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modifiable risk factors for ASCVD (5)
- 1) cigarette smoking
- 2) HTN
- 3) total cholesterol
- 4) low HDL-C (<40mg/dL)
- 5) diabetes
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non-modifiable risk factors for ASCVD (4)
- 1) gender
- 2) race
- 3) family hx of CHD
- 4) age (male:
 45yo; female: 55yo)
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2 factors that improve/decrease risk of MI
- daily fruits/vegetables
- exercise
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clinical presentation of ischemic heart disease (2)
- 1) sudden cardiac death due to electrical instability
- 2) angina
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clinical presentation of angina (4)
- 1) substernal chest pressure sensation
- 2) radiation of discomfort to shoulder, back, arm, or neck
- 3) predictable patter - brought on by exertion, relieved w/ rest/meds
- 4) short duration - 1-15 min
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clinical consequences of atherosclerosis (6)
- 1) stroke
- 2) transient ischemic attacks in brain arteries
- 3) stable angina
- 4) unstable angina
- 5) MI
- 6) peripheral artery/vascular disease
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test that represents the total of electrical vectors arising from myocardial cells as they depolarize & repolarize;
gives info on HR, rhythm, conduction times, ischemia, infarction, hypertrophy
electrocardiogram (EKG/ECG)
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used to evaluate "baseline" heart rhythms; recording durations last 24-48 hrs; typically ordered to evaluate sx of palpitations, dizziness, or syncope
Holter Monitor (ambulatory EKG)
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"real-time" 2D imaging of the heart; non-invasive measurement of LV fcn, valvular morphology, & valve fcn
echocardiography
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significance of Doppler echocardiography
Doppler technology allows determination of speed & direction of blood flow
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used for dx of obstructive CAD, risk assessment/prognosis in pts w/ sx or prior hx of CAD, post MI risk assessment/prognosis
exercise stress test
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advantages of exercise stress test (5)
- 1) low cost
- 2) wide availability
- 3) pt acceptability
- 4) exercise capacity determined
- 5) convenience
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disadvantages to exercise stress test (4)
- 1) limited sensitivity/specificity
- 2) doesn't localize ischemia
- 3) no estimate of LV fcn
- 4) requires cooperation & ability to walk
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clinical use for coronary artery calcium (CAC) score
ASCVD risk assessment in asymptomatic adults w/ intermediate and low to intermediate risk pts
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ultrasound image of carotid artery walls, used for ASCVD risk assessment in asymptomatic adults at intermediate risk
carotid artery intima-media thickness (CIMT)
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describe a coronary angiography
catheter is inserted into a blood vessel in groin or arm -> threaded in to reach the heart/beginning of ateries -> contrast dye is injected -> fluid visible by x-ray to examine blood vessels & chambers of heart
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use for coronary angiography
- document presence/severity of disease in pts w/ suspected CAD & high risk features w/ exercise stress test
- NOT rec'd in asymptomatic pts
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different between coronary angiography & CCTA
- no catheter threaded through blood vessels
- can't receive treatment PCI if needed at time of procedure
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describe angioplasty/percutaneous coronary intervention (PCI)
temporarily insert & expand a tiny balloon at the site of blockage
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indications for coronary angioplasty/PCI (3)
- acute MI
- significant CAD w/ obstruction
- significant angina sx
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describe coronary artery bypass surgery (CABG)
surgery bypasses blood around clogged arteries to improve blood flow & oxygen to heart
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indications for CABG (3)
- left main coronary stenosis
- 2-3 vessel CAD
- medically refractory angina not amenable to PCI
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clinical presentation of ASCVD (7)
- 1) acute coronary syndromes
- 2) hx of MI
- 3) stable/unstable angina
- 4) coronary revascularization
- 5) stroke
- 6) transient ischemic attack
- 7) peripheral arterial disease or revascularization
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