Arteriosclerosis Flashcards
what layer is artherosclerosis in?
arterial intima
what are atheromas
formation of focal plaques
what is one of the most important modifiable risk factors for atherosclerosis?
CIGARETTE SMOKING
2 risk factors increases your risk by how much?
4x risk
3 risk factors increases your risk by how much?
7x risk
as total serum cholesterol rises above _____, coronary risk rises linearly
160
genetic disorder: incr in chylomicrons, no premature AS
Type I: Familial lipoprotein lipase deficiency
genetic disorder: incr LDL, premature AS
IIa Familial hypercholesterolemia
genetic disorder: incr LDL & VLDL, premature AS
IIb Familial combined hypercholesterolemia
genetic disorder: incr IDL, premature AS
III Familial type III lipoproteinemia
genetic disorder: incr VLDL, premature AS
IV Familial hypertriglyceridemia
genetic disorder: no HDL w/ severe AS
V Only Familial AI/CII deficiency
type 5 dyslipoproteinemias and risk
start developing AS in their 20’s
what secondary disorders have high cholesterol
- nephrotic syndrome
- alcoholism
- hypothyroidism
- DM
correlation of long term elevations of CRP and atherosclerosis
high CRP = higher risk of atherosclerosis
what is the initial process driving atherosclerosis?
damage to endothelial cells
what induces endothelial injury?
hypercholesteremia, disturbed flow
key features of atherosclerosis (3)?
- Smooth muscle cell proliferation
- Accumulation of connective tissue elementscollagen, elastin, proteoglycans
- Lipid deposition: intra & extracellular
what is in a fibro fatty atheroma?
necrotic core surrounded by foamy macrophages
is atherosclerosis an acute or chronic inflammatory disease?
CHRONIC
what are the different cells involved in atherosclerosis?
endothelial cell, t-lymphocyte, smooth muscle cell, platelet, macrophage
once necrotic tissue gets into the vasculature, what is it called?
grumous (pro-thrombotic)
what is the main complication of lesions?
rupture or ulceration–>causes instant thrombosis
what is the most predictive in determining risk of issues assc’d with plaques?
VULNERABLE PLAQUE
what is vulnerable plaque?
soft with lipid filling core, prone to rupture due to plaque hemorrhage or fibrous cap disruption
role of inflammation in plaque rupture?
vulnerable plaque–>rupture–>thrombus–>MI
what are methods of primary prevention
Statins, control BP, DM, control clotting, diet and lifestyle change
secondary prevention?
Tissue plasminogen activator, angioplasty with stent
placement (coronary of carotid), carotid endarterectomy, CABG
where do atherosclerotic lesions most often form?
branch points in heart vasculature, can affect major arteries throughout the body
what is an abnormal ankle brachial pressure index (ABPI)?
ABPI >1.3
what does an abnormal ABPI suggest?
calcification of the artery walls & incompressible vessels
when to start worrying about potential for aortic aneurysm?
when thrombotic tissue >5 cm
in minimal and moderate coronary artery disease, what happens to the size of the lumen?
compensatory expansion of vessel wall maintains CONSTANT lumen
what happens to lumen on severe CAD?
expansion is overcome & lumen narrows
what is the name of the hypothesis that says what happens to the size of the lumen over time with coronary remodeling?
glagov’s coronary remodeling hypothesis
when the lumen is reduced by _______, the vessel can no longer dilate enough to meet demands for incr blood flow
70-80%
