Coronary Vascular Disorders and Angina Pectoris

Vocabulary flashcards covering pathophysiology, risk factors, lipid management, angina types, diagnostic testing, pharmacology, and invasive procedures for coronary vascular disorders.

Coronary Atherosclerosis

An abnormal accumulation of lipid, fatty substances, and fibrous tissue in the lining of arterial blood vessel walls that blocks and narrows coronary vessels, reducing blood flow to the myocardium.

Foam Cells

Macrophages that ingest lipids and transport them into the arterial wall during the inflammatory response phase of vascular plaque formation.

Total Cholesterol Target

A recommended blood level of less than $200\text{ mg/dL}$, serving as an overall marker of circulating lipid burden.

Triglycerides Target

A recommended blood level of less than $150\text{ mg/dL}$; elevated levels accompany metabolic syndrome and diabetes.

Statins (HMG-CoA Reductase Inhibitors)

Medications such as atorvastatin, simvastatin, and rosuvastatin that lower total cholesterol, LDL, and triglycerides while raising HDL; monitored for myalgia, arthralgia, and liver function.

Fibric Acids (Fibrates)

Lipid-lowering agents such as fenofibrate and gemfibrozil that increase HDL and lower triglycerides by decreasing lipid synthesis; contraindicated in severe kidney and liver disease.

Bile Acid Sequestrants

Medications such as cholestyramine, colesevelam, and colestipol that lower LDL and slightly increase HDL; administered before meals and may decrease the absorption of other drugs.

Ezetimibe

A cholesterol absorption inhibitor that lowers LDL by inhibiting cholesterol absorption in the small intestine, often combined with a statin.

Angina Pectoris

Chest pain or discomfort caused by insufficient coronary blood flow to meet myocardial oxygen demand, usually secondary to significant coronary atherosclerosis.

Stable Angina

Predictable and consistent chest pain that occurs on exertion and is relieved by rest or nitroglycerin.

Unstable Angina

Also called preinfarction or crescendo angina; chest pain whose symptoms increase in frequency and severity and may not be relieved by rest or nitroglycerin.

Intractable (Refractory) Angina

Severe, incapacitating chest pain that does not respond to usual medical measures and requires advanced intervention.

Variant (Prinzmetal) Angina

Chest pain occurring at rest rather than exertion, caused by coronary artery vasospasm and associated with reversible ST-segment elevation; primary treatment is calcium channel blockers.

Silent Ischemia

Objective diagnostic evidence of myocardial ischemia (such as ECG changes during a stress test) without patient-reported pain; common in patients with diabetes and older adults.

Retrosternal Area

The poorly localized region deep in the chest directly behind the sternum, where anginal pain is most commonly felt.

Nitroglycerin

A potent vasodilator that dilates veins to lower preload and relaxes systemic arterioles to decrease afterload; sublingual administration ideally relieves ischemic pain within $3\text{ minutes}$.

Beta-Adrenergic Blocking Agents

Medications such as metoprolol and atenolol that reduce myocardial oxygen consumption by blocking beta-adrenergic stimulation, lowering heart rate, contractility, and blood pressure.

Calcium Channel Blockers

Medications such as amlodipine and diltiazem that exert negative inotropic effects to reduce myocardial workload; used as primary therapy for coronary vasospasm and in patients unresponsive to beta-blockers.

P2Y12 / ADP Receptor Antagonists

Antiplatelet agents such as clopidogrel, prasugrel, and ticagrelor that prevent platelet aggregation, commonly used alongside aspirin as dual antiplatelet therapy after stent placement.

Acute Coronary Syndrome (ACS)

An emergent continuum of acute myocardial ischemia—including unstable angina, NSTEMI, and STEMI—that leads to myocardial cell death if definitive interventions are not performed promptly.

Troponin (I and T)

Myocardial cell proteins regulating contraction that serve as cardiac-specific critical markers of myocardial injury; detectable within a few hours of acute MI and remaining elevated for up to $2\text{ weeks}$.

CK-MB

An isoenzyme of creatine kinase specific to cardiac muscle that rises and falls rapidly following injury; historically used to detect reinfarction.

Myoglobin

A heme protein released rapidly from damaged muscle that rises early after injury but is not cardiac-specific; used primarily to rule out MI.

Door-to-Balloon Time

The clinical quality benchmark measuring the time elapsed between hospital arrival and emergency percutaneous coronary intervention balloon inflation.

Phase I Cardiac Rehabilitation

The inpatient phase of cardiac rehabilitation beginning upon diagnosis, focusing on low-level activity, self-care, and initial patient education.

Percutaneous Transluminal Coronary Angioplasty (PTCA)

An interventional procedure performed in the cardiac cath lab where a balloon-tipped catheter is inflated under high pressure to compress atheroma and dilate the vessel wall.

Coronary Artery Stent

An expandable woven mesh placed over an angioplasty balloon and expanded against the vessel wall to provide structural support and maintain patency.

Retroperitoneal Hematoma

A PCI complication caused by an arterial leak into the retroperitoneal space, characterized by back, flank, or abdominal pain, hypotension, tachycardia, and agitation.

Cardiopulmonary Bypass (CPB)

An extracorporeal circuit that mechanically circulates and oxygenates blood while the heart is stopped with potassium-rich cardioplegia solution, maintained under hypothermia at approximately $32^{\circ}\text{C}$ ($89.6^{\circ}\text{F}$).

Off-Pump CABG (OPCAB)

Coronary artery bypass surgery performed through a median sternotomy on a beating heart using a myocardial stabilization device without cardiopulmonary bypass.