01b: Atherosclerosis

Question 1

Which vessels are favored sites of atherosclerosis/atheroma formation?

Answer 1

1. Abdominal aorta
2. Coronary aa
3. Carotid aa
4. Popliteal aa

Question 2

Atherosclerosis: intimal lesion composed of which cell types?

Answer 2

Endothelial, smooth muscle, macrophages, inflammatory cells

Question 3

T/F: Lipid found in atheroma is mainly cholesterol.

Answer 3

False - cholesterol esters

Question 4

What’s a “fatty streak”?

Answer 4

Accumulation of foam cells in the intima

Question 5

Rupture of plaque is more likely in atheromas with which main characteristics?

Answer 5

1. Large lipid core (over 40% of atheroma volume)

2. Thin fibrous cap (with little smooth muscle)

Question 6

Complications of atherosclerosis:

Answer 6

1. Calcification
2. Hemorrhage
3. Rupture/erosion
4. Embolization

Question 7

Arterial stenosis: a “significant” lesion is reduction by (X)% of diameter and symptoms (present/absent) at rest.

Answer 7

X = 50-70

Absent (symptoms upon exertion)

Question 8

Arterial stenosis: a “critical” lesion is reduction by (X)% of diameter. (Y)% stenosis will reduce resting flow.

Answer 8

X = 75+
Y = 90+

Question 9

Risk factors for atherosclerosis.

Answer 9

1. Diabetes
2. Hyperlipidemia
3. HT
4. Smoking
5. Male sex
6. Age
7. Genetics

Question 10

What’s a “false” aneurysm?

Answer 10

A psueudo-aneurysm; outpouching of blood vessel (not widening of the original vessel)

Question 11

Histopathology of MI: 1-3h from infarction.

Answer 11

Wavy fiber change

Question 12

Histopathology of MI: 4-12h from infarction.

Answer 12

1. Coagulation necrosis
2. Neutrophil infiltration (6-8h)
3. Nuclear pyknosis (at 12h)

Question 13

Histopathology of MI: when does neutrophil infiltration peak?

Answer 13

48h

Question 14

Histopathology of MI: 3 days after infarction.

Answer 14

Vessel proliferation

Question 15

Histopathology of MI: 4 days after infarction.

Answer 15

1. Fibroblast proliferation

2. Macrophage infiltration

Question 16

Histopathology of MI: 9 days after infarction.

Answer 16

Collagen deposition

Question 17

Histopathology of MI: 2-4 weeks post-infarction.

Answer 17

Granulation tissue formation/peak

Question 18

Histopathology of MI: when would you expect to see mature scar?

Answer 18

Over 6 weeks post-infarct

Question 19

Infarctions can be described pathologically by the extent of (X) they produce within the myocardial wall. (Y) infarcts span its entire thickness.

Answer 19

X = necrosis
Y = transmural

Question 20

The (X) myocardial layers are particularly susceptible to ischemia because this zone is subjected to the highest (Y) and has few (Z) that supply it.

Answer 20

X = subendocardium (innermost)
Y = pressure from the ventricular chamber
Z = collateral connections

Question 21

Typical pressures in RA

Answer 21

0-6

Question 22

Typical pressures in RV

Answer 22

24/6

Question 23

Typical pressures in Pulm a

Answer 23

24-30/12

Question 24

Typical PCWP

Answer 24

6-12

Question 25

Typical pressures in LA

Answer 25

6-12

Question 26

Typical pressures in LV

Answer 26

90-140/6-12

Question 27

Typical pressures in Aorta

Answer 27

90-140/60-90

Question 28

RA wave forms and their significance.

Answer 28

v: passive filling (during systole) y: rapid emptying a: atrial contraction x: atrial relaxation

Question 29

RV has one named "a" wave, which signifies (X).

Answer 29

X = atrial kick (end of diastole)

Question 30

Pulm a waveform characterized by (X) peak and (Y) trough. What wave makes it similar to aortic P waveform?

Answer 30

``` X = systolic Y = diastolic ``` Dicrotic notch (signifying pulmonic valve closure)

Question 31

PCWP has waveform similar in morphology to (X).

Answer 31

X = RA

Question 32

Aortic stenosis: what would you look for in the hemodynamic tracing to ID this disease state?

Answer 32

Significant systolic P drop between LV and aorta

Question 33

Aortic regurgitation: what would you look for in the hemodynamic tracing/waveform to ID this disease state?

Answer 33

1. Continuous rise in LV diastolic filling pressure | 2. Gradual decline in aortic diastolic P with absence of dicrotic notch

Question 34

Mitral stenosis: what would you look for in the hemodynamic tracing/waveform to ID this disease state?

Answer 34

High PCWP with significant P gradient between diastolic PCWP and LVEDP

Question 35

Mitral regurgitation: what would you look for in the hemodynamic tracing/waveform to ID this disease state?

Answer 35

1. Elevated PCWP | 2. Hallmark feature: pronounced V wave on PCWP (venous filling)

Question 36

Tricuspid stenosis: what would you look for in the hemodynamic tracing/waveform to ID this disease state?

Answer 36

Elevated RA P with high P gradient between diastolic Ps of RA and RV

Question 37

Pulmonic stenosis: what would you look for in the hemodynamic tracing/waveform to ID this disease state?

Answer 37

Elevated RV P with high P gradient between systolic Ps of RV and pulmonary a

Question 38

In (X) shock, all heart pressures are decreased, CO is (increased/decreased), and (SVR/PVR) is increased.

Answer 38

X = hypovolemic Decreased Both increased

Question 39

Why is SVR (high/low/normal) in hypovolemic shock?

Answer 39

High; | Compensatory vasoconstriction in response to hypotension (low CO)

Question 40

Cardiogenic shock: what's the main issue?

Answer 40

Reduced tissue perfusion because heart is unable to pump adequate amount of blood (low CO)

Question 41

In (X) shock, diastolic filling pressures are increased, CO is (increased/decreased), and (SVR/PVR) is (increased/decreased).

Answer 41

X = cardiogenic Decreased; Both increased

Question 42

In (X) shock, all heart pressures are essentially normal. CO is (increased/decreased), and (SVR/PVR) are (increased/decreased).

Answer 42

X = septic Increased Decreased (systemic vasodilation via inflammatory mediators)

Question 43

In massive PE, why is PVR (high/low/normal) and SVR (high/low/normal)?

Answer 43

High because embolism causes "stenosis" of pulmonary vasculature; High due to vasoconstriction (response to low BP)

Question 44

In massive PE, heart pressures are (high/low/normal).

Answer 44

High on R side of heart

Question 45

Hallmark feature of cardiac tamponade involves (X) of heart pressures.

Answer 45

X = diastolic equalization

Question 46

Cardiac tamponade: CO is (increased/decreased), SVR/PVR are (increased/decreased), and patient is (hyper/hypo)-tensive.

Answer 46

Decreased; Increased; Hypotensive

Question 47

T/F: O2 saturation in SVC, IVC, RA, RV, and PA are about the same (75%).

Answer 47

True

Question 48

A rise in O2 saturation by (X)% is considered significant and diagnostic for (R/L) to (R/L) shunt.

Answer 48

X = 7 | L to R

Question 49

Patent ductus arteriosus can be detected by step (up/down) in (X).

Answer 49

``` Up; Pulm artery (inappropriate connection between PA and aorta) ```

Question 50

Renal a stenosis in elderly male likely caused by (X). And in young female likely caused by (Y).

Answer 50

``` X = atherosclerosis Y = fibromuscular dysplasia ```