Arteriosclerosis

Question 1

what layer is artherosclerosis in?

Answer 1

arterial intima

Question 2

what are atheromas

Answer 2

formation of focal plaques

Question 3

what is one of the most important modifiable risk factors for atherosclerosis?

Answer 3

CIGARETTE SMOKING

Question 4

2 risk factors increases your risk by how much?

Answer 4

4x risk

Question 5

3 risk factors increases your risk by how much?

Answer 5

7x risk

Question 6

as total serum cholesterol rises above _____, coronary risk rises linearly

Answer 6

160

Question 7

genetic disorder: incr in chylomicrons, no premature AS

Answer 7

Type I: Familial lipoprotein lipase deficiency

Question 8

genetic disorder: incr LDL, premature AS

Answer 8

IIa Familial hypercholesterolemia

Question 9

genetic disorder: incr LDL & VLDL, premature AS

Answer 9

IIb Familial combined hypercholesterolemia

Question 10

genetic disorder: incr IDL, premature AS

Answer 10

III Familial type III lipoproteinemia

Question 11

genetic disorder: incr VLDL, premature AS

Answer 11

IV Familial hypertriglyceridemia

Question 12

genetic disorder: no HDL w/ severe AS

Answer 12

V Only Familial AI/CII deficiency

Question 13

type 5 dyslipoproteinemias and risk

Answer 13

start developing AS in their 20’s

Question 14

what secondary disorders have high cholesterol

Answer 14

1. nephrotic syndrome
2. alcoholism
3. hypothyroidism
4. DM

Question 15

correlation of long term elevations of CRP and atherosclerosis

Answer 15

high CRP = higher risk of atherosclerosis

Question 16

what is the initial process driving atherosclerosis?

Answer 16

damage to endothelial cells

Question 17

what induces endothelial injury?

Answer 17

hypercholesteremia, disturbed flow

Question 18

key features of atherosclerosis (3)?

Answer 18

1. Smooth muscle cell proliferation
2. Accumulation of connective tissue elementscollagen, elastin, proteoglycans
3. Lipid deposition: intra & extracellular

Question 19

what is in a fibro fatty atheroma?

Answer 19

necrotic core surrounded by foamy macrophages

Question 20

is atherosclerosis an acute or chronic inflammatory disease?

Answer 20

CHRONIC

Question 21

what are the different cells involved in atherosclerosis?

Answer 21

endothelial cell, t-lymphocyte, smooth muscle cell, platelet, macrophage

Question 22

once necrotic tissue gets into the vasculature, what is it called?

Answer 22

grumous (pro-thrombotic)

Question 23

what is the main complication of lesions?

Answer 23

rupture or ulceration–>causes instant thrombosis

Question 24

what is the most predictive in determining risk of issues assc’d with plaques?

Answer 24

VULNERABLE PLAQUE

Question 25

what is vulnerable plaque?

Answer 25

soft with lipid filling core, prone to rupture due to plaque hemorrhage or fibrous cap disruption

Question 26

role of inflammation in plaque rupture?

Answer 26

vulnerable plaque-->rupture-->thrombus-->MI

Question 27

what are methods of primary prevention

Answer 27

Statins, control BP, DM, control clotting, diet and lifestyle change

Question 28

secondary prevention?

Answer 28

Tissue plasminogen activator, angioplasty with stent | placement (coronary of carotid), carotid endarterectomy, CABG

Question 29

where do atherosclerotic lesions most often form?

Answer 29

branch points in heart vasculature, can affect major arteries throughout the body

Question 30

what is an abnormal ankle brachial pressure index (ABPI)?

Answer 30

ABPI >1.3

Question 31

what does an abnormal ABPI suggest?

Answer 31

calcification of the artery walls & incompressible vessels

Question 32

when to start worrying about potential for aortic aneurysm?

Answer 32

when thrombotic tissue >5 cm

Question 33

in minimal and moderate coronary artery disease, what happens to the size of the lumen?

Answer 33

compensatory expansion of vessel wall maintains CONSTANT lumen

Question 34

what happens to lumen on severe CAD?

Answer 34

expansion is overcome & lumen narrows

Question 35

what is the name of the hypothesis that says what happens to the size of the lumen over time with coronary remodeling?

Answer 35

glagov's coronary remodeling hypothesis

Question 36

when the lumen is reduced by _______, the vessel can no longer dilate enough to meet demands for incr blood flow

Answer 36

70-80%