Dr. Tann Flashcards
What are some important risk factors for coronary artery disease?
1st degree relatives w/ CAD High Cholesterol HTN Older age Smoking Obesity Stress Diabetes Metabolic Syndrome--collection of risk factors.
What are the options for treating athersclerosis?
Meds or insertion of a stent. Basically–we don’t want a blood clot!!
What are the options for treating athersclerosis with a blood clot?
This needs to be physically removed.
What can mimic athersclerosis?
Vasospasms.
How does the blood vessel appear on imaging? Ultrasound in particular.
Adventitia–with a lot of collagen will appear gray or white.
Media–with a lot of smooth muscle cells–doesn’t reflect waves & appears dark.
Intima–If there is plaque it will appear different shades of white or gray.
What is the purpose of imaging?
To confirm your suspicion.
What is the artery’s response to plaque buildup?
It remodels itself to protect the lumen. It first expands outward. Then eventually it succumbs & the lumen narrows.
T/F if there is plaque buildup the flow will necessarily be bad.
False. Even with plaque buildup the artery can sometimes compensate & create good flow.
What is your fear with plaque?
So there is this nasty thrombogenic stuff trapped in the plaque buildup. A fibrous cap keeps it form contacting the blood in the lumen. Your fear is that if it ruptures there will be fast blood clot formation.
Which additions to the intima are dangerous & indicate unstable plaque & dangerous intimal thickening?
Lipid pool
Microcalcifications
Which cells are thought to destabilize a plaque & fibrous cap?
Inflammatory cells
activated macrophages
What is it that causes plaque growth?
Hemorrhage & rupture.
What is a thin cap fibro-atheroma? What are its characteristics?
Vulnerable Plaque Large necrotic core thin fibrous cap presence of macrophages & lymphocytes presence of type I collagen absence of many smooth muscle cells
What is stable angina? How do you treat it?
Heart pain during exertion. Relieved w/ rest. Pressure or tightness.
Indicates improper O2 flow to the heart.
Modify risk factors
Beta blockers
ACE inhibitors
Statins
Calcium channel blockers
What is unstable angina? How is it treated?
Chest pain when at rest or with higher frequency.
This could indicate a partially occluding platelet-rich thrombus.
This causes no permanent damage.
You will sometimes see ST depression with this.
Treated aggressively, with meds, with diagnostic catheter, hemodynamic support & IV fluids
If the thrombus of unstable angina grows, what may happen?
Complete occlusion! Emergency! ST elevation.
What is NSTEMI?
Non ST elevation MI.
Note, an MI with ST elevation is more easy to localize where the damage is.
What was the new treatment for MI in 1979 that was considered crazy talk?
Angioplasty
What were two other types of therapy for MI that were developed in the late 1980s & early 1990s?
Thrombolytic & Fibrinolytic therapy.
What does aspirin try to do vs. what warfarin & heparin try to do?
Aspirin-anti-platelet
Warfarin & heparin–anti-thrombin
What was one of the major dangers of fibrinolytic therapy?
Ischemia
Reinfarction
Brain hemorrhage
What are most patients who go to the ER with chest pain treated with?
anti-coagulants
Which coronary artery when messed with is called the widowmaker?
LAD
What are 3 possible post-MI problems?
Ventricular Septal Rupture
Free Wall Rupture
Mitral regurgitation (b/c of papillary muscle dysfunction)
