Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clin Med - Cardio Exam #2 > ASCVD (Duval) > Flashcards

ASCVD (Duval) Flashcards

1
Q

What are the 3 patterns of vascular disease manifested by the thickening and inelasticity of the arteries?

A

1) Atherosclerosis
2) Monckeberg’s medial calcific sclerosis
3) Arteriosclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is medial calcific sclerosis and who does it affect?

A

The calcification of the muscle wall (media) of the arteries that may ossify. There is NO narrowing of the vessel lumen. Affects patients older than 50 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is arteriosclerosis?

A

The thickening and narrowing of the vascular walls and arterioles. It’s associated with HTN and DM.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the 2 variants of arteriolosclerosis?

A

1) Hyaline

2) Hyperplastic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is atherosclerosis?

A

The build up of intimal fibro-fatty plaques that narrow the vascular lumen and weaken the atrial walls (media).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the major targets of atherosclerosis and what could they cause?

A

1) The aorta (AAA, PVD, intestinal ischemia
2) Coronary arteries (IHD and MI)
3) Cerebral arteries (stroke)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is and what happens in the 3 phases of atherosclerosis?

A

Preclinical phase - when a normal artery becomes gets fibro-fatty plaques and endothelial dysfunction occurs
Clinical horizon - when the plaques get advanced and vulnerable. You see cell death, thrombus formation, calcification
Clinical phase - WHere you would see critical stenosis, aneurysm or plaque rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What has a significant reduction in IHD and stroke in the last 50 years been due to?

A

1) Life style changes
2) Improved IHD therapy
3) the prevention of reoccurrences

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is CRP, what does it correlate with and what reduces it

A

C-reactive Protein - a systemic marker of inflammation synthesized by the liver. It correlates with the risk of IHD, stroke, PVD and SCD. Its levels are reduced by smoking cessation, weight loss, exercise and statins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

T/F Risk factors are additive?

A

False: Two risk factors correspond to 4x risk of MI

3 risk factors correspond to a 7x risk.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Outside of the normal, what are some other risk factors of atherosclerosis?

A

Type A personality, estrogen deficiency, chlamydia pneumonia, hyperhomocysteinemia and Lipoprotein (Lp(a))

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is hyperhomocystinemia?

A

An inborn error of metabolism resulting in high levels of circulating homocysteine. It can be caused by low folate and vitamin B intake. It correlates with CAD, PVD, stroke and venous thrombosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is Lipoprotein Lp (a)

A

An altered form of LDL. There is a correlation btwn that and coronary and cerebral vascular disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the 5 steps to the response to injury hypothesis?

A

1) Chronic endothelial injury
2) Endothelial dysfunction and monocyte adhesion/emigration
3) Smooth muscle cell emigration & macrophage activation
4) Macrophages and smooth muscle cells engulf lipids.
5) Proliferation of Smooth muscle cells , extra cellular matrix and extracellular lipid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the 2 most important contributors to endothelial injury?

A

1) Hemodynamics

2) Hypercholesterolemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is hemodynamics?

A

Shear stress and turbulent flow to arteries where plaques occur at branch points and the posterior abdominal aorta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are macrophages role in atherosclerosis?

A

The engulf lipoproteins to become foam cells. Also they rercruit WBC, oxidize LDL and elaborate growth factors.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Atherosclerosis starts off as a ______ _________?

A

Fatty streak

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Where are fatty streaks more commonly found?

A

The long axis of the aorta. The aortic valve ring, posterior thoracic aorta, coronary arteries and abdominal aorta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Where are fatty streaks most found

A

Abdominal aorta (most), coronary arteries 2nd, popliteal arteries 3rd, and thoracic artery 4th.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Name the 6 types of atherosclerosis lesions classified by the AHA

A 
Type 1 - Fatty dot (precursor)
Type 2 - Fatty streak
Type 3 - Intermediate lesion
Type 4 - Atheroma
Type 5 - Fibroatheroma
Type 6 - Complicated plaque
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are 4 causes of an aneurysm?

A

1) congenial defect
2) local infection
3) trauma
4) systemic disease (AS syphilis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the most common aortic aneurysm?

A

Atherosclerotic aneurysms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Where are most Atherosclerotic aneurysms found?

A

In the infrarenal aorta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what is the most common cause of Ischemic Heart disease?

A

Atherosclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the 4 syndromes associated with Ischemic Heart disease?

A

1) Angina pectoris
2) MI
3) Sudden cardiac death
4) Chronic IHD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Who is more at risk for Ischemic Heart disease?

A

Men over women until 9th decade
Males over 60 and females over 70.
Those with HTN, DM, smoking, elevated LDL or genetic issues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is critical stenosis defined as

A

75 percent narrowing.

29
Q

What are some other causes of IHD?

A 
Reduced blood supply issues - Emboli from vegetations, vasculitis and systemic HTN
Increased demand (LVH) - Systemic HTN, valvulopathy
30
Q

What is angina pectoris?

A

Intermittent chest pain d/t reversible myocardial ischemia

31
Q

What are the 3 variants of Angina Pectoris?

A

1) Stable angina
2) Prinzmetal’s or variant angina
3) Unstable angina

32
Q

What is stable angina

A

Episodic chest pain associated with exertion or stress. The pain is described as crushing, squeezing and may radiate to left arm. A fixed lesion greater than 75% vessel lumen

33
Q

What relieved stable angina

A

NTG it reduces preload and augments coronary blood flow

34
Q

What is Prinzmetal’s or variant angina? What relieves it?

A

Where chest pain occurs at rest or while sleeping. There is a vasospasm near the plaque. It responds to vasodilators

35
Q

What is Unstable Angina

A

Aka crescendo and perinfarction angina. It angina with increasing frequency, longer duration and more intense pain. Due to acute plaque changes like thrombosis, embolization and vasospasm

36
Q

What is Myocardial infarction?

A

Local ischemia leading to corresponding myocardial necrosis and death of heart muscle

37
Q

T/F Myocardial infarction is irreversible

A

True

38
Q

What is the most common cause of MI

A

Coronary artery thrombosis (preexisting plaque disrupted)

39
Q

How long after an MI does necrosis begin?

A

20-30 minutes and max size after 3-6 hours

40
Q

What is the importance of the MI timeline

A

Its the window for thrombolytic therapy

41
Q

What are the most common places infarcts occur (thrombi form)?

A

Left anterior descending artery - Anterior/apical (apex) infarcts
Right coronary artery - posterior/basal infarcts
Left circumflex artery - lateral infarct

42
Q

What areas gets the larger infarcts

A

The ones with the more proximal occlusion

43
Q

What happens in the first 24 hours of an MI?

A

0 to 12 hours - Gross -nothing, Microscopic wavy fibers and edema
12 to 18 hours - Gross nothing, Micro: coagulation necrosis CBN,
18 to 24 hours - Gross slight, Micro: neutrophils and necrosis

44
Q

What happens in the first 10 days of an MI?

A

3 days - Gross- pallor, Microscopic - peak neutrophils
4-7 days - Gross - Central pallor and hyperemic border, Microscopic- macrophages with early granulation tissue (scaring)
10 days - Gross - yellow soft sunken, Microscopic prominent granular tissue

45
Q

What happens from 10 days to 8 weeks for an MI?

A

4 weeks - maturing fibrosis

8 weeks - gross - firm and gray, microscopic - dense scar tissue

46
Q

What is contraction band necrosis?

A

Coarse transverse bands of myocytes d/t hyper contraction of reperfused dying calls triggered by influx of calcium

47
Q

What are some complications of MI?

A

1) Papillary muscle dysfunction
2) Rupture
3) Mural thrombi
4) Acute pericarditis
5) Ventricular aneurysm

48
Q

When would papillary muscle dysfunction occur and what could it cause?

A

Occur about 3 days after MI.

Can result in severe Mitral regurg and LV failure

49
Q

What are the two types of myocardial ruptures

A

External - in first 2 weeks (peak 4-7 days) of MI d/t poorly developed granulation tissue fibrosis
Internal (septal) - acute L to R shunt and CHF

50
Q

What is a mural thrombi

A

A thrombi formed on an endocardial surface overlying an infarct that may cause stroke.

51
Q

How common is acute pericarditis to a person with an MI and how long would it take?

A

About 15% of MI patients

It would occur 2 to 4 days after transmural infarct

52
Q

What is a ventricular aneurysm?

A

When a fibrous myocardium bulges during systole. Usually anteroapical

53
Q

What is the outcome of a ventricular aneurysm?

A

1) arrhythmia
2) papillary muscle dysfuction
3) CHF
4) embolization

54
Q

T/F the pain from an MI can be relieved by nitroglycerine

A

False

55
Q

What is the percent of MIs that are silent?

A

20-30 percent (in diabetic, HTN and elderly)

56
Q

What is the percent of patients with MIs who make it alive to the hospital?

A

About 75%

57
Q

Of the 75% that make it to the hospital alive having an MI what is their fate?

A 
10-20% no complications
75-95% get arrhythmias
60% get LVF with pulmonary edema
10% get cardiogenic shock
4-8% get rupture
15-49% get a thromboembolism
58
Q

What are the EKG abnormalities in a patient with MI

A

Q waves, ST changes and T wave inversions

59
Q

What would you see in Creatine Kinase labs in a patient with MI

A

Total CK - rise 2-4 hours, peake 24 hours, decline 72 hrs.

CK-MB - rise 2-4 hours, peak 18 hours, decline 48 hrs.

60
Q

How long after a clean CK test is an MI ruled out

A

2 days

61
Q

T/F troponin I is more cardiospecific than CK-MB

A

True

62
Q

What Troponin readings would you see in a patient with MI?

A

Rise 2-4 hours, persists 4-7 days

63
Q

Other than an MI what other heart issue could be seen in elevated troponins?

A

Unstable angina progressing to an AMI

64
Q

What is chronic ischemic heart disease

A

AKA ischemic cardiomyopathy. It’s progressive CHF d/t long term ischemic myocardial injury. Angina and infarcts are common

65
Q

What gross morphology might you see in a patient with chronic ischemic heart disease?

A

Moderate to severe CAD, cardiomegaly, multiple foci of fibrosis, cardiac hypertrophy, a thick opaque endocardium and adherent thrombi

66
Q

What microscopic features might you see in a patient with chronic ischemic heart disease?

A

Extensive fibrosis, atrophic and hypertrophic fibers, subendocardial vacuolation

67
Q

What are the s/s of chronic ischemic heart disease

A

Severe progressive HF
possible angina or infarcts
Arrhythmias

68
Q

What is the most common mechanism of sudden cardiac death

A

Lethal ventricular arrhythmia (Vfib) d/t IHD

69
Q

What are 3 syndromes due in part to acute plaque changes?

A

1) Unstable Angina
2) Acute MI
3) Sudden cardiac death

Clin Med - Cardio Exam #2 (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions