B3W1

Question 1

Three layers of blood vessels and what type of cells is each one

Answer 1

tunica intima (endothelial) , tunica media (VSMC) , tunica externa (fibrous layer)

Question 2

What is artherosclerosis

Answer 2

deposits of plaques in blood vessels

Question 3

Where do fatty streaks accumulate

Answer 3

tunica intima

Question 4

What are fatty streaks made of

Answer 4

cholesterol

Question 5

if a plaque ruptures then there is …….

Answer 5

myocardial infarction

Question 6

What are foam cells

Answer 6

macrophage cells which engulf cholesterol

Question 7

What is atheroma and why is it important

Answer 7

fatty substance that lines the tunica intima and degrades tissue, this is important because it is the first step to diagnosing atherosclerosis

Question 8

High risks for atherosclerosis

Answer 8

necrotic cores, TCFA, spotty calcifications, remodeling

Question 9

Anatomical vascular imaging (general list of non invasive and invasive)

Answer 9

Non-Invasive:
Carotid Intima Media Thickness (ultrasound)
Carotid Plaque (ultrasound)
Coronary Angiography (CCTA)

Invasive:
Intravascular optical conherence tomography (iOCT)
intravascular ultrasound (IVUS)
coronary angiography (ICA)

Question 10

Functional Testing Vascular Imaging (general list)

Answer 10

Non invasive:
BART (brachial artery reactive testing):
Flow mediated dilation (FMD)
hyperemic flow (via ultrasound)
myocardial perfusion imaging (SPECT)

invasive:
fractional flow reserve (FFR)

Question 11

How does ultrasound anatomically test

Answer 11

used for structure not the fx, aids in detection of plaques and presence, Carotid intima media thickness (higher IMT, higher risk)

Question 12

Best vascular anatomical imaging resolution

Answer 12

iOCT > IVUS > ICA

Question 13

3 types of BART and what are they used for

Answer 13

uses ultrasound to measure diameter and velocity of flow through artery

flow mediated dilation, flow independent dilation, hyperemic velocity

Question 14

Flow Mediated Dilation

Answer 14

non invasive functional testing:
-BP cuff occludes vessels for 5 minutes leading to local ischemia in the hand
-there is local dilation of vessel because of metabolites being released
-cuff is then released and blood rushes to the hand allowing for sheer stress to cause vasodilation

-if there is high after occlusion dilation = healthy
-if there is low after occlusion dilation = increased risk of CV disease and indicates dysfunctional epithelium

Question 15

Flow independent dilation

Answer 15

non invasive functional testing

nitroglycerin is administered into artery to see local dilation

-sees a higher response than FMD

Question 16

Hyperemic velocity

Answer 16

non invasive functional testing

measures microvascular endothelial function

Question 17

Invasive coronary angiography (ICA) (general)

Answer 17

invasive functional testing imaging

uses vasoactive compounds to measure and monitor endothelial activity

Question 18

what does ACh do in invasive coronary angiography

Answer 18

-causes vasoconstriction of areas with endothelial dysfunction because there is a decrease in ability of endothelial cells to produce NO
-therefore Ach is inducing Gq pathway which leads to constriction

-healthy tissue would allow for normal dilation

-area which did not respond to Ach can be treated with nitroglycerin to aid in dilation

Question 19

SPECT - what does it do

Answer 19

non invasive functional testing
used to see myocardial perfusion

Question 20

SPECT - how does it work

Answer 20

non invasive functional testing

-inject Sestamibi tracer (vasodilator that simulates exercise)
-defects in perfusion are seen during exertion (rest v exercise)
-Measure:
– @ rest: perfusion occurs at a more dilated state because vessel is making up for the stenosis by increasing baseline dilation
– @ exercise: when there is an increase in metabolic demand, vasodilation will occur and other arteries will change size to accommodate for demand, but the occluded artery will already be at full dilation and will not be able to grow

Question 21

Fractional Flow Reserve - what does it do

Answer 21

invasive functional testing
measures the blood flow and pressure in specific area and makes a ration of maximal flow

Question 22

EQ for fractional flow reserve

Answer 22

measuring two sides of a plaque

Pd/Pa (probe distal/probe anterior) = (flow after stenosis / flow before stenosis)

Values: if FFR is low = stenosis of vessel = increased risk of CV disease

Question 23

what is the normal FFR value

Answer 23

FFR = > 0.80

Question 24

FFR is the current standard for …..?

Answer 24

guiding stenting decisions