Dr. Tann

Question 1

What are some important risk factors for coronary artery disease?

Answer 1

1st degree relatives w/ CAD
High Cholesterol
HTN
Older age
Smoking
Obesity
Stress Diabetes
Metabolic Syndrome--collection of risk factors.

Question 2

What are the options for treating athersclerosis?

Answer 2

Meds or insertion of a stent. Basically–we don’t want a blood clot!!

Question 3

What are the options for treating athersclerosis with a blood clot?

Answer 3

This needs to be physically removed.

Question 4

What can mimic athersclerosis?

Answer 4

Vasospasms.

Question 5

How does the blood vessel appear on imaging? Ultrasound in particular.

Answer 5

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.

Question 6

What is the purpose of imaging?

Answer 6

To confirm your suspicion.

Question 7

What is the artery’s response to plaque buildup?

Answer 7

It remodels itself to protect the lumen. It first expands outward. Then eventually it succumbs & the lumen narrows.

Question 8

T/F if there is plaque buildup the flow will necessarily be bad.

Answer 8

False. Even with plaque buildup the artery can sometimes compensate & create good flow.

Question 9

What is your fear with plaque?

Answer 9

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.

Question 10

Which additions to the intima are dangerous & indicate unstable plaque & dangerous intimal thickening?

Answer 10

Lipid pool

Microcalcifications

Question 11

Which cells are thought to destabilize a plaque & fibrous cap?

Answer 11

Inflammatory cells

activated macrophages

Question 12

What is it that causes plaque growth?

Answer 12

Hemorrhage & rupture.

Question 13

What is a thin cap fibro-atheroma? What are its characteristics?

Answer 13

Vulnerable Plaque
Large necrotic core
thin fibrous cap
presence of macrophages & lymphocytes
presence of type I collagen
absence of many smooth muscle cells

Question 14

What is stable angina? How do you treat it?

Answer 14

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

Question 15

What is unstable angina? How is it treated?

Answer 15

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

Question 16

If the thrombus of unstable angina grows, what may happen?

Answer 16

Complete occlusion! Emergency! ST elevation.

Question 17

What is NSTEMI?

Answer 17

Non ST elevation MI.

Note, an MI with ST elevation is more easy to localize where the damage is.

Question 18

What was the new treatment for MI in 1979 that was considered crazy talk?

Answer 18

Angioplasty

Question 19

What were two other types of therapy for MI that were developed in the late 1980s & early 1990s?

Answer 19

Thrombolytic & Fibrinolytic therapy.

Question 20

What does aspirin try to do vs. what warfarin & heparin try to do?

Answer 20

Aspirin-anti-platelet

Warfarin & heparin–anti-thrombin

Question 21

What was one of the major dangers of fibrinolytic therapy?

Answer 21

Ischemia
Reinfarction
Brain hemorrhage

Question 22

What are most patients who go to the ER with chest pain treated with?

Answer 22

anti-coagulants

Question 23

Which coronary artery when messed with is called the widowmaker?

Answer 23

LAD

Question 24

What are 3 possible post-MI problems?

Answer 24

Ventricular Septal Rupture
Free Wall Rupture
Mitral regurgitation (b/c of papillary muscle dysfunction)