1. Arteriosclerosis
    is defined as a thickening and loss of elasticity and hardening of the arterial walls.
  2. Atherosclerosis
    is fatty substances within the walls of the arteries.
  3. Atherosclerosis begins when
    waxy cholesterol (atheromas) becomes deposited on the intima of the major arteries.
  4. Atheromas interfere with
    the absorption of nutrients by the endothelial cells that compose the vessel lining and obstruct blood flow
  5. Modifiable risk factor
    is one in which an individual may exercise control by changing a lifestyle or personal habit.
  6. non-modifiable
    risk factor is a consequence of genetics over which an individual has no control.
  7. Coronary Artery Disease Non- modifiable Risk Factors


    ¡Family history and heredity
  8. Modifiable Major Risk Factors

    ¡Elevated serum lipids


    ¡Physical inactivity

  9. Modifiable Contributing Risk Factors
    ¡Diabetes mellitus

    ¡Stress and behavior patterns

  10. lack of oxygen supply to heart =
  11. Stable Angina
    temporary and reversible
  12. Acute Coronary Syndrome
    Oxygen supply is prolonged and not immediately reversible
  13. Ischemia develops when the demand for
    • myocardial oxygen exceeds the ability of the
    • coronary arteries to supply the heart with oxygen

    ¡Increased demand for oxygen (anxiety, hypertension, hyperthyroidism)

    ¡Decreased supply of oxygen (anemia, pneumonia, CHF)
  14. Angina pectoris
    chest pain not accompanied by irreversible damage to myocardial cells.
  15. Severe ischemia with cell damage is termed
    myocardial infarction.
  16. Chest pain
    is the major manifestation.

    Angina : reversible no cell death

    Mi: cell death and not reversible

    Treat as if it were an MI untill you are certain
  17. Types of Angina
    ¡Stable Angina Pectoris

    ¡Silent Ischemia

    ¡Prinzmetal’s Angina

    ¡Nocturnal Angina and Angina Decubitus

    ¡Unstable Angina
  18. Stable Angina
    ¡Occurring intermittently, predictable

    ¡Same pattern of onset, duration and intensity

    ¡Last 3-5 minutes

    ¡Usually subsides with rest (Pain at rest unusual)

    ¡Usually controlled by medications
  19. Nocturnal Angina
    ¡Occurs at night (not necessary during sleep)
  20. Angina Decubitus
    ¡Lying down

    ¡Is relieved by standing or sitting
  21. Silent Ischemia
    ¡80% of patients with myocardial ischemia are asymptomatic

    ¡Associated with patients with HTN and DM

    Asymptomatic and is a sign of a heart attack
  22. Prinzmetal’s Angina (variant angina)
    ¡Occurs at rest in response to spasms of coronary arteries

    ¡Rare form

    ¡Associated with patients with migraines and Raynaud’s Disease

    ¡Usually not precipitated by activity

    ¡Spasms may be caused by intracellular calcium histamine, prostaglandins, epinephrine etc.

    ¡Cyclic burst of pain at same time each day

    ¡May be relieved by some form of exercise

    ¡May be considered unstable angina
  23. Unstable Angina
    ¡Occurs at rest

    ¡Worsening pattern


    ¡Considered to be acute coronary syndrome

    ¡Deterioration of a once stable atherosclerotic plaque

    • ¡Require immediate hospitalization, monitoring
    • and bedrest

    ¡Can progress to MI
  24. Angina (chest pain) symptoms
    ¡Vague sensation, discomfort

    ¡Strange feeling pressure, squeezing, heavy,choking

    ¡Almost never stabbing or sharp

    ¡Usually doesn’t change with breathing or position

    ¡Severe burning or indigestion

    ¡May radiate
  25. Myocardial Infarction
    ¡Pain (severe, immobilizing pain not relieved by rest)

    ¡Nausea and Vomiting

    ¡Sympathetic Nervous System Stimulation (diaphoresis, cool clammy skin, “cold sweat”)

    ¡Fever: cell death

    ¡Cardiovascular Manifestations (initial increase BP and HR) decrease urine output, crackles in lungs peripheral edema)
  26. Complications of Myocardial Infarction

    Congestive Heart Failure

    Cardiogenic Shock

    Papillary Muscle Dysfunction

    Ventricular Aneurysm


    Pulmonary Embolism

    If pt comes in ed with stable angina have to think its an MI and rule it out do an ECK and xray then if proved its not then they go from there
  27. Test for Angina
    • H&P,
    • CXR,
    • ECHO,
    • enzymes etc
  28. Tests for MI
    Electrocardiogram Findings

    Serum Cardiac Markers

    Other Measures
  29. MONA
    treatment for angina




  30. Treatment ABCDE for pts with Angina
    A: aspirin watch signs of bleeding, stool color, GI distress, when taken for cardiac disease or prevention it usually once a day

    B: why give beta blocker? Lowers bp and HR there by decreasing afterload and workload of heart

    C: stain breing cholesterol down, stop smoking

    D: keep sugar under control

    E: exercise, education
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