Car 17 - Atherosclerosis

Question 1

What is the difference b/w arteriosclerosis vs atherosclerosis?

Answer 1

Arteriosclerosis: general term describing hardening of the arteries. Atherosclerosis: a type of arteriosclerosis, fibrous plaques and atheromas of intima of arteries.

Question 2

What is Monckeberg arteriosclerosis?

Answer 2

Medial calcific sclerosis, calcifications in media of artery. Seen in elderly and arteries of extremeties. It is benign; does not obstruct bloodflow.

Question 3

What is arteriolosclerosis?

Answer 3

Hyaline thickening of arterioles. Found in essential HTN and DM.

Question 4

Outline the Pathogenesis of Atherosclerosis.

Answer 4

Endothelial injury: leads to ^ vascular permeability, leukocyte adhesion and thrombosis. Accumulation of lipoproteins: occurs in the vessel wall and is mostly LDL. Monocyte adhesion to the endothelium: subsequent migration of the monocytes into the intima and then transformation of these cells into macrophages and foam cells. Platelet adhesion. Factor release: activated platelets, macrophages and vascular wall cells; induces smooth muscle recruitment. Smooth muscle proliferation and ECM (extracel matrix) production. Lipid accumulation: occurs extracellularly and w/i macrophages and smooth muscle cells.

Question 5

What are the complications of Atherosclerosis Based on Location of Plaque?

Answer 5

Smaller vessels can become occluded and then compromise distal tissue perfusion. Ruptured plaque can embolize atherosclerotic debris and cause distal vessel obstruction or can lead to acute vascular thrombosis (stroke). Destruction of the underlying vessel wall can lead to aneurysm formation, w/ secondary rupture and thrombosis.

Question 6

What is the pathophysiology of Abdominal Aortic Aneurysm?

Answer 6

Caused by atherosclerotic plaque compressing the underlying media. Nutrient and waste diffusion is compromised. Media degenerates and necroses, leading to arterial wall weakness.

Question 7

What are the complication of abdominal aortic aneurysm?

Answer 7

Rupture leading to fatal hemorrhage, embolism from atheroma, obstruction of a branch vessel and impingement on an afjacent structure (ureter).

Question 8

What is the clinical symptom of abdominal aortic aneurysm (AAA)?

Answer 8

Presents as a pulsating mass in the abdomen.

Question 9

What are 5 deadly causes of Acute Chest pain?

Answer 9

Aortic dissection (or dissecting aortic aneurysm). Unstable angina. MI. Tension pneumothorax. Pulmonary embolism (PE).

Question 10

What cares does one have to take with abdominal aortic aneurysm (AAA)?

Answer 10

Serial ultrasound every 6 months. If it is bigger than 5 cm, surgical repair.

Question 11

What branch provides blood to the SA node?

Answer 11

SA nodal branch from the right coronary artery.

Question 12

What does a “right-dominant” heart mean?

Answer 12

The right coronary artery feeds the inferior portion of the left ventricle by way of the posterior intraventricular branch. Typically normal for most people.

Question 13

What branch provides blood to the AV node?

Answer 13

The AV nodal branch from the Right coronary artery.

Question 14

Where does coronary artery most often occur?

Answer 14

In the Anterior interventricular branch AKA left anterior descending artery. When this occludes, this is called anterior wall MI, “the widow maker”.

Question 15

When the coronary arteries fill?

Answer 15

During diastole. The opening to the coronary arteries are right above the aortic valve.

Question 16

What is the posterior part of the heart? What would enlargement of it cause?

Answer 16

The left atrium. Enlargement would cause dysphagia due to compression of the esophagus. Also can cause hoarseness due to compression of the recurrent laryngeal nerve.

Question 17

What are the symptoms of angina?

Answer 17

Retrosternal pain/pressure. Neck, jaw, shoulder pain. SOB. Diaphoresis. On women the only symptom might be fatigue.

Question 18

When does angina occur?

Answer 18

When there is at least 75% narrowing of the lumen of the artery.

Question 19

What are the different types of angina? What is the most common type of angina?

Answer 19

Stable (predictable). Unstable (unpredictable). Prinzmetal’s (due to coronary vasospasms, unpredictable). The most common is angina.

Question 20

How do we treat Prinzmetal’s angina?

Answer 20

Dihydropridine Calcium channel blockers (CCB). It causes ST segment elevation only during brief episodes of chest pain.

Question 21

What is the most likely cause of chest pain in ST segment elevation only during brief episodes of chest pain?

Answer 21

Prinzmetal’s angina.

Question 22

What is the most likely cause of chest pain when patient is able to point to localize the chest pain using one finger?

Answer 22

Musculoskeletal chest pain.

Question 23

What is the most likely cause of chest pain in chest wall tenderness on palpation?

Answer 23

Musculoskeletal chest pain.

Question 24

What is the most likely cause of chest pain in rapid onset sharp pain that pain that radiates to the scapula?

Answer 24

Aortic dissection.

Question 25

What is the most likely cause of chest pain in rapid onset sharp pain 20-y.o and associated w/ dyspnea?

Answer 25

Spontaneous pneumothorax.

Question 26

What is the most likely cause of chest pain in occurs after heavy meals and improved w/ antacids?

Answer 26

GERD.

Question 27

What is the most likely cause of chest pain lasting hours-days and is somewhat relieved by sitting forward?

Answer 27

Pericarditis.

Question 28

What is the most likely cause of chest pain that is made worse by deep breathing and/or motion?

Answer 28

Musculoskeletal pain.

Question 29

What is the most likely cause of chest pain in a dematomal distribution?

Answer 29

Zoster virus.

Question 30

What is the most common cause of non-cardiac chest pain?

Answer 30

GERD or musculoskeletal pain?

Question 31

What are the most common locations for atherosclerosis, and what disorders result from plaques in these locations?

Answer 31

1 Abdominal aorta (AAA). 2: Coronary arteries (MI, Angina). 3: Popliteal arteries (claudication/PVD). 4: Carotid arteries (TIA, strokes, dementia).

Question 32

A patient w/ poorly-managed HTN has acute, sharp substernal pain that radiates to the back and progresses over a few hours. death occurs in a few hours. Diagnosis?

Answer 32

Aortic dissection.

Question 33

What is the most likely cause of chest pain in the following scenario: Acute onset dyspnea, tachycardia, and confusion in the hospitalized patient.

Answer 33

Pulmonary embolus.

Question 34

What is the most likely cause of chest pain in the following scenario: rapid onset of sharp pain in the 20-y.o and associated w/ dyspnea?

Answer 34

Spontaneous pneumothorax.

Question 35

What is the most likely cause of chest pain in the following scenario: Pain began the following an intensive new exercise program.

Answer 35

Musculoskeletal pain.

Question 36

What is the most likely cause of chest pain in the following scenario: ST segment elevation only during brief episodes of chest pain.

Answer 36

Prinzmetal’s angina.

Question 37

What is the most likely cause of chest pain in the following scenario: Sharp pain lasting hours to days and is somewhat relieved by sitting forward.

Answer 37

Pericarditis.

Question 38

What is the most likely cause of chest pain in the following scenario: Chest wall tenderness on palpation.

Answer 38

Musculoskeletal chest pain.

Question 39

What are four benefits of taking statins?

Answer 39

Decrease LDL. Improve coronary endothelial function. Inhibit platelet thrombus formation. Anti-inflammatory properties.