Atherosclerosis & ACS

Question 1

Atheroma Definition

Answer 1

Fatty material forming plaque in arteries

Question 2

Sclerosis Definition

Answer 2

Abnormal hardening of body tissues

Question 3

Atherosclerosis Definition

Answer 3

plaque build up on arterial walls causing narrowing

Question 4

Arteriosclerosis Definition

Answer 4

age-related thickening and hardening of arteries

Question 5

Difference between lipoproteins

Answer 5

LDL - Low density (bad)
HDL - High density (good)

Question 6

Formation of atherosclerosis

Answer 6

1. LDL enters tunica intima and becomes oxidised
2. Endothelial activation: leukocyte receptors, ROS, and metalloproteases released
3. Monocytes & T helper cells migrate in; macrophages from foam cells
4. Foam cells stimulation: smooth muscle migration and proliferation, collagen production - arterial hardening, chemokines and IGF-1 attract immune cells
5. Foam cell death: releases lipids & DNA = inflammation = plaque rupture risk
6. Rupture: triggers clotting (thrombus) = impedes blood flow = ischaemia/infarction

Question 7

What happens when LDL enters the tunica intima?

Answer 7

Becomes oxidised

Question 8

components of endothelial activation

Answer 8

leukocyte receptors
ROS
metalloproteases released

Question 9

What do foam cells stimulate

Answer 9

Smooth muscle migration and proliferation
Collagen production = arterial hardening
Chemokines & IGF-1 attract more immune cells

Question 10

What can cause coronary artery disease

Answer 10

atherosclerosis or vasospasm

Question 11

Definition of MI

Answer 11

sudden, total or near-total blockage of coronary artery

Question 12

Patterns of MIs

Answer 12

Transmural MI: full thickness necrosis
Non-transmural MI: Partial-thickness necrosis

Question 13

Types of MI

Answer 13

Atherosclerotic or oxygen supply/demand imbalance

Vasospasm

Non-atherosclerotic dissection

oxygen supply/demand imbalance

Question 14

Important characteristic of non-transmural MIs

Answer 14

Often don’t produce Q waves, but show ST depression instead

Question 15

What conditions fall under acute coronary syndrome?

Answer 15

MI non-obstructive coronary arteries

Unstable angina STEMI & NSTEMI

Question 16

Why is ACS different to stable angina?

Answer 16

Dynamic stenosis, ruptured or inflammed plaque

Symptoms at rest and exertion

ECG changes at rest

Elevation of troponin

Question 17

How is unstable angina different to stable angina?

Answer 17

further narrowing

Commonly caused by intraluminal plaque, thrombosis, vasospasm and hypertension

Response to medication depends on degree of narrowing

Question 18

Risk Factors with Chest Pain

Answer 18

Worsening Angina
Prolonged Pain
Pulmonary Oedema (left sided HF)
Hypotension
Arrythmias (conduction affected)

Question 19

Treatment of ACS

Answer 19

12 Lead
IV/IO access
Systolic BP
Allergies
Oxygen (if hypoxic)
Aspirin 300mg
GTN 400-800mcg
Morphine (titrate 2mg/min) - or paracetamol/entonox
Defib pads attached
Transfer & pre-alert to hospital