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Cardiovascular System > Atheroma formation > Flashcards

Atheroma formation Flashcards

1
Q

Un-modifiable risk factors for atheroma

A
  • Age increases risk
  • Gender - M>F low oestrogen, post menopause
  • Ethnicity - asians are at greater risk of heart disease, Afro-Caribbean’s have higher risk of hypertension
  • Genetics - fibrinogen (clotting factor disorders), lipid disorders, unlikely to be single gene disorders
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2
Q

Modifiable risk factors for atheroma

A
  • Obesity
  • Raised cholesterol
  • Smoking
  • Hypertension
  • Physical inactivity
  • Metabolic syndrome (diabetes, high BP, obesity)
  • Hyperglycaemia
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3
Q

Pathogenesis of atheroma

A
  • LDL accumulates under artery endothelium and oxidises
  • Macrophages and T cells influx
  • Local irritation - macrophages die and this triggers smooth muscle proliferation and collagen deposition (artery tries to heal)
  • Activates clotting cascade
  • Thrombus forms - breaks off to form embolus
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4
Q

Occlusion of carotid artery

A

Stroke

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5
Q

Occlusion of coronary artery

A

MI

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6
Q

NSTEMI

A

Non-ST elevated MI

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7
Q

Acute coronary syndrome

A

Sudden reduced blood supply

  • NSTEMI (non-ST segment elevated MI)
  • STEMI (ST elevated MI)
  • Unstable angina
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8
Q

Cardiac ischaemia

A

Left anterior descending artery supplies LV

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9
Q

What is angina?

A

Blood can get down coronary artery but can’t increase blood supply when needed = pain

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10
Q

Sx of coronary thrombosis

A

sudden onset left sided chest pain radiating to right arm, sweating, shortness of breath, aspirin 300mg given, arm pain on climbing stairs = coronary thrombosis

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11
Q

Treatment for STEMI

A

aspirin 300mg then 75mg for life, prasugrel (P2Y12 inhibitor) and aspirin, heparin, stent, immediate percutaneous coronary intervention (coronary arteries reopened)

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12
Q

What is PCI?

A

Wire passed into coronary artery, balloon inflated, stent deployed to keep artery open

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13
Q

NSTEMI on ECG

A

T wave inversion

ST complex flat

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14
Q

how to diagnose NSTEMI

A

Blood test for troponin T

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15
Q

MI on blood test

A

Troponin T and I

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16
Q

How to differentiate between NSTEMI and unstable angina by blood test

A

NSTEMI = troponin rise but angina means none

17
Q

sx unstable plaque

A

chest pain at rest, intermittent, often reduced exercise tolerance

18
Q

Treatment NSTEMI low risk

A

300mg aspirin and 75mg/day for life, ticagrelor, clopidogrel if high bleeding risk

19
Q

Treatment NSTEMI high risk

A

angiography within 72h, stent, heparin, prasugrel or ticagrelor with aspirin

20
Q

Glycoprotein iib/iiia

A

Glycoprotein iib/iiia inhibitors stops pathway, blocks integrin receptor for fibrinogen by inhibiting fibrinogen bridges, used when patient receiving PCI - abciximab, tirofiban

21
Q

Stabilising coronary plaque

A
  • Reduce vulnerability of people by managing risk factors (cholesterol by statins, control BP, quit smoking)
  • Reduce risk of thrombosis = antithrombotic drugs, need to compare bleeding risks for other agents
22
Q

Post STEMI treatment

A

Antiplatelets:

  • Aspirin
  • Clopidogrel - maintain stent patency
  • Beta blocker - bisoprolol
  • ACEi - rampiril
  • Statin for all pts with coronary disease - atorvastatin
  • GI protection - lansoprazole
23
Q

Stents

A

Maintains lumen in coronary artery - nickel-titanium alloy

Drug eluting stents in majority of small vessels or long lesions (sirolimus or paclitaxel are expensive)

24
Q

Stent restenosis

A

Stent can cause further aggregation of collagen

Requires subsequent PCIs

25
Q

Siroliumus and paclitaxol

A
  • Anti-proliferative and immunomodulatory 0 angiographic restenosis in <5%
  • Effects: non specific with respect to cell type
  • Endothelium may never recover
  • Wall may recede from stent (positive remodelling) leaving stent struts mal-apposed
26
Q

Stent thrombosis

A
  • Iatrogenic
  • Avoided by good technique and anti-platelet drugs
  • Aspirin for life and clopidogrel for up to a year
27
Q

Widowmaker’s lesion

A

L main artery - more common in men, high risk of death

Cardiovascular System (21 decks)

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