Atherosclerosis

Question 1

What is atherosclerosis

Answer 1

• a process where lipid deposits accumulate in the intimal layer of medium and large arteries
• this causes narrowing or blockage

Question 2

what can atherosclerosis lead to

Answer 2

• coronary artery disease (CAD, CHD, ASHD)
• Cerebral vascular disease
• peripheral vascular disease (PAD/PVD)

Question 3

atherosclerosis in the heart

Answer 3

• coronary arteries partial occlusion = angina pectoris (ischemic hear disease)
• coronary arteries total occlusion = MI

Question 4

atherosclerosis in brain

Answer 4

• carotid or cerebral arteries partial occlusion = TIA
• carotid or cerebral arteries total occlusion = stroke CVA

Question 5

atherosclerosis in Aorta

Answer 5

• occlusion = aneurysm
• rupture or hemorrhage

Question 6

atherosclerosis in legs

Answer 6

• iliac arteries
• peripheral vascular disease
• gangrene and amputation

Question 7

atherosclerosis in the coronary arteries and how it affects perfusion in the heart tissue

Answer 7

• occlusion occurs = all tissue below is impacted
• when the vessel is narrowed it can grow little extra vessels but this takes long so it will occur well with slow narrowing
• Right coronary artery
• Left coronary artery – anterior descending

Question 8

Arterial wall

Answer 8

• inner layer: intima made of endothelial
• Muscular layer: media
• outer layer: adventitia (collagen and fibrin)
• atherosclerosis occurs between intimal and muscular

Question 9

atherosclerosis progress

How does it happen (not sequence)

Answer 9

• happens over many years
• genetic but heavily tied to lifestyle
• fatty substance comes from breakdown of fats and cholesterol
• high LDL causes them to push through intimal layer
• high HDL are tumble weeds that can clear fats out

Question 10

atherosclerosis timeline

Answer 10

• foam cells
• fatty streaks in vessels
• intermediate lesions
• atheroma
• fibrous plaque
• complicated lesion/rupture (can cause a blood clot/embolism)

Question 11

Stages of atherosclerosis

Answer 11

• stage 1: normal coronary artery
• stage 2: beginning atheroma; fatty streaks
• stage 3: beginning of encroachment of coronary artery; atheroma/fatty layer formed
• stage 4: Blockages hardening into plaques
• stage 5: crack or rupture in coronary artery
• stage 6: closing off the channel of artery: clot totally blocking the channel

Question 12

Embolus

Answer 12

• thrombus breaks off and is carries in blood
• until it becomes lodged in a smaller artery causing occlusion

Question 13

What is often the first symptoms of CAD and how does it occur?

Answer 13

• angina
• when supply does meet demand
• if supply decreases and demand stays the same/increases
• if demand increase and supply remains the same or decreases

Question 14

Angina types

Answer 14

• stable exertional angina - related to activity
• unstable angina
• prinzmetal angina
• silent angina

Question 15

Stable vs unstable angina

Answer 15

Stable angina:

• EKG shows no cell death
• can be predicted using RPP
• goes away but continues to monitor
• fixed blockage
• overtime gets worse

unstable angina

• Thrombus developed that narrows vessel even more
• not going away with rest/nitro
• unpredictable
• attracts clotting factors
• a previously stable angina now becomes unstable

Question 16

Prinzmetal angina

Answer 16

• related to a vasospasm
• functioning of sympathetic and parasympathetic relationship
• unrelated to activity can occur whenever

Question 17

Silent angina

Answer 17

• angina equivalence
• most commonly in women (women’s symptoms are overlooked)
• these people get nausea, SOB, pain between shoulder blades, sweating, indigestion, excessive fatigue
• related to activity just symptoms not felt in the heart

Question 18

Other causes of chest pain

Answer 18

• pericarditis
• MSK problems
• pulmonary
• GI

Question 19

Acute coronary syndrome

Answer 19

1. atherosclerosis plaque: results from unstable plaque

causes either

• transient ischemia/unstable angina
• sustained ischemia/MI
• necrosis

Question 20

Clinical manifestations of Acute coronary syndrome

Answer 20

• ischemia pain leads to presentation to MD or emergency department
• EKG and bloodwork preformed
• ischemia looks different than MI
• Diagnosed as stable angina or unstable angina
• unstable anginas can progress to MI or sudden death

Question 21

Anginal pain regions

Answer 21

• chest
• left arm
• shoulder/between shoulder blades
• neck
• jaw

Question 22

Diagnosis of CAD

what can be used to diagnosis

Answer 22

• EKG
• echo
• stress test
• cardaic CT, MRI
• angiography
• cardiac catheterization

Question 23

be aware of what with these types of patients

Answer 23

• change in a previous stable pattern (occurs more frequently, lasts longer, more intense)
• angina lasting longer than 20 minutes
• occurrence of a patient typical angina that is at a significantly lower level than previous or does not respond to nitroglycerin

Question 24

Prevention and management:

Answer 24

• lifestyle change is first line of defense
• heart healthy diet
• increase physical activity
• lose weight
• quit smoking
• manage BP
• medications

Question 25

statin meds

Answer 25

• atorvastatin (lipitor)
• fluvastatin (lescol,lescol XL)
• lovastatin (menacer)
• pravastatin (Pravachol)
• rosuvastatin (crestor)
• simvastatin (zocor)