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Clin Med-Cardiology Exam 1 > ASCVD Pathology > Flashcards

ASCVD Pathology Flashcards

1
Q

what is Arteriosclerosis

A

Vascular disease manifested by thickening and inelasticity of arteries

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2
Q

what are the 3 patterns of arteriosclerosis

A

atherosclerosis (AS)
Monckeberg’s medial calcific sclerosis
arteriolosclerosis

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3
Q

what is Medial Calcific Sclerosis

A

Calcification of muscle wall (media) of arteries
May ossify
No narrowing of vessel lumen
Patients older than 50 years.

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4
Q

what are the two types of Arteriolosclerosis� and are associated with

A

Thickening and narrowing of vascular walls of small arteries and arterioles,Associated with hypertension and diabetes

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5
Q

what are the two types of Arteriolosclerosis

A

hyaline and hyperplastic

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6
Q

what is Atherosclerosis

A

Intimal fibrofatty plaques
narrow vascular lumen
weaken arterial wall (media)

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7
Q

what are the major targets of Atherosclerosis

A

aorta, coronary arteries, cerebral arteries

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8
Q

what is the epidemiology and risk factors of Atherosclerosis.

A

Responsible for half of all deaths in the western world
Ubiquitous in developed nations
Less common in Central and South America, Africa, Asia, Japan
Begins in early childhood

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9
Q

What has caused a reduction in Atherosclerosis

A

Life-style changes (diet, smoking, control of HTN)
Improved therapy for IHD
Prevention of recurrences

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10
Q

what are the constitutional RF for Atherosclerosis

A

Age 40 to 60 year olds have 5X incidence of MI
Sex (males have 5X death rate from IHD until menopause
same MI frequency by 7th to 8th decade)
Genetics (familial clustering of other risk factors
genetic defects (eg familial hypercholesterolemia)

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11
Q

what are the acquired risk factors for Atherosclerosis

A

Hyperlipidemia
Hypertension 160/95 has 5X risk IHD than < 140/90
Smoking 1ppd X years has 200% increase in death rate from IHD
Diabetes 2X incidence of MI, increased risk of stroke, 100X risk of gangrene
C-reactive protein
“Soft” risk factors`

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12
Q

What does C-Reactive protein tell us

A

Systemic marker of inflammation synthesized by liver

Level correlates with risk of IHD/MI, stroke, PVD, SCD

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13
Q

what reduces CRP

A

smoking cessation, weight loss, exercise, statins

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14
Q

what is the role of HDL

A

Reverse transport of cholesterol from cells/plaque to liver for excretion in bile

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15
Q

what elevated HDL

A

Exercise and ETOH

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16
Q

what reduces HDL

A

Obesity and smoking reduce HDL

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17
Q

True of False risk factors are not additive

A

TRUE

18
Q

what are other RF for AS

A 
Inadequate physical activity
Type A personality
Obesity
Estrogen deficiency
High carbohydrate diet
Hardened (trans) unsaturated fat intake
Chlamydia pneumoniae
19
Q

what is Hyperhomocystinemia

A

Inborn error of metabolism resulting in high levels of circulating homocysteine
Can also be caused by low folate and vitamin B intake
Level correlates with CAD, PVD, stroke and venous thrombosis

20
Q

what is Lipoprotein Lp (a)

A

Altered form of LDL (apolipoprotein B-100 of LDL linked to apolipoprotein A)
Correlation between increased lipoprotein Lp(a) and coronary and cerebral vascular disease

21
Q

Response to Injury Hypothesis

A

Focal chronic endothelial “injury”
Endothelial dysfunction and monocyte adhesion/emigration
Smooth muscle cell emigration and macrophage activation
Macrophages and SMCs engulf lipid
Proliferation of SMCs, ECM deposition, extracellular lipid.

22
Q

Cellular Events in AS

A 
Endothelial injury
Lipids
Macrophages
Smooth muscle cells
Infection
23
Q

Endothelial Injury

A 
Endotoxin		
Hypoxia	
Smoking 
Viruses
Immune reactions
Homocysteine
 Hemodynamics
Hypercholesterolemia
24
Q

Hemodynamics

A

Shear stress and turbulent flow
plaques occur at branch points and posterior abdominal aorta
Lesion protected areas associated with induction of atheroprotective genes

25
Q

Severity of AS correlates with total

A

LDL cholesterol levels

26
Q 
AHA classifications of lesions
Type I - 	
Type II - 	
Type III - 	
Type IV - 	
Type V - 	
Type VI -
A 
Fatty dot
Fatty streak
Intermediate lesion
Atheroma
Fibroatheroma
Complicated plaque
27
Q

what is an Aneurysms

A

Abnormal dilatation of arteries/veins due to weakening of vessel wall

28
Q

What is the most common cause of aortic aneurysms

A

Atherosclerotic Aneurysms

29
Q

Ischemic Heart Disease

A

Also called coronary heart (artery) disease (most common cause is atherosclerosis)
Most common cause of death (1/3 of all deaths) in developed countries

30
Q

Ischemic Heart Disease 4 syndromes

A

angina pectoris
sudden cardiac death
myocardial infarction
chronic IHD

31
Q

Coronary Artery Thrombosis

A

Plaque rupture exposes thrombogenic lipids and subendothelial collagen
Complete occlusion results in AMI
Incomplete occlusion results in U/A or sudden death or microinfarcts downstream

32
Q

other causes of IHD

A 
Emboli from vegetations
Vasculitis
Systemic hypotension
 Systemic hypertension
Valvulopathy
33
Q

Angina Pectoris

A

Intermittent chest pain due to reversible myocardial ischemia

34
Q

Three types of angina pectoris

A

stable angina
Prinzmetal’s or variant angia
unstable angina

35
Q

Stable Angina

A

Episodic chest pain associated with exertion or stress
Chest pain is crushing, squeezing, may radiate to left arm
Fixed lesions > 75% vessel lumen
Relieved by rest, NTG (reduces preload and augments coronary blood flow)

36
Q

Prinzmetal’s Angina

A

Also called variant angina
Chest pain occurs at rest or while sleeping
Vasospasm near plaque
Responds to vasodilators

37
Q

Unstable Angina

A

Also called crescendo and preinfarction angina
Increasing frequency of chest pain
More intense and longer duration
Due to acute plaque change

38
Q

Myocardial Infarction

A

Local ischemia leading to corresponding myocardial necrosis

Single most common cause of death in industrialized nations

39
Q

Pathogenesis of MI

A 
Coronary artery thrombosis
most common cause of MI
preexisting plaque disrupted
Vasospasm
Platelet aggregation
Hypoperfusion
40
Q

Infarct location

A

LAD (40 to 50%) - anterior/apical infarcts
RCA (30 to 40%) - posterior/basal infarcts
LCX (15 to 20%) - lateral

41
Q

Complications of MI

A 
Papillary muscle dysfunction
Rupture
Mural thrombi
Acute pericarditis
Ventricular aneurysm
42
Q

Clinical Features of MI

A

Severe crushing substernal chest pain +/- radiate to neck, jaw, epigastrium, shoulder, left arm for hours to days unrelieved by NTG

Clin Med-Cardiology Exam 1 (8 decks)

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