5. Rorabaugh - Atherosclerosis And PVD Flashcards
Atherosclerosis
Arterial inflammation and the deposition of fatty plaques (atheromas) w/in the arterial wall
Blood flow it blocked
Agents to treat Hyperlipidemia
Hint, there’s 5
- HMG-CoA Reductase Inhibitors
- Niacin
- Bile Acid Binding Resins
- Ezetimbe
- Fabric Acid Derivatives
MOA of HMG CoA Reductase Inhibitors
Inhibit 3-hydroxy-3methylglutaryl coenzyme A reductase. This blocks the rate limiting stop in cholesterol formation.
Ex. Statins
MOA of Niacin
Vitamin B3, indirectly decreases LDL production in hepatocyte by inhibiting VLDL secretion
MOA of Bile Acid Binding Resins
Prevent enterohepatic reuptake of bile acids (cholesterol metabolites) which would otherwise be reabsorbed in the jejunum and be converted back into cholesterol
Ex. Colestipol and cholestyramine
MOA of Ezetimbe
Inhibits intestinal cholesterol absorption
MOA of Fibric Acid Derivatives
Binds to a nuclear transcription factor that alters the expression of specific genes involved in lipid transport/metabolism
MOA of Aspirin in Atherosclerosis
- Inhibit platelet aggregation
2. Decreases inflammation of arterial wall
Can atherosclerosis be revered?
Yes! Lifestyle changes can reverse coronary artery stenosis and significantly alter progression of CAD
Characteristics of Atherosclerotic Renal Artery Stenosis
- atherosclerosis in the renal artery, restricting blood flow
- can affect one or both kidneys
- typically found in pts who have other comorbid diseases
- with decreased renal perfusion, kidneys think that BP is low and respond by activating the RAS system to increase BP
Stages of ARAS
- Acute occlusion and 2. occlusion for days/weeks –> increased BP, elevated renin and ANG II, elimination of obstruction can normalize BP
- Occlusion for months –> renin/ANG levels are not elevated, elimination of obstruction does not normalize BP
Signs and Symptoms of ARAS
- Onset of HTN before 30 or severe after 55 yrs
- Malignant or resistant HTN
- Atrophy of kidney
- Unexplained pulmonary edema
- Unexplained congestive heart failure
Treatment goals ARAS
- Normalize BP
- Preserve renal function
- Decrease risk of adverse CV events
Treatment of ARAS
- Statins to alter lipid profile
- Anti-HTN
- Glycemic control
- Surgical option to restore blood flow
Atherosclerotic Mesenteric Artery Disease (AMAD)
Stenosis of mesenteric arteries caused by atherosclerosis
Signs and Symptoms of AMAD
- Abdominal pain from eating
- Significant weight loss
Treatment of AMAD
Usually surgery
- Endarterectomy: remove plaque from mesenteric artery
- Bypass graphting
- Stent
Arteriolosclerosis obliterates
Plaque in blood vessels that carry blood to the legs
Classification of Claudation in Atherolosclerosis Obliterans
- Asymptomatic
- Intermittent claudication - can walk, pain sometimes
2a. Pain free at rest, claudication (pain) while walking for long time
2b. Pain free at rest, claudication when long for short time - Pain at rest and at night
- Necrosis/gangrene
Treatment of Atherolosclerosis Obliterans
Decrease serum cholesterol, stop smoking, limited exercise, antiplatelet therapy, avoid cold weather
Thromboangitis Obliterans (Berger’s Disease)
Fingers and hands have segmental inflammation, only a small section of blood vessels are inflamed, causing vasoconstriction, decreasing blood flow, and leading to necrotic fingers
Typical Pt of Thromboangitis Obliterans
Smoker
Diagnosis of Thrombangitis Obliterans
Onset of ischemia in toes/fingers, tobacco use, exclusion of embolic sources, no other atherosclerotic risk factors
Treatment of Theromboangitis Obliterans
Avoid tobacco
No cure, only treatment of symptoms; pain management, antibiotics to prevent infection, amputation of necrotic tissues
Raynaud’s Disease
Vasospasms in arteries of fingers and toes
Stages of Raynaud’s
- Sudden loss of arterial blood flow –> white fingers
- Small quantity of blood enters capillary and becomes desaturated of oxygen –> fingers turn blue
- Vasodilation causes redness and inflammation –> red and inflamed fingers
Treatment of Raynaud’s
- Alpha-1 antagonists (prazosin), blocking NorEpi stimulated vosospasms
- Nitroglycerin Ointment to dilate the vessels
- CCBs
- Avoid cold temperatures
Varicose Veins
Caused by leaking valves in the veins. Gravity causes large quantities of blood to pool in distal part of the vein, leading to swelling and distention of the vein.
Treatment of Varicose Veins
Conservative: avoid prolonged standing, elevate legs, compression
Laser therapy - heats vein to destroy blood flow, decreases distention and pain
Sclerotherapy - chemical injected to destroy blood flow
Endogenous obliteration - probe goes in vein and uses heat to destroy the vein
Surgical Treatment of Varicose Veins
- Ligation - tie off the vein so blood cannot flow
- Phlebotomy - cut the vein so blood cannot flow
- Stripping - physical take the vein out
Arteriosclerosis
Hardening of the arteries - thinking and loss of elasticity of arterial walls
