Coronary Artery Disease

Atherosclerosis

— Plaque(cholesterol containing deposits) build-up in the arteries

— Abnormal accumulation of lipid deposits and fibrous tissue within arterial walls and lumen

— These substances block and narrow the coronary vessels in a way that reduces blood flow to the myocardium

Arteriosclerosis

— Arteries go thick and stiff

— Restricts blood flow to the organs and body

— Caused by formation of PLAQUE

Acute coronary syndrome

— Usually characterized by an acute onset of your myocardial ischemia(low blood flow)

— Occurs with no warning; may result to your myocardial death/myocardial infarction due to myocardial ischemia; if not managed, you will die

Non ST-segment Elevation MI(Unstable Angina)

— Reduce blood flow in a coronary artery, often due to rupture of your atherosclerotic plaque; Artery isnt completely occluded, ischemia is whats happening

— Also called pre-infarction(necrosis) angina

— Sudden chest pain that is persistent; not relieved by rest or oral nitrates

ST-segment Elevation MI

— Have ECG evidence of acute MI

— More serious form of heart attack

— Coronary artery is completely blocked, large part of the heart muscle is unable to receive blood; this type of heart attack requires immediate emergency revascularization, to restore blood flow

Chronic Ischemic Heart Disease

— Result of a decrease myocardial oxygen and conception; nawawalan/ na-reduce ang supply

— Slowly builds up

Angina pectoris

— Chest pain

— Increase O2 demand, but not enough O2 supply; Because there is decrease coronary perfusion to the heart

— It is a clinical syndrome usually characterized by episodes of pan, or pressure in the anterior chest

— Predisposing factors: 5 Es

Stable angina

— Pain is predictable

— Relieved by rest and nitroglycerine

— Occurs during exertion

Unstable

— Aka pre-infarction angina, or crescendo angina

— Sx increased in frequency

— Not relieved by NTG/rest

— Severe pain

Variant/Prinzmetat

— Caused by vasospasm; narrowing artery by vasoconstriction

— Pain even at rest

Aspirin/ Antiplatelets/ Anticoagulants

— Should be given with proton pump inhibitors or H2 blockers so gi won’t be upset

Beta-blockers

— Blocks catecholamines

— Decrease HR and BP

— Check BP before and after

Calcium Channel blockers

— pines

— Slows HR

— Decrease strength of myocardium contraction

Nitroglycerine

— Vasodilator, reduces preload

— Max dose: 3 tablets, every 5 mins

— Interval: q5 mins/sublingual

— SE: headache/dizziness

— Patch; use gloves; avoid hairy areas/wounds

— Check BP first

Myocardial infarction

— A result of an emergency situation known as Acute coronary Syndrome

— When the muscle tissue of the heart does not receive blood and o2 = myocardial death of necrosis

— Chest pan due to almost complete obstruction of coronary arteries leading into cardiac cell necrosis

— Heart attack

Levine’s sign

— Hallmark for myocardial infarction

— Hand clutching on the chest

T-wave invertion

— Site of ischemia

— Inverted Twave

ST-segment elevation

— site of injury

Pathologic Q-wave

— Denotes old MI

— Infarction

Troponin I(early) and T(late)

— Most definitive of cardiac damage

Ck-MB

— If elevated=acute MI

— Cardiac specific, increased later than troponin and first to decrease

— Muscle injury

Morphine

— Analgesia (relieve pain)

— Watch out for overdose; dilated pupils; shallow breathing

• Antidote: Naloxone

Thrombolytics

— Prevents thrombus formation especially in the left ventricle

— Watch out for: bleeding; Avoid IM, IV only

— Contraindicated in hemorrhagic stroke(past 6 months)

Pecutaneous Transluminal Coronary Angioplasty

— Done to improve the blood the blood flow in the coronary arteries

• Avoid coughing

Coronary Artery Bypass Graft

— Vein from another part of the body