angina

Question 1

what are the three types of arterial disease

Answer 1

artherosclerosis (large/medium)
monckberg (medium)
arteriosclerosis (small)

Question 2

dystrophic calcification is associated with which kind of arterial disease

Answer 2

monckerberg arteriosclerosis: media classically involved

Question 3

which layer is affected in monckeberg?

Answer 3

media. lumen unaffected

Question 4

which layer affected in artherosclerosis

Answer 4

intima, cholesterol plaque within vessel walls

Question 5

causes of artherosclerosis

Answer 5

smoking, diabetes, HTN, dyslipidemia, age

Question 6

What happens to the artery when its damaged?

Answer 6

platelets binds to the subendothelium and releases PDGF and cytokine: monocyte adhesion and macrophage stays activated in vessel intima (and eats the lipids)= foam cell

smooth muscle also digests the fat. (PDGF recruits this step)

many foam cells= fatty streak

foam cells fibrous cap formation (plaque)–>complex atheroma (calcification)

Question 7

in atheroma formation _____ also proliferate and deposit extracellular matrix by secreting collagen and other fibrous materials.

Answer 7

smooth muscle cells

Question 8

What are the two forms of arteriosclerosis

Answer 8

hyaline: pink amorphous material on H & E staining
hyperplastic: onion skin appearance

Question 9

What are the factors involved in smooth muscle cell recruitment?

Answer 9

PDGF
FGF
Endothelin-1
Interleukin-1

Question 10

Whats the difference between stable and unstable plaque?

Answer 10

Fibrous cap determines plaque stability.

Question 11

progressive, decreased coronary blood flow and increased VEGF- what kind of plaque

Answer 11

stable

Question 12

chronic inflammation, macrophage activation, metalloprotienases break down the extracellular matrix protiens–>thin cap fibroatheromas. risk of rupture–>thrombus formed over plaque, acute coronary syndrome. what type of plaque?

Answer 12

unstable plaque. no collateral circulation

Question 13

atherosclerotic plaque stability is not related to which factors

Answer 13

plaque size or luminal narrowing
only related to fibrous cap

Question 14

What are the types of coronary artery disease

Answer 14

angina
acute coronary syndrome
-unstable angina, NSTEMI, STEMI

Question 15

What are the three criteria of angina

Answer 15

retrosternal chest pain
worse with exertion
improved with rest or nitroglycerin

Question 16

angina presents with ___% of stenosis

Answer 16

> 70% of stenosis, without tissue infarction

Question 17

In stable angina, what are the ECG changes and cardiac enzymes?

Answer 17

ECG–> no ST changes
cardiac enzymes-> not significantly elevated

Question 18

retrosternal radiating non pleurtic non reproducible to palpation

Answer 18

stable angina

Question 19

Why are dipyridamole and adenosine used to stress test the heart?

Answer 19

vasodilators, increase the HR (reflex tachycardia)

Question 20

what do you give for stable angina (medical management)

Answer 20

antianginal therapy (nirates)
antiplatelet (asprin, clopidogrel)–> decrease risk of occlusive thrombus formation
statin therapy–> atorvastatin: decrease risk of acute coronary events
antihypertensive –> ACE inhibitor, ARB.

Question 21

What is vasospastic angina

Answer 21

transient coronary vasospasm

Question 22

presentation of vasospastic angina

Answer 22

younger patient, smoking, cocaine, triptans***, alcohol.
recurrent chest pain, occuring at night, but not affected by exertion.

Question 23

ecg during vasospastic angina

Answer 23

ST elevation during an episode

Question 24

treatment for vasospastic angina

Answer 24

symptomatic: nitroglycerin
preventative: calcium channel blockers

Question 25

Which situation do you avoid nitrates?

Answer 25

right venticular MI

Question 26

What cardiac drugs do you avoid in the AV block?

Answer 26

B blockers and Calcium channel blockers