atherosclerosis + aneurysm + CAD + IHD

Question 1

general term for hardening of arteries

Answer 1

arteriosclerosis

Question 2

calcification in MEDIA of artery in EXTREMITIES
seen in ELDERLY
no obstruction of blood flow

Answer 2

Monckeberg (medial calcific sclerosis)

MEDIAl = MEDIA

Question 3

HYALINE thickening of ARTERIOLES

ESSENTIAL HTN and diabetes

Answer 3

arteriolosclerosis

Question 4

fibrous plaques and atheromas of INTIMA of LARGE + MEDIUM-sized arteries

Answer 4

atherosclerosis

ATHerosclerosis = ATHeroma

Question 5

risk factors for atherosclerosis

Answer 5

hypertension
hyperlipidemia (↑LDL, ↓HDL)
diabetes
smoking
family history
sedentary lifestyle

Question 6

atherosclerotic plaque compressing underlying media → nutrient + waste diffusion compromised → media necrosis → arterial wall weakness

Answer 6

abdominal aortic aneurysm

Question 7

PULSATILE mass in abdomen

>50yo SMOKER

Answer 7

abdominal aortic aneurysm

Question 8

complication of abdominal aortic aneurysm

Answer 8

rupture of vessel → fatal hemorrhage
embolism of atheroma
obstruction of branch vessel
impingement on adjacent structures (ureter)

Question 9

management after AAA

Answer 9

serial US every 6 mo
need surgery if
>5.5 cm in asymptomatic pt on US OR
if >↑ 0.5 cm in 6 mo (OR 1 cm in 1 yr)

Question 10

inadequate supply of O2 to heart relative to demand

common cause: atherosclerosis

Answer 10

ischemic heart disease: angina, CAS, MI, SCD, chronic IHD

Question 11

retrosternal pain/pressure/squeezing
may RADIATE to neck, jaw, shoulder pain
SOB
diaphoresis
women: may only have FATIGUE

Answer 11

angina

Question 12

narrowing of coronary artery >75% (can no longer dilate as compensation) will cause

Answer 12

angina

Question 13

chest pain predictable with activity
resolves with REST
EKG: ST depression or elevation

Answer 13

stable angina

Question 14

↑ frequency, duration or severity of pain compared to previous episodes of chest pain or
unpredictable pain or
PAIN at REST
SIGN OF IMPENDING MI
EKG: ST depression

Answer 14

unstable angina

Question 15

PAIN at REST - brief episodes
due to coronary artery spasm
more common in young adults
EKG: ST segment elevation during chest pain

Answer 15

prinzmetal angina

Question 16

treatment of prinzmetal angina

Answer 16

dihydropyridine CCB: nifedipine (relax coronary artery)

Question 17

5 deadly causes of acute chest pain

Answer 17

must r/o these causes:
aortic dissection (or dissecting aortic aneurysm)
unstable angina
MI
tension pneumothorax: breath in, air trapped in pleural cavity
PE

Question 18

ST segment elevation only during brief episodes of chest pain WITHOUT exertion

Answer 18

prinzmetal angina

Question 19

patient is able to point to location of chest pain using one finger

Answer 19

musculoskeletal chest pain (cardiac is diffuse)

Question 20

chest wall tenderness on palpation

Answer 20

musculoskeletal chest pai

Question 21

rapid onset sharp chest pain that radiates to scapula

Answer 21

aortic dissection

Question 22

RAPID onset SHARP pain in a 20 yo and associated SOB

Answer 22

spontaneous pneumothorax

Question 23

chest pain occurs after heavy meals and improves with antacids

Answer 23

GERD or esophageal spasm (nitrates will relieve pain since relaxes smooth muscle (won’t be able to distinguish if heart or esophagus cause, not always associated with meals)

Question 24

sharp pain lasting hrs-days and somewhat RELIEVED by sitting FORWARD

Answer 24

pericarditis

Question 25

pain made worse by deep breathing and/or motion

Answer 25

pleurisy - inflammation of pleura

musculoskeletal pain: inflamed muscles or ribs

Question 26

chest pain in a dermatomal distribution

Answer 26

herpes zoster virus

pain first then rash second

Question 27

most common cause of non-cardiac chest pain

Answer 27

GERD or

musculoskeletal

Question 28

20% collapsed lung
chest pain
SOB
no shift of mediastinum (build up of pressure not as great)

Answer 28

spontaneous pnuemothorax

Question 29

acute onset dyspnea, tachyardia, CONFUSION in hospital patient

Answer 29

pulmonary embolus

Question 30

antianginal therapy

Answer 30

↓ myocardial O2 demand: combo more effective then either alone
nitrate: ↓ preload (relax veins)
ß blocker: ↓afterload: ↓ HR, contractility

Question 31

lipid lowering agents

Answer 31

1) ↓LDL
HMG-CoA reductase inhibitors (statins): biggest ↓LDL
bile acid resins: cholestyramine
cholesterol absorption blockers: ezetimibe
2) ↑HDL
niacin: biggest ↑HDL
3) ↓TG
statins
niacin
fibrates: biggest ↓TG
omega-3-FA

Question 32

chest pain due to myocardial ischemia (due to obstruction or spasm of coronary arteries)
worsens GRADUALLY
PAIN during EXERTION only = STABLE
PAIN during REST or more SEVERE = UNSTABLE (as atherosclerosis worsens)

most common cause of obstruction: atherosclerosis

Answer 32

angina pectoris

Question 33

factors that ↑ myocardial O2 demand

Answer 33

preload
blood pressure (afterload)
contractility
ejection time
heart rate

Question 34

what is preload

Answer 34

end diastolic volume: how much blood gets back to heart

↑EDV →↑CO (↑ O2 demand of heart)

Question 35

which lipid is most closely associated with atherosclerosis, CAD

Answer 35

LDL (not HDL or TG)

Question 36

lipid that removes fat + cholesterol from cells (including arteries) → transport to liver

Answer 36

HDL

Question 37

lipid that is

associated with atherosclerosis + heart disease (not as significant as LDL)

Answer 37

TG

Question 38

complication of ↑↑↑ TG

Answer 38

increased risk of pancreatitis