Artherosclerosis Flashcards
What is the first overt sign of atherosclerotic plaque?
The “bulge” under the endothelial lining of arteries known as a “FATTY STREAK”
I am an LDL. I weasel my way under the arterial epithelium. What happens between now and when I grow up to be a fatty streak?
Monocytes are recruited to destroy me. They become macrophages and eat me. Then they turn into foam cells that just sit under the endothelium….These lipid filled foam cells are THE FATTY STREAKS! (Can that be our team name???)
In the presence of atherosclerotic plaque formation, how much can the artery walls expand before there is any change in the diameter of the arterial lumen?
40%
What test would you order to most accurately detect the amount of atherosclerotic plaque present in an arterial wall?
arterial US. (remember an angiogram will only show us the patency of the lumen)
What symptoms will your patient have once they’ve had a 40% narrowing of their ARTERIAL cross sectional area?
None
When does your patient start experiencing symptoms of limited coronary blood flow? (How much occlusion?)
75% of the LUMINAL cross sectional area is occluded.
True of False, you can have a patient with reliable stable angina who has a 60% occlusion of luminal cross section area.
False, they would not have angina symptoms at that stage.
What is the term for “death of the myocytes?”
Myocardial Infarction
What is the most common trigger for an MI?
Rupture of a plaque causes immediate clot formation and occlusion
You have twin patients. Testing has revealed one of them has a coronary plaque that is a 30% occlusion and the other has a 70% occlusion. Which one is more likely to have an MI?
50/50. Size of plaque is not an important factor in whether it will rupture.
Are you more concerned about a patient with a stable plaque that is occluding the coronary artery by 80% or an unstable plaque that is occluding a coronary artery by 20%?
UNSTABLE could rupture! Stable plaques develop very slowly
If a doctor tells you “This infarct is transmural!” How bad is the occlusion? What must be done immediately?
100% occlusion. Call the cath lab! Stent placement must occur in 90 minutes
Once you’ve determined a patient has a soft plaque, what is your plan?
You want to stabilize said plaque by hardening it. You plan to prescribe a STATIN to accomplish this
What test will you order to screen for risk of atherosclerosis?
Lipid panel
What age, according to the USPSTaskForce, should you begin screening for Lipids?
Men: 35 Women: 45
What are the reasons you’d screen pts for lipids before the target age?
If they had CAD risk equivalents: PVD, symptomatic carotid dz, AAA, DM, >20% Framingham risk
How often should you screen patients for lipids if they are A) on therapy B) not on therapy and h/o good lipid levels?
A) test yearly for patients on cholesterol therapy
B) test Q5years for patients who are “at goal” without therapy
this is a FASTING test
How do you calculate LDL cholesterol?
LDL = TC- (VLDL + HDL)
VLDL is another term for _____________
triglycerides
which type of cholesterol is most affected by a meal (hence the need for fasting test)
VLDL/TG
Your patient has a Framingham risk of >20%. What is their target LDL? _________ You’d consider lifestyle changes before adding drug therapy unless their LDL was > ____________
Target= <100mg/dL. If their level is b/t 100-129 recommend lifestyle changes. If level is 130+ add drug therapy
What factors are considered in the Framingham risk score?
Age, cholesterol, smoking, HDL, systolic BP
What major risk factors are not considered on the Framingham risk score?
FHx
What are some effective therapeutic lifestyle changes that can reduce your risk of developing atherosclerotic plaques?
1) reduce intake of saturated fats and cholesterol
2) loose wt
3) Increase activity/exercise
4) Increase fiber (hey! chocolate cheerios)
When you counsel your patient to implement these lifestyle changes, you should tell them to realistically expect a ______% decrease in their LDL.
5%
What is the first line tx for cholesterol?
STATINS
What’s the best type of cholesterol med to increase HDL?
Nicotinic Acid
Whats the best type of cholesterol med to decrease LDL?
STATIN
What’s the best type of choseterol med to decrease TG’s?
Fibrates
What are the normal, borderline, high, and very high values for triglycerides?
normal <150, borderline = 150-199, high = 200-499, very high = 500+
When looking at terrible lipid panel results, what’s your first priority? Meaning, which levels are you MOST concerned about controlling? What about your secondary goal?
LDL primary, TG secondary
What is a likely complication of “very high” TG’s? (>500)
pancreatitis
Framingham risk is <20% but your patient has 2 risk factors. Target LDL is ____________. Treat with drug therapy when LDL exceeds ___________.
Target is < 130mg/dL. Treat with lifestyle changes unless level is > 160mg/dL, then add drug therapy
Framingham risk is low, patient has only 1 risk factor. Target LDL is _____________ Treat with drug therapy when LDL exceeds_________
Target is under 160mg/dL. Recommend lifestyle change unless over 190, then add drug therapy
