CV Lecture 3 Flashcards
What is Arteriosclerosis?
- A thickening or hardening of the arterial wall
* The innermost layer undergoes a series of changes that ↓ the artery’s ability to change lumen size
What is Atherosclerosis?
• A type of arteriosclerosis • Major Risk Factor for development of: ∗ Cardiovascular Disease – coronary artery disease (CAD) and acute coronary syndromes (ACS) ∗ Cerebrovascular Disease ∗ Peripheral Vascular Disease (PVD)
What are the risk factors of Atherosclerosis?
- Genetic predisposition and diabetes have a fairly direct effect on the development of atherosclerosis
- Indirect risk factors – obesity, sedentary lifestyle, smoking, and stress
- Research points to ↑ levels of C-Reactive Protein
What is Pathophysiology of Atherosclerosis?
• The exact pathophysiology is unknown but thought to occur from vascular damage R/T HTN, cholesterol levels, toxins from renal failure, or smoking.
∗ An inflammatory response triggers plaque development
∗ A stable or unstable plaque (made of collagen, cholesterol, cell debris, smooth muscle cells, and, especially in older patients, calcium) develops which partially or completely occludes the blood flow of an artery
What happens when a plaque ruptures due to Atherosclerosis?
thrombosis and vasoconstriction obstruct the lumen causing inadequate perfusion to distal tissues
What are the clinical manifestations of Atherosclerosis?
• Manifestations depend on ∗ Vessel involved ∗ Site of the lesion ∗ Age of patient ∗ Genetic makeup ∗ Physiologic status of the individual • HTN develops if atherosclerosis ↑ systemic vascular resistance (SVR) • Cerebral or myocardial ischemia is a life-threatening manifestation of atherosclerosis in vessels of the brain or heart
Lipid levels of patients with Atherosclerosis will be?
Increased
What is a desirable Total Serum cholesterol level?
<200 mg/dL
What is borderline and high risk cholesterol level?
▪ Borderline High Risk – 200 – 239 mg/dL
▪ High Risk – 240 mg/dL and over
What is Homocysteine?
∗ Amino acid derived from dietary protein
What can an increase level of Homocysteine do?
∗ Positive correlation between ↑ levels and development of PVD, CAD, Stroke, and Venous Thrombosis
What level of Homocysteine is a risk factor and what happens with high levels of homocysteine?
∗ High levels effects cell wall elasticity and permits plaque buildup
∗ Level > 15 mmol/L is a risk factor
What are some ways to lower homocysteine level if needed?
∗ Can lower by eating diet rich in B-complex vitamins, particularly folic acid
∗ 1 mg supplement of folic acid daily can improve endothelial function and lower homocysteine levels
What is • C-Reactive Protein (CRP)?
∗ One of the acute phase proteins that increases during systemic inflammation
▪ Inflammation is a common component to the development of lipid containing plaques
What level of C-Reactive Protein (CRP) puts someone at risk for heart disease?
level > 3 mg/dL
How can you decrease C-Reactive Protein (CRP)?
∗ Can decrease with ASA, exercise, statins
What are some ways to help manage Atherosclerosis?
Therapeutic Lifestyle Changes (TLC) =
- DIET : ↓ Red meats, eggs and milk products, liver, organ meats
∗ ↑ soluble fiber – fruits, vegetables, oats, and legumes (10 – 25 g/day) and plant stanols/sterols (2 g/day)
-EXERCISE: ↑ physical activity.
∗ With diet therapy the average reduction in total cholesterol is 10 – 15%
-QUIT SMOKING
When is drug therapy usually initiated with Atherosclerosis?
after a 6 month trial of dietary alterations without success
Atherosclerosis-
What is the action of HMG-CoA Reductase Inhibitors (statins) ?
▪ ↓ cholesterol production in the liver and ↑ clearance of LDL-C from the blood
