Coronary Artery Disease

Coronary Artery Disease ●​ Coronary Artery Disease ○​ Condition of coronary arteries ⇒ supply blood to heart muscle ○​ Heart muscle will become narrowed and blocked ●​ Most usual cause of atherosclerosis ○​ Build up of cholesterol plaques ⇐ arterial wall ●​ CAD ⇒ reduced blood flow on myocardium ○​ Result on various coronary disease ■​ Ischemia ■​ Infarction Pathophysiology ●​ Endothelial injury ○​ Damage to inner lining of coronary arteries ●​ Lipid accumulation ○​ LDL cholesterol depo ○​ Arterial wall ●​ Inflammatory response ○​ Engulfment of LDL by macrophage ⇒ foam cell formation ●​ Fatty streak formation ○​ Visible lesion in arteries ●​ Atherosclerotic plaque formation ○​ Smooth muscle proliferation ○​ Fibrous cap formation ●​ Rupture of plaque ○​ Cause thrombosis ○​ Cause acute coronary event Rx ●​ Non-modifiable ○​ Age ○​ ○​ ○​ ○​ Male sex FHx Hx on heart disease Genetic predisposition ●​ Modifiable ○​ Smoking ○​ Hypertension ○​ Diabetes mellitus ○​ Hyperlipidemia ○​ Obesity ○​ Physical inactivity ○​ Diet ■​ High fat/cholesterol ■​ Anything considered ‘unhealthy’ ○​ Excessive use of alcohol Cx ●​ Stable symptoms ○​ Angina pectoris ○​ Chest pressure/tightness ○​ Pain radiating on joints ■​ Arm ■​ Jaw ■​ Neck ○​ Short breath ○​ Fatigue ●​ Acute symptoms ○​ ○​ ○​ ○​ Severe chest pain Vomiting Nausea Sweating ■​ Diaphoresis ■​ Dizziness CAD has possibility to lead patient to Acute Coronary Syndrome. Followed by unstable angina and myocardial infraction Acute Coronary Syndrome ●​ ACS ○​ Syndrome from acute myocardial ischemia ■​ Reduced coronary blood flow ■​ From atherosclerotic plaque rupture or erosion ●​ Leads to platelet thrombus ○​ Spectrum ■​ Unstable angina (UA) ●​ Ischemic symptoms without myocardial necrosis ●​ Negative troponin ■​ NSTEMI ●​ Present myocardial necrosis ●​ Troponin positive ●​ No ST-elevation ■​ STEMI ●​ Complete coronary occlusion ●​ ST-elevation + increase of troponin ○​ Alternatives ■​ New LBBB ■​ Posterior MI eq Pathophys 1.​ Rupture of erosion of plaques exposed to collagen 2.​ Platelet adhesion and activation a.​ TXA2 b.​ ADP 3.​ Aggregation ●​ Coagulation cascade ⇒ Fibrin clot ●​ Partial or total occlusion ⇒ Ischemia ⇒ Infraction if prolonged Red flagged S ●​ Central chest pressure and tightness > 10-20 min ●​ Radiation ○​ Left arm ○​ Jaw ○​ Neck ●​ Diaphoresis ●​ Nausea and vomiting ●​ Dyspnea Atypical ●​ Common for women, elderly and diabetes ●​ Dyspnea ●​ Fatigue ●​ Epigastric pain ●​ Syncope Immediate concern ●​ Hypotension ●​ Pulmonary edema ●​ Severe pain which is ongoing ●​ Arrhythmias ●​ LOC alteration Ax 1.​ Vitals on ABCs+ 2.​ 12 lead ECG = within 10 min 3.​ Troponin a.​ Could be repeated if its early or negative 4.​ IV access, lab, need of CXR a.​ CBC b.​ Electrolytes c.​ Creatinine