, Oxygen, Nitroglycerin, Aspirin)
- Medications
- Invasive treatment options
- Patient education
- Psychosocial considerations
Potential Complications of MI
- Further information is required to populate this section
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