Ch.-40-part-2 - Ch 40 CAD and ACS Part 2 Nicotine increases...

Ch. 40 CAD and ACS Part 2
Nicotine increases risk for CAD by as many as 6 times. Patients need to understand that the lower
amount of nicotine per cigarette does not decrease the risk. Of course I’m talking about those cigarettes
that are labeled as lights. Nicotine is a CNS stimulant and thus increases the SNS response, those things
we are familiar with such as increased HR, those flight or fight responses and symptoms you are familiar
with. In saying this increases the workload of the heart, where you have carbon monoxide competing
with O2 consumption for use. That definitely causes an increase on the myocardium. So every time that
nicotine is ingested or inhaled, this cycle begins again.
Other things, managing cholesterol. We have several types of medications on the market now to help
reduce cholesterol numbers because we know the significance that it has to the development of CAD.
Antihyperlipidemics will include the classes of statin drugs, bile acid sequestrants, and then those things
that also work to decrease your cholesterol absorption. The downside of these classes of medications is
of course that they have some significant side effects. Also listed on this slide, niacin that is something
that can be bought over the counter, even side effects with niacin use that actually works by lowering
the LDL levels. Another thing that have seen lately last several years is that red yeast rice that can be
bought over the counter, does turn client’s urine red/pink, that is something that has been proven to
lower a person’s cholesterol. Again it’s over the counter, scripts not needed for it.
Lab assessment will include troponin levels, the evaluation of troponin, creatinine and kinase, and then a
CK MB, those are 2 separate things, myoglobin, imaging assessment which would include valium stress
test or scan and then a stress test like a tread mill stress test. A valium scan is going to be essentially an
isotope that is injected to stress the heart to do the same thing the tread mill would do; increasing those
SNS response and putting an increase on cardiac oxygen consumption, trying to induce those changes
and then evaluation of that after those changes are induced or see if the changes that occurred were
abnormal or normal to that stress response. 12 lead EKG or electrocardiogram will be able to obtain, and
then a cardiac catheterization. Then which could actually lead to a cardiac intervention using balloon
therapy or PTCA where a stint is placed.
For enzymes, cardiac enzymes, as you have heard of before, you have your CK, you have your whole
cardiac enzymes include your CK, creatinine and kinase, CK MB, you need to know the difference
between the two. CK is just general muscle injury that incurs, however it is part of that initial evaluation
and part of that enzyme panel. The MB is going to be more specific to myocardial damage that has been
done. And you see this MB stands for myocardial bound, and so it is a direct correlation to myocardial
injury. You will also see elevations in LDH and this is of course from lactate is a byproduct of anaerobic