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exb 117 midterm > 5-6. Atherosclerosis > Flashcards

5-6. Atherosclerosis Flashcards

1
Q

What is atherosclerosis?

A

A sequential, repetitive process of endothelial damage and sub-endothelial accumulation of fibro-fatty deposites, leading to inflammation

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2
Q

What does atherosclerosis ultimately lead to?

A

Vascular occlusion –> limit or completely stop bloodflow

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3
Q

List the layers of the arterial wall from innermost to outermost.

A
  • Tunica intima
  • Tunica media
  • Tunica adventitia
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4
Q

What is the tunica intima composed of?

A
  • Endothelium

- Internal elastic lamina

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5
Q

What is the tunica media composed of?

A

Smooth muscle cells

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6
Q

What is the tunica adventitia composed of?

A
  • External elastic lamina
  • Connective tissue
  • Vaso vasorum
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7
Q

In what type and size arteries does atherosclerosis most commonly occur?

A
  • Medium/large arteries

- Coronary and cerebral arteries

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8
Q

Describe the process and stages of atherosclerosis?

A
  1. Fatty streak
  2. Fatty plaque
  3. Fibrous plaque
  4. Complicated plaque
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9
Q

What % of Americans die from atherosclerosis?

A

21%

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10
Q

What is the “clinical threshold” (final step) for atherosclerosis?

A

Diminished blood flow (occlusion) often due to thrombus (clot) formation

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11
Q

What can happen if occlusion occurs in the carotid arteries?

A
  • Transient ischemia attack
  • Stroke
  • Cerebrovascular accident
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12
Q

What can happen if occlusion occurs in the coronary arteries?

A
  • MI
  • Sudden death
  • Angina pectoris
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13
Q

What can happen if occlusion occurs in the peripheral arteries?

A

Claudication

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14
Q

What can happen if occlusion occurs in the aorta?

A

Aneurysm

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15
Q

Define claudication.

A

“Angina of the limb”: insufficient blood flow to the limb causes sx of aching, cramping, and burning

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16
Q

What initiates endothelial damage?

A

Big 5 risk factors

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17
Q

List the Big 5 risk factors of atherosclerosis.

A
  • Smoking
  • High blood lipids (LDL cholesterol)
  • Hypertension
  • Diabetes
  • Lack of physical activity
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18
Q

Other than the big 5 risk factors, what are some dependent risk factors that initiate endothelial damage?

A
  • Chronic inflammatory states
  • Lack of estrogen
  • Homocysteine
  • Psychological stress
  • Obesity
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19
Q

What is atherogenesis?

A

Endothelial dysfunction and increased lipoprotein entry

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20
Q

What is the body’s response to atherogenesis?

A

INFLAMMATORY:

  • lipoprotein modification, recruitment of leukocytes
  • foam cell formation
  • development of fatty streak
  • recruitment of smooth muscle cells
  • formation of fibrous plaque
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21
Q

When can regression occur during atherosclerosis?

A
  • During the early stages (before fibrous plaque)

- When serum cholesterol level is significantly reduced (due to drugs or change in lifestyle)

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22
Q

What does atherosclerosis regression lead to?

A

Plaque stabilization (doesn’t shrink much if at all)

23
Q

What are the clinical benefits of atherosclerosis regression?

A
  • Decreased angina sx
  • Decreased MIs
  • Decreased total CV mortality
24
Q

What is the mechanism of atherosclerosis regression?

A

Decreased blood cholesterol via reverse cholesterol transport by HDL

25
Q

What are the natural first presentations of coronary artery disease? % of each?

A
  • 20-25% sudden death
  • 45-55% MI
  • 20-35% angina
26
Q

What decreases myocardial O2 supply?

A

Coronary atherosclerosis (~60% occlusion)

27
Q

What increases myocardial O2 demand?

A

Exercise (via increase in RPP)

28
Q

What occurs if myocardial O2 demand is greater than the supply?

A
  • Angina
  • Arrhythmia, ST depression
  • Hypotension
  • Exercise intolerance
  • Dyspnea
  • MI
  • Sudden death
29
Q

What is the gold standard of coronary artery disease diagnosis?

A

Angiogram

30
Q

What are the non-invasive ways to diagnose coronary artery disease?

A
  • Exercise electrocardiography (GXT, stress test)
  • Nuclear medicine (myocardial thallium perfusion)
  • Echocardiography
31
Q

How does exercise electrocardiography work to diagnose coronary artery disease?

A

Creates a transient ischemia by increasing myocardial demand beyond the flow limits of the potential atherosclerotic lesion

32
Q

How does echocardiography work to diagnose coronary artery disease?

A

Exercise stress is used to precipitate transient ischemia –> heart is visualized echocardiographically, looking for “hypokinetic/akinetic” wall segments

33
Q

What interventions are used to increase myocardial O2 supply?

A

Revascularization:

  • PCTA
  • CABG
  • Angioplasty
  • Angiogenesis
34
Q

What interventions are used to decrease myocardial O2 demand?

A
  • Meds

- Exercise training

35
Q

How does angioplasty increase myocardial O2 supply?

A

Catheter inserted –> tiny ballon inflated –> smooshes fatty plaque up against artery wall –> stent inserted to maintain opening –> increases bloodflow

36
Q

How does angiogenesis increase myocardial O2 supply?

A

Catheter inserted –> growth factor capsules implanted in the myocardial wall –> spurs the growth of new blood vessels

37
Q

What is the goal for physical activity when trying to limit endothelial damage?

A
  • 3-6 hrs/week
  • 10K steps/day
  • 150 MetxMins/day
  • 450-750 MetxMins/week
38
Q

What is the ideal blood glucose level?

A

Less than 110 mg/dl

39
Q

What are the ideal levels for blood lipids?

A
  • LDL less than 130

- HDL greater than 50

40
Q

How does medical therapy (drugs) help treat atherosclerosis?

A

Lowers RPP –> reduces the heart’s demand for oxygen at any level of whole body work

41
Q

What are the agents used to lower RPP?

A
  • Nitrates
  • Beta blockers
  • Ca2+ channel blockers
  • Exercise training
42
Q

How do nitrates lower RPP?

A
  • Veno and vasodilators
  • Lowers BP
  • Lowers wall tension
43
Q

How do beta blockers lower RPP?

A

Blocks receptors for catecholamines –> lowers HR & BP

44
Q

How do Ca2+ blockers lower RPP?

A

Lowers HR (chronotropy) and contractility (inotropy)

45
Q

How does exercise training lower RPP?

A
  • Reduces catecholamine release
  • Lowers HR
  • Lowers BP
46
Q

What is a simple, safe intervention to lower platelet “stickiness”?

A

Micro aspirin treatment

47
Q

What are the goals of cardiac rehab?

A
  • Rehabilitate the patient to be a fully functional member of society and their family
  • Decrease the risk of a recurrent cardiac event
48
Q

What does cardiac rehab NOT do?

A
  • Repair deficits in cardiac function

- Re-establish blood flow

49
Q

What are the phases of cardiac rehab?

A
  1. Inpatient or acute
    2a. Early outpatient or subacute
    2b. Progressive conditioning
  2. Maintenance
50
Q

What medications are prescribed as a part of cardiac rehab?

A
  • Aspirin
  • Lipid lowering agents
  • Beta blockers
  • ACE inhibitors
51
Q

What single disease process accounts for ~1/3 of all deaths in the U.S.?

A

Atherosclerosis

52
Q

What is the primary non-pharmaceutical intervention to elevate HDL?

A

Aerobic exercise

53
Q

What is the primary non-pharmaceutical intervention to lower LDL? What are additional interventions?

A
  • *Diet intervention
  • high fiber
  • regular exercise

exb 117 midterm (4 decks)

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