Cardiac Pathology

Question 1

Which layer of the Artery Wall is Endothelium in?

Answer 1

Tunica Interna

Question 2

Which layer of the artery wall is Tunica Media in?

Answer 2

Smooth Muscle

Question 3

What are the Key functions of Vascular Endothelial Cells?

Answer 3

• Semi-permeable Barrier
• Produce Nitric Oxide as local level BP control
• Prevent Platelets sticking to vessel walls
• Reduce inflammation
• Production of new blood vessels (Angiogensis)

Question 4

What is the importance of L-arginine

Answer 4

• can be converted to Nitric Oxide by enzymes
• Smooth muscle cells causing relaxation

Question 5

What cause endothelial cell dysfunction and what does it lead to?

Answer 5

• Atherosclerotic Risk Factors such as Diabetes, HTN, HLD, Cigarettes
• Reduced NO production
• Decreased Flexibility / reactivity of the vessel
• Atherogenesis (fatty streaks)

Question 6

What is the first visible sign of Atherosclerosis

Answer 6

• Atherogenesis: Formation of abnormal fatty or lipid masses in arterial walls (fatty streaks)

Question 7

What are Non-Modifiable Risk Factors?

Answer 7

• Gender
• Age
• Family History

Question 8

What is Atherosclerosis and what can it lead to?

Answer 8

• Atherosclerosis is the hardening and narrowing of arteries due to plague buildup
• occurs because of the inflammation of the endothelium
• can lead to heart attack, stroke, or death

Question 9

What is Plague made up of?

Answer 9

• Fat
• Cholesterol
• Calcium
• Other substances found in blood

Question 10

What are fatty streaks and how do they develop?

Answer 10

• Lighter areas in arteries caused by lipid deposition
• Can eventually develop into plagues
• Initial visible lesion
• Presence of Foam cells

Question 11

How does Endothelium damage lead to Foam cells?

Answer 11

• Endothelium damaged
• LDL comes in from the blood
• Endothelium sends marker
• Monocyte comes in and turn into Macrophages to eat the LDL
• Macrophages eat themselves to death and become Foam cells

Question 12

What is Fibrous Cap?

Answer 12

• Composed of smooth muscle cells and collagen covering the plaque over luminal aspect

Question 13

Vulnerable Plaque

Answer 13

• Thin fibrous cap, inflammatory cells, Large lipid core
• Ruptures, Thrombus, can lead to an Acute Coronary Syndrome

Question 14

Stable Plaque

Answer 14

• Thick, smooth muscle cells, small lipid core
• Reduced Coronary Flow Reserve (CFR)
• Demand Ischema +/- Angina

Question 15

What are the two main types of myocardial infarction?

Answer 15

• Full thickness (Transmural)
• Partial Thickness ( Sub-endocardial)

Question 16

What are the characteristics of Myocardiac Ischemia?

Answer 16

• Compromised blood flow (caused by a blockage)
• Insufficient for Metabolic needs
• Demand greater than Supply
• Silent myocardial is ischemia

Question 17

What is Angina Pectoris? and what are the typical presentations?

Answer 17

• Symptom of chest pain
• Squeezing, pressure, heaviness, tightness or pain
• Decreased blood flow with increased O2 demands

Question 18

How can Angina symptoms be different in Women?

Answer 18

• Nausea, shortness of breath, abdominal pain or extreme fatigue
• can happen without chest pain
• discomfort in the neck, jaw or back
• can experience stabbing pain

Question 19

How can you differentiate between stable and unstable angina?

Answer 19

Stable angina has a predictable threshold (occurs with exertion), while unstable angina is unpredictable, lasts over 15 minutes, and can lead to a myocardial infarction​

Question 20

What is Demand Ischemia?

Answer 20

Stable Angina

Question 21

What is Supply Ischemia?

Answer 21

Unstable Angina

Question 22

Which Angina is Chronic narrowing (atherosclerosis)?

Answer 22

• Stable Angina

Question 23

Which Angina is Non-occlusive thrombosis / ruptured plaque?

Answer 23

• Unstable Angina

Question 24

How to relieve symptoms of Stable Angina?

Answer 24

• rest
• reduce stress
• nitroglycerin

Question 25

Unstable Angina can progress to?

Answer 25

• Myocardial Infarction
• Requires immediate attention