CAD

Question 1

Where does atherosclerosis occur?

Answer 1

branch pts, exiting vessels, post abd aorta

hemodynamic turbulence is a indicator

Question 2

inflamm markers

Answer 2

high sensitivity C-reactive protein (HSCRP) ***
acute phase interleukins (IL-1, IL-6)
serum amyloid a****
prego assoc plasma protein a
chronic infection

Question 3

risk factors for atherosclerosis

Answer 3

genetic abn
family history
increase age
male

modifiable - hyperlipidemia, HTN, smoke, diabetes, vit def, obese, sedentary life, inflamm

Question 4

where do lipids accum at

Answer 4

intima by macrophages and oxidation

Question 5

oxidized ldl forms

Answer 5

foam cells and a lesion called fatty streak

Question 6

proteins in flamm exudate are

Answer 6

clotting prot
complement
kinin cascade (vasodiliation)
fibrinolytic protein

Question 7

what receptor takes in oxidized lipids

Answer 7

scavenger receptor CD36, TLR-4

Question 8

what does inflammasomes produce

Answer 8

IL-1 and IL-18

inflam cytokines

Question 9

what does neutrophil NETosis do?

Answer 9

scaffold for platelet/rbc activation, aggregation, thrombosis, elastase

Question 10

what contributes to smooth m cell proliferation

Answer 10

pdgf
fibroblast growth factor
transforming growth factor-a
intima changes thickness 
breakdown elastic mem (decrease contractile/ Venous Pressure)

Question 11

adaptive immunity mechanisms increase what, with what cells and mediators

Answer 11

cells: Th1, Th17, B cells
mediators: IFNy, TNF, IL-17
increase: adhesion mol expression, release cytokines/chemokines, mch/hla ii expression, ag presentation, oxldl uptake, marcophage activation

Question 12

gen of lipid reactive T and B cells

Answer 12

hypercholesterolemia leads to build up of LDL in intima, mod to look like intruder, taken by macro and presented to T cells, self reactive now and lead to vascular inflammation and atherosclerosis

Question 13

what happens to a fatty streak over time

Answer 13

covers with a fibrous cap (dense collagen fibers)

center necrotic, lipid, debris, foam cells, thrombus, surrounded by zone of inflammatory and smooth m cells

Question 14

thrombosis due to erosion vs due to rupture

Answer 14

thick, angina and non-stemi, white platelet rich thrombus

thin, STEMI, red fibrin rich thrombus

Question 15

phases of atherosclerosis

Answer 15

norm -> fatty streak -> fibrofatty plaque -> advanced vul plaque -> aneurysm and rupture, occlusion by thrombus, critical stenosis (middle age)

Question 16

pro-coagulant markers and process marker

Answer 16

plasma homocysteine, tissue plasminogen activator, plasminogen activator inhibitor

process markers - fibrinogen

Question 17

can you use non-specific anti-inflammatories and selective inhibitor COX2 to treat atherosclerosis?

Answer 17

NO
it makes things worse and increase mortality
destabilizes the plaques

Question 18

arterial wall response to injury

Answer 18

1. chronic endothelial injury (risk factors)
2. endothelial dysfunction (increased perm, leukocyte adhesion, monocyte adhesion, emigration)
3. macrophage activation, sm recruit
4. macrophages and sm cells engulf lipid
5. sm proliferation, collagen and matrix deposition, extracellular lipid

Question 19

Frequently Affected Arteries

Answer 19

Abdominal aorta > Coronary arteries > Popliteal arteries > Internal carotid arteries > Circle of Willis

Question 20

cardiac risk based on levels of hs-CRP

Answer 20

high >3 mg/L
avg 1-3 mg
low <1 mg