atherosclerosis + aneurysm + CAD + IHD Flashcards
general term for hardening of arteries
arteriosclerosis
calcification in MEDIA of artery in EXTREMITIES
seen in ELDERLY
no obstruction of blood flow
Monckeberg (medial calcific sclerosis)
MEDIAl = MEDIA
HYALINE thickening of ARTERIOLES
ESSENTIAL HTN and diabetes
arteriolosclerosis
fibrous plaques and atheromas of INTIMA of LARGE + MEDIUM-sized arteries
atherosclerosis
ATHerosclerosis = ATHeroma
risk factors for atherosclerosis
hypertension hyperlipidemia (↑LDL, ↓HDL) diabetes smoking family history sedentary lifestyle
atherosclerotic plaque compressing underlying media → nutrient + waste diffusion compromised → media necrosis → arterial wall weakness
abdominal aortic aneurysm
PULSATILE mass in abdomen
>50yo SMOKER
abdominal aortic aneurysm
complication of abdominal aortic aneurysm
rupture of vessel → fatal hemorrhage
embolism of atheroma
obstruction of branch vessel
impingement on adjacent structures (ureter)
management after AAA
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)
inadequate supply of O2 to heart relative to demand
common cause: atherosclerosis
ischemic heart disease: angina, CAS, MI, SCD, chronic IHD
retrosternal pain/pressure/squeezing may RADIATE to neck, jaw, shoulder pain SOB diaphoresis women: may only have FATIGUE
angina
narrowing of coronary artery >75% (can no longer dilate as compensation) will cause
angina
chest pain predictable with activity
resolves with REST
EKG: ST depression or elevation
stable angina
↑ 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
unstable angina
PAIN at REST - brief episodes
due to coronary artery spasm
more common in young adults
EKG: ST segment elevation during chest pain
prinzmetal angina
treatment of prinzmetal angina
dihydropyridine CCB: nifedipine (relax coronary artery)
5 deadly causes of acute chest pain
must r/o these causes:
aortic dissection (or dissecting aortic aneurysm)
unstable angina
MI
tension pneumothorax: breath in, air trapped in pleural cavity
PE
ST segment elevation only during brief episodes of chest pain WITHOUT exertion
prinzmetal angina
patient is able to point to location of chest pain using one finger
musculoskeletal chest pain (cardiac is diffuse)
chest wall tenderness on palpation
musculoskeletal chest pai
rapid onset sharp chest pain that radiates to scapula
aortic dissection
RAPID onset SHARP pain in a 20 yo and associated SOB
spontaneous pneumothorax
chest pain occurs after heavy meals and improves with antacids
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)
sharp pain lasting hrs-days and somewhat RELIEVED by sitting FORWARD
pericarditis
pain made worse by deep breathing and/or motion
pleurisy - inflammation of pleura
musculoskeletal pain: inflamed muscles or ribs
chest pain in a dermatomal distribution
herpes zoster virus
pain first then rash second
most common cause of non-cardiac chest pain
GERD or
musculoskeletal
20% collapsed lung
chest pain
SOB
no shift of mediastinum (build up of pressure not as great)
spontaneous pnuemothorax
acute onset dyspnea, tachyardia, CONFUSION in hospital patient
pulmonary embolus
antianginal therapy
↓ myocardial O2 demand: combo more effective then either alone
nitrate: ↓ preload (relax veins)
ß blocker: ↓afterload: ↓ HR, contractility
lipid lowering agents
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
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
angina pectoris
factors that ↑ myocardial O2 demand
preload blood pressure (afterload) contractility ejection time heart rate
what is preload
end diastolic volume: how much blood gets back to heart
↑EDV →↑CO (↑ O2 demand of heart)
which lipid is most closely associated with atherosclerosis, CAD
LDL (not HDL or TG)
lipid that removes fat + cholesterol from cells (including arteries) → transport to liver
HDL
lipid that is
associated with atherosclerosis + heart disease (not as significant as LDL)
TG
complication of ↑↑↑ TG
increased risk of pancreatitis
