ateroma formation Flashcards
Age - increases risk
Gender - men low estrogen , post menopause - women then
Ethnicity - asians heart disease , afro caribbeans have higher risk of hypertension which predisposes
Genetics - fibrinogen - clotting factor disorders , lipi disorders , unlikely to be single gene disorders although FH strong predictor
non-modifiable risk factors
Obesity Raised blood cholesterol Smoking Hypertension Physical inactivity Metabolic syndrome - diabetes , High BP and obesity - collectified potent combo Hyperglycaemia High cholesterol levels
major modifiable risk factors
pathogenesis of atherosclerosis
low density lipids LDL accumulate and oxidation this leads to macrophages being recruited then die and cause inflammation leading to smooth muscle cell proliferation and narrowing of artery and collagen deposition
atherogenesis
the formation of fatty deposits in the arteries.
atherothrombosis
Atherothrombosis is the condition that occurs when a thrombus forms over an unstable atherosclerotic plaque. Thrombus formation is triggered by rupture or erosion of the unstable plaque, which exposes the endothelial surface of the diseased artery to various elements in the blood that activate coagulation.
Atherosclerosis
Atherosclerosis is a disease in which plaque builds up inside your arteries. Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. Over time, plaque hardens and narrows your arteries. This limits the flow of oxygen-rich blood to your organs and other parts of your body.
angina
Angina is a type of chest pain caused by reduced blood flow to the heart. Angina (an-JIE-nuh or AN-juh-nuh) is a symptom of coronary artery disease. Angina, also called angina pectoris, is often described as squeezing, pressure, heaviness, tightness or pain in your chest.
T wave inversion
formation of a plaque starts normal then fatty streak ( yellow) forming atheromatous plaque and arthersosclerotic plaque and this can lead to angina. This plaque may rupture and cause a fissure or thrombosis leading to what
MI
stroke
critical leg schema
cardiovascular death
when LDL and cells accumulate this ruptures leading to clotting cascade fromigt thrombus
what is the Standard treatment for acute coronary syndrome leading to ST elevation MI
Aspirin 300mg loading then 75mg life long
Prasugrel ( P2Y12 inhibitor) and aspirin
Unfractionated heparin in cath lab ( 70-100)
Immediate percutaneous coronary intervention of fibrinolysis( dissoble thrombosis) if more than 120min away from PCI - som areas stuggle to get within 2 hours
Drug eluting stent
all within 12-24hrs
don’t use ulna and radial before femoral
what is percutaneous coronary intervention PCI
Percutaneous Coronary Intervention (PCI, formerly known as angioplasty with stent) is a non-surgical procedure that uses a catheter (a thin flexible tube) to place a small structure called a stent to open up blood vessels in the heart that have been narrowed by plaque buildup, a condition known as atherosclerosis.
what cardiac enzyme can be used as a marker for MI
troponin T
Normal myocytes troponin bind to actin - when the cardiomyocyte dies as result of ischemia the troponin breaks off where it can be found
NSTEMI - troponin rise
Unstable angina - little or no troponin rise -arthersoclerotic plaque rupture but no result in cell death
what is the GRACE score
scoring system to risk stratifiy patients with diagnosed ACS to estimate their in-hospital and 6-month to 3-year mortality
Low risk
Load 300mg aspirin +75 mg OD lifelong
Ticagrelor with aspirin
Aspirin ± clopidogrel if high bleeding risk
Consider angiography if young and worsening
High risk
Same aspirin stuff
Angiography within 72horus ( sooner if unstable)
Drug eluting stent if indicated
Prasugrel or ticagrelor with aspirin
Heparin
what does a statin do
Statins lower cholesterol and stabilize the plaques making them go hard so they don’t rupture and fall off
example of ACEi
ramipril
example of beta blocker
bisoprolol
