Intro to ASCVD (Stable Ischemic Heart Disease and ACS)

Cardiovascular Disease (CVD)

CAD, HF, stroke, HTN

Ischemic Heart Disease (IHD)

Arteries of heart cannot deliver enough blood to heart and cause ischemia

Coronary Artery Disease (CAD)

Buildup of black inside the coronary arteries; can be obstructive or non-obstructive

Peripheral arterial disease (PAD)

Narrowing of the peripheral arteries in legs, stomach, arms and head

Acute coronary syndrome (ACS)

STEMI, NSTEMI, UA

Atherosclerotic cardiovascular disease (ASCVD)

ACS, hx of MI, stable or unstable angina, coronary revascularization, stroke, TIA, PAD

-right atrium

-right ventricle

The right coronary artery takes blood where?

coronary arteries

supplies blood to heart tissues (fills with blood in diastole)

-left atrium

-left ventricle

The circumflex coronary artery takes blood where?

left ventricle

Where does the left anterior descending coronary artery take blood?

colateral circulation

small blood vessels in the heart are formed to get around the blockage

MI, angina, and death

What can ischemic heart disease result in?

atherosclerosis

-Inflammatory process characterized by the thickening and hardening of vessel walls

-Artery loses the ability to change lumen size

atherosclerosis

What is the leading contributor to CAD and cerebrovascular disease?

when ≥ 50% of the lumen is affected

When do you classify it as obstructive CAD?

atherogenesis

-medical emergency

-when the lesion ruptures collagen is released and platelet adhesion starts forming blood clots -> the lumen eventually gets completely blocked leading to muscle death/damage

CVD

#1 cause of death in men and women

1/3

How many Americans have at least 1 form of CVD?

modifiable risk factors for CAD/PAD

-Unhealthy diet/alcohol

-Lack of physical exercise

-Obesity

-Smoking

-HTN

-Dyslipidemia

-Insulin Resistance/DM

-Stress

smoking, HTN, dyslipidemia

43% of Americans have at least one of what 3 risk factors of CAD/PAD?

non-modifiable risk factors for CAD/PAD

Age

-Men >45 yrs old

-Women >55 yrs old

Family history of early heart disease

-Men <55 yrs old

-Women <65 yrs old

the # of risk factors

The risk of thrombotic events increase with what?

stable IHD

-May or may not be symptomatic (angina)

-Chronic management as outpatient

unstable IHD

-Acute Coronary Syndromes [Unstable Angina (UA), Non-ST elevated myocardial infarction (NSTEMI), ST-elevated myocardial infarction (STEMI)]

-Medical emergency

atherosclerosis

What is the main contributor to both stable and unstable IHD?

acute coronary syndromes

Results from diminished myocardial blood flow due to occlusive or partially occlusive coronary artery thrombosis

STEMI

-injury entire thickness of myocardial wall

-ST segment elevation; Q wave

-postive troponin

NSTEMI

-injury limited to subendocardial myocardium

-ST segment depression; T wave inversion, or no change

-positive troponin

Unstable angina

-ischemic not significant enough to cause necrosis

-no change in EKG

-negative troponin

myocardial cells

become ischemic within 10 seconds of coronary occlusion (only remain viable for 20 mins under ischemic conditions)

-CK-MB

-Troponin

-Myoglobin

What are the enzymes released from myocardial cells after injury?

cardiac enzymes

Useful in confirming diagnosis and estimating infarct size

measure troponin

Quick release and slower elimination

15%

A single measure of cardiac enzymes is not sufficient. What % of initial values are false negative?

cardiac enzymes test 1

ASAP after symptoms present

cardiac enzymes test 2-3

1-6 hours later

patient's symptoms

Troponins may be elevated for non-cardiac reasons. A positive test should always be correlated to ___________.

27%

What % of Americans can recognize all the major symptoms of a heart attack?

Stable Ischemic heart disease S/S

Exertional Angina

-Squeezing, crushing, heaviness or tightness

-Usually not sharp

-Doesn’t change with inspiration/expiration

-Not reproducible

-May radiate

Physical Exam usually nonspecific

precipitating factor

-typically some level of exercise or exertion

-ask what were you doing when the pain started

palliative measures

-Relieved by rest w/ or w/o SL NTG within 5-10 min

-Is there anything that helps the pain go away? If you rest does the pain get better? Does SL NTG help?

quality of the pain

-Described as a continuous squeezing, heaviness or tightness

-how would you describe the pain

region

-substernal

-where is the pain located?

radiation

-Arm, back, down into the abdomen; up into the neck

-does the pain seem to radiate or go to other locations?

severity

-Report a ≥ 5 on pain scale (subjective)

-on a scale of 1-10, how would you rate your pain?

temporal pattern

-Pain last < 20 min and usually 5-10 min

-how long did the pain last?

Dx of stable ischemic heart disease (SIHD)

-EKG

-Stress Test (Exercise Stress Test, Pharmacologic Stress Test)

-Myocardial Perfusion Imaging

-Cardiac CT (Coronary Calcium Score)

-Cardiac MRI

-Coronary Angiography

recurrent MI or fatal CHD

Within 5 yrs after MI, 17% of males and 21% of females will have what?

die

Within 5 years after first MI 36% of males and 47% of females ______

20%

What % of people after 5 yrs of PAD dx will have a nonfatal MI or stroke?

30%

What % of people dx with PAD 5 yrs ago will die?