Determine Atherosclerotic Disease + Atherosclerotic Disease

Question 1

Disease primarily of the arterial endothelium

Plaques will invade tunica intima and cause thickening and scarring of the tunica media.

Answer 1

Pertinent Anatomy: Atherosclerotic Disease

Question 2

1) Coronary arteries
2) Lower extremities arteries: Aortoiliac segment, femoral-popliteal segment, and tibial segment.
3) Cerebral arteries
4) Carotid arteries
5) Aorta

Answer 2

The different sites that are most commonly affected of Atherosclerotic Disease

Question 3

Endothelial dysfunction, dyslipidemia, inflammatory and immunologic factors, plaque rupture, and smoking.

As plaques form, a new layer of endothelial tissue will cover the plaque and continue to cause inflammation and narrowing of the vessel. Along with endothelial tissue inflammation, tunica media thickens, and tunica intima becomes more rigid, leading to further vessel narrowing.

Dyslipidemia and abnormal lipids play a critical role in developing this disease.

Answer 3

Pathophysiology: Atherosclerotic Disease

Question 4

*Dyslipidemia and abnormal lipids play a critical role in the development of

Answer 4

Atherosclerotic Disease

Question 5

1) *Hypercholesterolemia
2) *Hypertension
3) *Diabetes Mellitus
4) Male gender
5) Smoking
6) Family history

Answer 5

Risk factors for atherosclerotic disease

Question 6

(1) *Coronary atherosclerosis leads to coronary arterial narrowing.
(2) *Number one killer in the United States.

Answer 6

Atherosclerotic Coronary Artery Disease (CAD)

Question 7

(a) Family history
(b) Male gender
(c) Hypercholesterolemia
(d) Diabetes mellitus
(e) Hypertension
(f) Physical inactivity
(g) Abdominal obesity
(h) Cigarette smoking
Excessive alcohol
(j) Poor diet: Low in fruits and vegetables, high in fat.
(k) Metabolic Syndrome

Answer 7

Risk Factors:
Atherosclerotic Coronary Artery Disease (CAD)

Question 8

Metabolic Syndrome:

Answer 8

Combination of medical disorders that, when
occurring together increase the risk of developing cardiovascular disease and diabetes

(abdominal obesity,
- triglycerides > 150 mg/dL,
- HDL < 40 mg/dL for men and < 50 mg/dL for women, fasting glucose > 110 mg/dL, and hypertension)

Question 9

(a) Chest pain
(b) Left shoulder pain
(c) Indigestion
(d) Nausea/Vomiting
(e) Pale
(f) Diaphoresis
(g) New heart murmur
(h) Rales on pulmonary examination
(i) S3
(j) S4
(k) Sudden cardiac death

Answer 9

Symptoms/Physical Exam Findings:
Atherosclerotic Coronary Artery Disease (CAD)

Question 10

(a) Lipid panel (looking for LDL, which is bad cholesterol, and HDL, which is good cholesterol).
(b) EKG
(c) Fasting glucose
(d) Troponin

*these are the same as hyperlipidemia

Answer 10

Labs/Studies:
Atherosclerotic Coronary Artery Disease (CAD)

Question 11

LDL is

Answer 11

bad cholesterol

Question 12

HDL is

Answer 12

good cholesterol

Question 13

1) ***Lifestyle changes: Increase activity and exercise.
2) Low-fat diet high in fruits and vegetables.
3) MOST important SMOKING CESSATION.
4) Moderate use of alcohol.
5) Control of HTN, Diabetes, and hypercholesterolemia.

Answer 13

Non Pharmacological Treatment:
Atherosclerotic Coronary Artery Disease (CAD)

Question 14

HMG-CoA reductase inhibitors
MOA: They work by inhibiting the rate-limiting enzyme in the formation of cholesterol.
- Atorvastatin (Lipitor) - Initial dose 10 mg before bedtime, titrate to a maximum dose of 80 mg

*NOTE: Adverse Reactions: Rhabdomyolysis
Monitoring: Need to check initial LFTs, then repeat in 3-6 months

• Aspirin (Bayer, Ecotrin, Enteric coated Aspirin) -The dose for primary prevention is *81 mg daily for > 10 years.

Answer 14

Pharmacological Treatment:
Atherosclerotic Coronary Artery Disease (CAD)

Question 15

1) Coronary Artery Bypass Grafting (CABG)-a large clot
2) Stenting (opening the artery)
3) Primary percutaneous coronary intervention

Answer 15

Surgical Treatment:
Atherosclerotic Coronary Artery Disease (CAD)

Question 16

(a) Number one thing is risk factor modification.
(b) If signs of Acute Myocardial Infarction need to MEDEVAC STAT.
(c) Treat underlying HTN, Diabetes, and Hypercholesterolemia.

Answer 16

Initial Care:
Atherosclerotic Coronary Artery Disease (CAD)

Question 17

***_____________________ are occlusive atherosclerotic lesions that develop in the legs and, less commonly, the arms causing decreased perfusion of the extremities.

S/S similar to CAD

It may be diffuse but usually occur segmentally (aortoiliac segments, Femoral- Popliteal segments, and Tibial segment)

*High correlation between smokers and patients with diabetes.

Answer 17

Atherosclerotic Peripheral Vascular Disease (PAD)

Question 18

(a) Claudication
(b) Patients with pain unrelieved by rest are at high risk for amputation.
(c) Diminished femoral, popliteal, or pedal pulses.
(d) Tissue ulceration and gangrene.
(e) Erectile dysfunction
(f) Loss of hair
(g) Thinning and cool skin
(h) Atrophy of muscles

Answer 18

Symptoms/Physical Exam Findings:
Atherosclerotic Peripheral Vascular Disease (PAD)

Question 19

***What is cramping pain or tiredness in the thigh, calf, or foot with walking or exercise and relieved by rest?

Answer 19

Claudication

Question 20

(a) Doppler examination with ABI
(b) ***CT Angiography and Magnetic Resonance Angiography if intervention is required. (GOLD STANDARD)
(c) Lipid panel
(d) Chemistry - to evaluate for renal dysfunction

Answer 20

Labs/Studies:
Atherosclerotic Peripheral Vascular Disease (PAD)

Question 21

1) SMOKING Cessation
2) Risk factor reduction
3) Weight loss
4) Consistent moderate exercise

Answer 21

Non Pharmacological Treatment:
Atherosclerotic Peripheral Vascular Disease (PAD)

Question 22

Treatment: Trial of Phosphodiesterase inhibitor:
Cilostazol
100 mg PO BID

Answer 22

Pharmacological Treatment: Atherosclerotic Peripheral Vascular Disease (PAD)

Question 23

1) Surgical Bypass
2) Endovascular angioplasty/stenting
3) Amputation

Answer 23

Surgical Treatment: Atherosclerotic Peripheral Vascular Disease (PAD)

Question 24

***EMERGENCY

Acute occlusion due to emboli or thrombus.

Emboli

Thrombus

50% goes to limbs 20% goes to brain

Atrial Fibrillation is the most common cause, but it can also be caused by valvular heart disease.

Claudication

Answer 24

Acute Arterial Occlusion of a Limb

Question 25

1. ________ are thrombus or plaque that breaks off and travels until the lumen becomes too small for the _______ to continue to move.
2. _______ large enough to occlude proximal arteries are almost always from the heart.

Answer 25

Emboli

Question 26

_______ is a blood clot that forms as a plaque ruptures, and platelets start to adhere and aggregate on the rupture site.

Answer 26

Thrombus

Question 27

50% of the heart goes to the lower extremity, 20% goes to cerebrovascular circulation, and the remainder goes to the upper limb, renal, and mesenteric circulation.

Answer 27

Arterial Occlusion

Question 28

Typical patient with a primary thrombus has a history of

Answer 28

Claudication

Question 29

(a) **Sudden onset of extremity pain with loss or reduction of pulses is diagnostic.

(b) **Neurological deficits: Numbness or paralysis

(c) Signs of severe arterial ischemia are the six 6 Ps

Answer 29

Symptoms and Physical Exam Findings:
Acute Arterial Occlusion of a Limb

Question 30

1) Pain
2) Pallor (or mottled with delayed capillary filling)
3) Poikilothermia (coolness)
4) *Pulselessness
5) Paresthesia
6) Paralysis

Answer 30

Signs of severe arterial ischemia

Question 31

(a) Chemistry may show systemic acidosis.

(b) Doppler will show little or no blood flow to distal vessels.

(c) CTA/MRA should be done in the operating room to prevent delay in revascularization.

Answer 31

Labs/Imaging: Acute Arterial Occlusion of a Limb

Question 32

Enoxaparin (Lovenox) anticoagulant
Dose: 1mg/kg SC q12 hours

Heparin Sulfate 5000-10,000 Units IV STAT

Immediate Revascularization within 3 hours. Delays increase the risk of irreversible tissue damage. Risk approaches 100% at 6 hours.

1) Surgical intervention
2) Endovascular Thrombolysis

Answer 32

Treatment: Acute Arterial Occlusion of a Limb

Question 33

Immediate Revascularization within _______. Delays increase the risk of irreversible tissue damage. Danger approaches 100% at ______.

1) Surgical intervention
2) Endovascular Thrombolysis

Answer 33

Revascularize: 3 hrs
Danger: 6 hrs

Question 34

(a) Give a dose of Heparin immediately 5000-10,000 Units IV STAT
(b) MEDEVAC immediately, do not delay.

Answer 34

Initial Care: Acute Arterial Occlusion of a Limb