Term
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Definition
| gender; age; family history or genetic composition; environmental influences such as climate, air pollution, trace metal composition of drinking water; and to some extent, diabetes mellitus |
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Term
| Risk factors that can be altered |
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Definition
| smoking, hypertension, hyperlipidemia, obesity, sedentary lifestyle, hyperuricemia, psychosocial factors such as stress and type A behavior patterns, and the use of certain drugs that may be detrimental, including progestins, corticosteroids, and cyclosporine. |
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Term
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Definition
elevated heart rate and blood pressure from nicotine
he negative inotropic effect of carboxyhemoglobin
increased platelet adhesiveness and promotion of aggregation resulting in thrombotic tendencies because of nicotine and carboxyhemoglobin; (d) lowered threshold for ventricular fibrillation during ischemia as a consequence of carboxyhemoglobin; and (e) impaired endothelial function owing to smoking |
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Term
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Definition
| <130/80 mm Hg for patients with stable angina, unstable angina, non–ST-segment myocardial infarction, ST-segment myocardial infarction and <120/80 mm Hg in patients with left ventricular dysfunction |
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Term
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Definition
A – anticoagulation, ACE-I/ARBs, anti-anginals.
B – beta blockers, blood pressure.
C – cholesterol management, cigarette smoking, cardiac re-vascularization.
D – diabetes, diet.
E – education, exercise |
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Term
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Definition
• Age (NCEP says males over 45, females over 55. JNC says males over 55, females over 65).
• Family History (CHD in 1st degree male before 55 or female before 65).
• Current cigarette smoking.
• Hypertension (over 140/90 or on HTN medication).
• Dyslipidemia (low HDL, high TC and LDL).
• Diabetes Mellitus – considered to have “equivalent risk” as someone who already has IHD.
• Microalbuminuria.
• Physical inactivity.
• Type A personality – controversial, but clotting factors are elevated in these people.
• Alcohol ingestion is not a risk factor for development of CAD, moderate amounts decrease CAD. |
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Term
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Definition
This is a seven-point risk score for ACS pts to predict the risk of death, re-infarction or severe ischemia.
•Age > 65 years.
•More than three coronary risk factors.
•Prior angiographic coronary obstruction.
•ST-segment deviation.
•More than 2 angina events within 24 hours.
•Use of aspirin within 7 days.
•Elevated cardiac markers.
• 0-2 = low risk
• 3-4 = intermediate risk
• 5-7 = high risk |
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Term
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Definition
| Aspirin affects platelet aggregation by irreversibly inhibiting prostaglandin cyclooxygenase. This effect lasts for the life of the platelet and prevents the formation of the platelet aggregating factor thromboxane A2. Nonacetylated salicylates do not inhibit this enzyme and have no effect on platelet aggregation. At somewhat higher doses, aspirin reversibly inhibits the formation of prostaglandin I2 (prostacyclin), which is an arterial vasodilator and inhibits platelet aggregation. |
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Term
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Definition
| Clopidogrel must be metabolized by CYP-450 enzymes to produce the active metabolite that inhibits platelet aggregation. The active metabolite of clopidogrel selectively inhibits the binding of ADP to its platelet P2Y12 receptor and the subsequent ADP-mediated activation of the glycoprotein IIb/IIIa complex, thereby inhibiting platelet aggregation. This action is irreversible. Consequently, platelets exposed to clopidogrel's active metabolite are affected for the remainder of their lifespan (approximately 7 to 10 days). Platelet aggregation induced by agonists other than ADP is also inhibited by blocking the amplification of platelet activation by released ADP |
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Term
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Definition
| Prasugrel is a thienopyridine class inhibitor of platelet activation and aggregation through the irreversible binding of its active metabolite to the P2Y12 class of adenosine diphosphate receptors on platelets |
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Term
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Definition
• Hypertension
• Hyperlipidemia
• Diabetes
• Smoking
• Family History |
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Term
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Definition
| The short-term goals of therapy for ischemic heart disease are to reduce or prevent the symptoms of angina that limit exercise capability and impair quality of life. Long-term goals of therapy are to prevent CHD events such as myocardial infarction, arrhythmias, and heart failure and to extend the patient's life. |
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Term
| Use of anti-platelet therapy in patient's at risk of IHD |
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Definition
Those with a 10-year risk greater or equal to 10%.
•Aspirin – 75-162.5mg QD.
oRole of ASA in women is controversial. Irreversible platelet inhibitor.
o81mg almost completely inhibits Thromboxane A2 synthetase. Platelet half-life 7-10 days.
•clopidogrel (Plavix) – 75mg QD
oThienopyridine that irreversibly inhibits ADP induced platelet aggregation.
o For those intolerant to ASA. |
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Term
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Definition
| intracellular sodium leading to reduced calcium overload, decreasing wall tension and contractile dysfunction |
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