Atherosclerosis Flashcards
3 layers of the artery
Intima, Media, Externa
2 parts of the tunica intima
Endothelium and Elastic membrane
Inner lining of tunica intima
Endothelium - Clot resistant!!
Tunica media
Smooth muscle that constricts and dilates
Tunica externa
Adventitia that holds arteries in place
5 Steps of atherosclerosis
Fatty Streak
Fibrous Cap
Disruption of vasa vasorum (neovascularization)
Fibrous plaque
Intraplaque hemorrhage
Foam cells
Macrophages that have eaten lots of LDL
Form fatty streak
Smooth muscle migrates to the site
Vasa vasorum disruption
Blood flow created to fatty streak making it grow
Fibrous cap
Collagen layed down over streak - more collagen=more stable
Fibrous plaque
Smooth muscle cells take up LDL and make the clot more stable
Positive remodeling
Increased vessel size d/t plaque making it UNSTABLE
Negative remodeling
Body constricts the vessel to stabilize plaque - STABLE angina
Interplaque hemorrhage
Critical event - Leads to an MI
2 things needed for atherosclerosis
Lipids and Inflammation
Four endothelial trauma etiologies with common mechanism
Turbulent blood flow - HTN
Diabetes
HLD
Cigarette smoking
Occurs due to loss of endothelial-derived nitric oxide
Inflammation in atherosclerosis
Worse if acute
Many immune cells migrate to the site
Plaque rupture and erosion
Plaque asymptomatic until 70-80% occlusion
Treat before erosion and rupture occurs
Vasculopath
All arteries affected by atherosclerosis
Percent of adults presenting with sudden death as first sign of heart attack
40-50%
Number of heart attacks that are silent
1 in 5
2 populations with abnormal heart attack symptoms
Females and Diabetics
Coronary artery disease risk equivalents - 6
Clinical CHD
Symptomatic carotid artery disease
Peripheral arterial disease
AAA
Diabetes mellitus
Chronic kidney disease
Concerning family history for heart disease
1st degree relative under 55 in men and under 65 in women had an event
Age and sex risk factors for CHD
Men 45+, women 55+
Males in general have higher prevalence
6 additional risk factors for CHD
High serum C reactive protein
High triglycerides (esp. in women)
Sleep apnea
Stress
Persistent heavy alcohol use
Elevated homocysteine levels
6- Major modifiable risk factors for CHD
Cigarette smoking
Dyslipidemia (High LDL and Low HDL)
HTN
DM
Obesity
Sedentary lifestyle
2 high intensity statins
Atorvastatin and Rosuvastatin
6 factors used to calculate 10-year-ASCVD risk
Age and Gender
Race
Cholesterol - LDL and HDL
Diabetes
Smoking
Blood Pressure
AAA screening recommendation from USPSTF
1 time screening in men 65-75 who have ever smoked with ultrasonography
Class B
Aspirin use USPSTF recommendation
40-59 low dose aspirin if ASCVD risk is greater than 10
Class C
BP recommendation screening for HTN from USPSTF
Anyone over 18
Class A
Prediabetes screening from the USPSTF
Screen in patients 35-70 who are overweight or obese
Statin use recommendations from USPSTF
40-75 years with 1 risk factor and ASCVD of 10%+
Class B
40-75 with 1 risk factor and 7.5-9.9% ASCVD risk
Class C
Healthy diet and exercise USPSTF recommendation
Class B for adults with any cardiovascular risk factors
Tobacco sensation for CV risk prevention USPSTF recommendation
Class A
