Artherosclerosis

Question 1

What is the first overt sign of atherosclerotic plaque?

Answer 1

The “bulge” under the endothelial lining of arteries known as a “FATTY STREAK”

Question 2

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?

Answer 2

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???)

Question 3

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?

Answer 3

40%

Question 4

What test would you order to most accurately detect the amount of atherosclerotic plaque present in an arterial wall?

Answer 4

arterial US. (remember an angiogram will only show us the patency of the lumen)

Question 5

What symptoms will your patient have once they’ve had a 40% narrowing of their ARTERIAL cross sectional area?

Answer 5

None

Question 6

When does your patient start experiencing symptoms of limited coronary blood flow? (How much occlusion?)

Answer 6

75% of the LUMINAL cross sectional area is occluded.

Question 7

True of False, you can have a patient with reliable stable angina who has a 60% occlusion of luminal cross section area.

Answer 7

False, they would not have angina symptoms at that stage.

Question 8

What is the term for “death of the myocytes?”

Answer 8

Myocardial Infarction

Question 9

What is the most common trigger for an MI?

Answer 9

Rupture of a plaque causes immediate clot formation and occlusion

Question 10

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?

Answer 10

50/50. Size of plaque is not an important factor in whether it will rupture.

Question 11

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%?

Answer 11

UNSTABLE could rupture! Stable plaques develop very slowly

Question 12

If a doctor tells you “This infarct is transmural!” How bad is the occlusion? What must be done immediately?

Answer 12

100% occlusion. Call the cath lab! Stent placement must occur in 90 minutes

Question 13

Once you’ve determined a patient has a soft plaque, what is your plan?

Answer 13

You want to stabilize said plaque by hardening it. You plan to prescribe a STATIN to accomplish this

Question 14

What test will you order to screen for risk of atherosclerosis?

Answer 14

Lipid panel

Question 15

What age, according to the USPSTaskForce, should you begin screening for Lipids?

Answer 15

Men: 35 Women: 45

Question 16

What are the reasons you’d screen pts for lipids before the target age?

Answer 16

If they had CAD risk equivalents: PVD, symptomatic carotid dz, AAA, DM, >20% Framingham risk

Question 17

How often should you screen patients for lipids if they are A) on therapy B) not on therapy and h/o good lipid levels?

Answer 17

A) test yearly for patients on cholesterol therapy
B) test Q5years for patients who are “at goal” without therapy

this is a FASTING test

Question 18

How do you calculate LDL cholesterol?

Answer 18

LDL = TC- (VLDL + HDL)

Question 19

VLDL is another term for _____________

Answer 19

triglycerides

Question 20

which type of cholesterol is most affected by a meal (hence the need for fasting test)

Answer 20

VLDL/TG

Question 21

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 > ____________

Answer 21

Target= <100mg/dL. If their level is b/t 100-129 recommend lifestyle changes. If level is 130+ add drug therapy

Question 22

What factors are considered in the Framingham risk score?

Answer 22

Age, cholesterol, smoking, HDL, systolic BP

Question 23

What major risk factors are not considered on the Framingham risk score?

Answer 23

FHx

Question 24

What are some effective therapeutic lifestyle changes that can reduce your risk of developing atherosclerotic plaques?

Answer 24

1) reduce intake of saturated fats and cholesterol
2) loose wt
3) Increase activity/exercise
4) Increase fiber (hey! chocolate cheerios)

Question 25

When you counsel your patient to implement these lifestyle changes, you should tell them to realistically expect a ______% decrease in their LDL.

Answer 25

5%

Question 26

What is the first line tx for cholesterol?

Answer 26

STATINS

Question 27

What’s the best type of cholesterol med to increase HDL?

Answer 27

Nicotinic Acid

Question 28

Whats the best type of cholesterol med to decrease LDL?

Answer 28

STATIN

Question 29

What’s the best type of choseterol med to decrease TG’s?

Answer 29

Fibrates

Question 30

What are the normal, borderline, high, and very high values for triglycerides?

Answer 30

normal <150, borderline = 150-199, high = 200-499, very high = 500+

Question 31

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?

Answer 31

LDL primary, TG secondary

Question 32

What is a likely complication of “very high” TG’s? (>500)

Answer 32

pancreatitis

Question 33

Framingham risk is <20% but your patient has 2 risk factors. Target LDL is ____________. Treat with drug therapy when LDL exceeds ___________.

Answer 33

Target is < 130mg/dL. Treat with lifestyle changes unless level is > 160mg/dL, then add drug therapy

Question 34

Framingham risk is low, patient has only 1 risk factor. Target LDL is _____________ Treat with drug therapy when LDL exceeds_________

Answer 34

Target is under 160mg/dL. Recommend lifestyle change unless over 190, then add drug therapy