Cardiac

Question 1

Definition of Atherosclerosis

Answer 1

Thickening and hardening of vessel are caused by accumulation of lipid-laden macrophages within arterial wall, which leads to formation of a lesion called a plaque

Classified as an inflammatory disease

Question 2

Stages of Atherosclerosis

Answer 2

1. Fatty streak: Earliest lesion. Composed of lipids
2. Fibrous plaque: Advanced lesion. Composed of lipids, collagen, smooth muscle cells, debris from cellular necrosis. Protrude into lumen of vessel
3. Complicated lesion: Plaques rupture due to release of macrophage degradative enzymes. Known as “unstable” plaques

Question 3

Common risk factors for atherosclerosis

Answer 3

Non-modifiable: Age, gender, hormones, family history

Modifiable: Tobacco, HTN, dyslipidemia, DM, obesity, sedentary lifestyle, alcohol, atherogenic diet

Non-traditional: Hyperhomocystinemia, Infection (cytomegalovirus, chlamydia pneumonia, H. Pylori as marked by C-reactive proteins)

Question 4

Pathogenesis of Atherosclerosis

Answer 4

Risk factor–>injury–>inflammation–>
Macrophages release oxygen radicals & growth factors. Oxidation of LDLs & smooth muscle cell proliferation–>
Engulfment of oxidized LDL & smooth muscle cells by macrophages–>
Fatty streak–>
Continued inflammation, increased release of oxygen free radicals, more smooth muscle cell proliferation, fibroblast proliferation, fibrous plaque–>
Continued inflammation, plaque ruptures, complicated lesion. Plaque hemorrhages, platelets adhere, clotting cascade, thrombus formation

Question 5

Clinical Manifestations of Atherosclerosis

Answer 5

Occur due to ischemia occuring distal from the site of occlusion. Atherosclerosis in:
Carotid Artery: CVA (stroke)
Femoral artery: Peripheral vascular disease (PVD)
Coronary artery: Angina and Myocardial Infarction (MI)
Renal artery: HTN, ESRD

Question 6

Thrombus formation

Answer 6

an abnormal clot that is formed in a vessel

Question 7

Embolus formation

Answer 7

floating clot that lodges somewhere

Emboli usually break off from thrombi

Question 8

Deep vein thrombosis

Answer 8

Thrombi in deep veins

Question 9

Virchow’s Triad

Answer 9

1. Endothelial damage–>transudate–>hemoconcentration
2. Flow/Stasis
3. Hypercoagulable state–>thrombosis

Question 10

Risk factors for venous thrombosis

Answer 10

Venous stasis, hyperreactivity of blood coagulation, vascular trauma

Question 11

Patho of DVT

Answer 11

Vascular trauma–>stasis–>platelets adhere
Platelets adhere to collagen–>ADP released–>additional platelets attracted–>platelet plug
Coagulation cascade

Pulmonary embolus (if dislodges) 
OR
Inflammation (if deep vein obstructed)-->Pain, erythema, fever, unilateral sweling, Homan's sign-->Venous insufficiency (if inflammation destroys valves)

Question 12

Definition of HTN

Answer 12

Sustained SBP of 140 mmHg or greater or DBP of 90 mmHg or greater

Question 13

Primary (Essential HTN)

Answer 13

No identifiable cause; modifiable

Question 14

Secondary HTN

Answer 14

Non-modifiable risks
Kidneys: Renal failure, renal artery stenosis
Hormonal changes: Hyperaldosteronism, Cushing’s syndrome, hyperthyroidism, pheochromocytoma (E/NE), pregnancy induced
Changes in arteries: Vasculitis
Drugs: Oral contraceptives, corticosteroids

Question 15

Malignant HTN (Hypertensive crisis)

Answer 15

Sudden increase in SBP and/or DBP

SBP greater or equal to 210 and/or
DBP greater or equal to 120

Medical emergency

Most cases caused by secondary HTN (e.g., Guillian Barre syndrome, autonomic dysreflexia, withdrawal from beta blockers) or poorly controlled primary HTN