Coronary Atherosclerotic Disease Flashcards Preview

SU18: Internal med final > Coronary Atherosclerotic Disease > Flashcards

Flashcards in Coronary Atherosclerotic Disease Deck (47)
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1
Q

coronary atherosclerotic disease is foundation for what?

A

chest pain and MI

2
Q

what can feel like a heart attack?

A

bad acid reflux

3
Q

angina is commonly seen in pts who do what drug?

A

crack cocaine

4
Q

what is the founding cause of coronary atherosclerotic disease?

A

atherosclerosis

5
Q

atherosclerosis

A

inflammation - plaque - stenosis

6
Q

cause of atherosclerosis

A

exact cause unknown but is multifactorial

contributing factors of heart disease:

  • hypertension
  • type 2 diabetes
  • abnormal blood lipid levels
  • tobacco
  • physical inactivity
  • obesity
7
Q

what is a significant contributing factor to heart disease?

A

hypertension

8
Q

atherosclerotic disease starts out what?

A

asymptomatic but as plaque grows and stenosis worsens, will result in clinical symptoms (ischemic heart disease)

9
Q

symptoms of coronary atherosclerotic disease

A
  • oxygen demand > supply

- chest discomfort = ischemia

10
Q

the most important symptom of someone that has had coronary atherosclerotic disease and #1 way to determine if treatable?

A

angina

11
Q

stable angina

A
  • precipitated by physical effort

- transient

12
Q

how is stable angina relieved?

A
  • rest

- nitroglycerin

13
Q

what is the prognosis of stable angina?

A

good

14
Q

unstable angina

A
  • precipitated by effort or rest
  • changing character
  • difficult resolution
15
Q

what is the prognosis of unstable angina?

A

poor

16
Q

is stable angina reversible?

A

yes

17
Q

when does stable angina occur?

A

when there is an increased demand on the heart

18
Q

unstable angina may be associate with what?

A

heart attack

19
Q

medical treatment of ischemic heart disease

A
  • reduce risk factors
  • treat contributing conditions
  • lifestyle mods
  • pharmacologic management
  • revascularization
20
Q

pharmacologic management of ischemic heart disease

A
  • nitrates (nitroglycerin)
  • beta blockers
  • dual antiplatelet therapy
21
Q

mechanism of nitrates

A

venodilator used for acute management of chest discomfort

22
Q

mechanism of beta blockers

A

decrease risk of MI by decreasing HR and contractility

23
Q

mechanism of antiplatelet therapy

A

make platelets less sticky so less likely to cause clots

24
Q

dual anti-platelet therapy for managing ischemic heart disease

A

aspirin +/- clopidogrel

25
Q

re-stenosis rate of balloon angioplasty

A

re-stenosis and return of symptoms in 6 mos for 10-50% of pts

26
Q

re-stenosis rate of ballon angioplasty with stent placement

A

re-stenosis rate reduced to 20-30%

27
Q

types of coronary artery stents

A
  • bare metal
  • drug- eluting
  • bioresorbable
28
Q

which type of stent has an increased rate of thrombosis for 1 yr after placement?

A

drug-eluting stent

29
Q

how is the increased risk of thrombosis treated?

A

with dual antiplatelet therapy

30
Q

coronary artery bypass grafting (CABG)

A
  • more invasive than placing stent

- reconnect area of myocardium that wasn’t getting enough O2 to a good source

31
Q

road to myocardial infarction starts with what?

A

plaque rupture

*if plaque becomes unstable and ruptures, thrombosis starts inside artery. as thrombosis continues, blood supply to heart m. reduced and m. tissue can start to die

32
Q

myocardial infarction

A

irreversible ischemic damage to myocardium

*dead cardiac m. tissue present

33
Q

acute management of MI

A
  • keep pt alive
  • immediate hospitalization and determination of ST segment changes
  • may receive thrombolytic therapy and/or revascularization
34
Q

chronic management of MI

A
  • nitrates
  • anti-platelet, anti-coagulant
  • cardiac drugs to decrease HR, contractility (Beta blockers)
  • statins (lowers cholesterol)
  • internal cardiac defibrillator, pacer
35
Q

type of risk imposed by unstable coronary syndromes

A

MAJOR

36
Q

type of risk imposed by history of ischemic disease

A

intermediate

37
Q

should you provide elective dental care to pt with history of a MI?

A
  • timing important so 1 mo after MI, pts are considered intermediate risk
  • <1 mo = pt considered unstable coronary syms so major risk
38
Q

pts who had an MI <1 mo ago are severely at risk for what?

A

having lethal arrythmia

39
Q

should you treat pts with stable angina?

A

yes, but elective care with mods

40
Q

should you treat pts with past MI (>1 mo)

A

yes, but elective care with mods and consultation with treating cardiologist

41
Q

mods for pts with stable disease

A
  • profound LA for procedure (0.036 mg epi)
  • manage stress/anxiety (shorter or morning appointments)
  • do not discontinue anti-platelet drugs
  • comfortable chair position, no rapid changes
  • avoid epi impregnated retraction cord
  • prepare for emergency
42
Q

should you txt pts with unstable coronary syndromes?

A
  • no, defer elective care

- emergency care only in conjunction with cardiologist consultation

43
Q

what should you do when your pt has chest pain while in your chair?

A
  • stop procedure, let pt position themselves
  • ask if similar to their normal angina
  • take vitals
  • nitroglycerin
44
Q

how often should you give a pt with chest pain nitroglycerin?

A
  • 1 tablet/sublingual spray Q5 minutes

- relief within 1-2 min

45
Q

should you give nitroglycerin to pts who has a systolic BP <90?

A

NO!

pt already has a low BO and if give nitroglycerin, will even lower BP more and pt will pass out

46
Q

what do you do when chest pain is not resolving with normal intervention?

A
  • activate EMS
  • pain not responding to nitroglycerin so tell pt to chew and swallow 325 MG aspirin
  • O2 via nasal cannula at 4L/min
  • BLS
47
Q

how can you prepare for/prevent emergency?

A
  • know pt’s syndromes
  • you and staff prepared to recognize symptoms
  • have O2 equipment, nitroglycerin option, and aspirin ready
  • determine threshold and plan for calling EMS