E3: Dyslipidemia/PAD

Question 1

Dyslipidemia aka Hyperlipidemia

Answer 1

elevated total or low-density lipoprotein (LDL) cholesterol levels, or low levels of high-density lipoprotein (HDL) cholesterol

Question 2

Atherosclerosis

Answer 2

disease in which plaque builds up inside the arteries

Question 3

Chain of Events Leading to CV Mortality (8)

Answer 3

1. Risk factors
2. Atherosclerosis, CAD, PAD
3. Ischemic Heart Disease, Angina, MI
4. Dysrhythmias or Loss of cardiac muscle
   —Dysrhythmias = Sudden death
5. Compensatory response (↑ AngII, NE, HR)
6. Ventricular remodeling (Hypertrophy, cardiomegaly
7. Heart failure
8. Death

Question 4

Macrophages develop into foam cells –> form ________ _________–> __________ plaques

Answer 4

Macrophages develop into foam cells –>
form fatty streaks –>
atherosclerotic plaques

Question 5

___ ASCVD risk is likely if TG > 500 mg/dL

Answer 5

↑

Question 6

Elevated TG ↑ risk of acute _______
a. Abdominal pain, dull, aching, nausea
b. may require hospitalization, death possible

Answer 6

pancreatitis

Question 7

Clinical presentation of elevated TG

Answer 7

Acanthosis Nigricans
Xanthomas

Question 8

Primary/Familial Dyslipidemia

Answer 8

Genetic defects cause cholesterol ↑

Question 9

Secondary (or acquired) Dyslipidemia

Answer 9

-Poor diet
-Lack of physical activity
-Diabetes
-Drugs:
↑ LDL: anabolic steroids, corticosteroids
↑ TG: estrogens, retinoids

Question 10

HeFH

Answer 10

mutations in LDLRgene of LDL receptor which normally removes LDL from the circulation, or apolipoprotein B(ApoB), part of LDL that binds with the receptor

Question 11

HoFH

Answer 11

two abnormal copies (homozygous)

Question 12

________ is the leading cause of PAD in patients > 40 years old and claudication is common. Define claudication

Answer 12

Atherosclerosis
claudication: Painful muscle cramping due to ↓ blood supply

Question 13

Other causes of PAD

Answer 13

thrombosis, embolism, vasculitis, and trauma

Question 14

Risk factors of PAD

Answer 14

Age: > 60 (CDC)
diabetes
smoking
hypertension
dyslipidemia
obesity

Question 15

PAD Pathophysiology
1. narrowing of the…
most commonly in the arteries of the..
2. _____ blockages do not totally impede blood flows
3. Lactic acid build up in active muscles due to _______ ___ _____
4. Severe blockage with time can lead to

Answer 15

1. narrowing of the peripheral arteries to the legs, stomach, arms
   most commonly in the arteries of the legs
2. Mild blockages do not totally impede blood flows
3. Lactic acid build up in active muscles due to lack of O2
4. Severe blockage with time can lead to occlusion

Question 16

PAD Symptoms (3)

Answer 16

1. Most patients are asymptomatic
2. intermittent claudication symptoms:
3. Atherosclerotic occlusion can lead to loss of circulation, limb amputation, gangrene

Question 17

intermittent claudication symptoms (3)

Answer 17

1. painful muscle cramping in the hips, thighs or calve when walking, climbing stairs or exercising
2. most typically occurs with exercise; in severe cases occurs at rest
3. intermittent; aching, tired, crampy muscle pain that comes and goes

Question 18

ABI Define

Answer 18

Ankle-Brachial Index
ankle systolic pressure/brachial systolic pressure

Question 19

ABI
1.0-1.4:
0.7-.09:
0.4-0.7:
<0.4:

General rule: < or equal to ___ has PAD

Answer 19

1.0-1.4: Normal
0.7-.09: Mild evidence of arterial disease
0.4-0.7: Moderate arterial disease
<0.4: Severe arterial disease

General rule: < or equal to 0.9 has PAD

Question 20

4 Complications from PAD

Answer 20

1. ↑ risk of functional limitation , ↑ cardiovascular disease and ↑ mortality
   –Pain upon movement decreases activity
2. ↑ Risk of coronary artery disease and ↑ stroke
   –Systemic atherothrombotic events more likely
3. Intermittent limb claudication leads to critical limb ischemia
4. Limb amputation associated with ↑ morbidity and mortality
   –½ of patients who have major limb amputation due to vascular disease will die w/in 1 year

Question 21

What is the most common presenting symptom at work for patients suffering from PAD?

Peripheral leg edema

Lower leg bruising

Poor wound healing

Pain upon walking

Answer 21

Pain upon walking

Question 22

A 76 yo woman presents with pain in her legs. The physical examination and bedside ABI testing suggest PAD. BP: 137/87 TC: 213 LDL: 133 HDL: 47 TG: 147 FBG: 121 Waist Circumference: 38 in ABI: 0.82

What is the clinical term for the symptoms she is experiencing?

Answer 22

Claudication