pathophysiology of vascular disease

Question 1

blood flow to donwstream tissue is inadequate if (2)

Answer 1

1. perfusion pressure too low

2. resistance too high

Question 2

vasculature fails to meet demands for increased blood flow if

Answer 2

resistance to flow can not be sufficiently lowered in order to increase flow

Question 3

most important adaptive mechanism for PVD

Answer 3

collateral pathways

Question 4

how does the body compensate for reduced blood flow caused by a blocked artery?

Answer 4

1. dilation of arterioles distal to stenosis
2. collateral artery formation
3. reduced tissue metabolism
4. increased oxygen extraction

Question 5

progressive disease involving the development of arterial wall lesions. As they grow, these lesions may narrow or occlude the arterial lumen. Complex lesions may also become unstable and rupture, leading to acute coronary events, such as unstable angina, myocardial infarction, and stroke.

Answer 5

atherosclerosis

Question 6

Turbulent flow and low shear stress leads to

Answer 6

endothelial injury and build-up of atherogenic material on the vessel wall.

Question 7

High shear stress (I.e. post-stenotic dilatation) causes

Answer 7

vessel dilation

Question 8

PVD becomes clinically apparent when diseased vessels become over _____ stenotic. Tandem lesions will cause greater symptoms.

Answer 8

50-70%

Question 9

tight enough to have an impact on flow at rest or during increased demand

Answer 9

significant PVD

Question 10

effort induced pain caused by accumulation of

Answer 10

1. anaerobic metabolites

2. lactic acid and adenosine monophosphate

Question 11

calf claudication, ischemic foot ulceration/gangrene

Answer 11

tibial atherosclerosis

Question 12

calf claudication

Answer 12

supertifical femoral atherosclerosis

Question 13

muscle ache, buttock/leg claudication, impotence

Answer 13

aortoiliac atherosclerosis

Question 14

loss of neurological function, transient ischemic event, amaurosis fugax, stroke

Answer 14

carotid atherosclerosis

Question 15

chest pain/discomfort, myocardial infarction, acute coronary syndrome, chronic stable angina

Answer 15

coronary atherosclerosis

Question 16

do not alter resistance to blood flow and have no impact on flow

Answer 16

non-obstructive blockages

Question 17

Blockages that do not restrict blood flow at rest but prevent flow increases needed meet increased demands (e.g. exertional angina)
Very tight blockages restrict flow at rest and at stress (e.g. rest pain)

Answer 17

obstructive blockages

Question 18

Claudicants can have a wide range of ABI. Less than ______ is considered severe PVD.

Answer 18

0.4

Question 19

Doppler systolic occlusion pressure at ankle versus arm measures pressure gradient between the two vascular beds at rest and with exercise (exercise increases flow (F))

Answer 19

ankle brachial index

Question 20

increasing myocardial oxygen demand leads to (2)

Answer 20

1. coronary vasodilation- decrease in resistance

2. increases coronary blood flow- increase in flow

Question 21

cardiac stress test is done to

Answer 21

stress the coronary vascular bed

Question 22

If the resistance cannot be sufficiently lowered to meet the requirements for coronary flow the heart becomes _____

Answer 22

ischemic

Question 23

ection of radio-opaque contrast dye to create an image of the arterial lumen
Allows more direct measurement of blockage
Give limited information about how sufficient are the collaterals

Answer 23

contrast angiography

GOLD STANDARD

Question 24

is useful for post operative follow up of bypass grafts and carotid endarterectom

-used to measure lumen area and the velocity of blood traveling across a stenosis which is proportional to the severity of the obstruction and the driving pressure.

Answer 24

Ultrasound

Question 25

Wall tension (T) is proportional to

Answer 25

radius (R) and pressure (P or blood pressure).

Question 26

Aneurysms form with ____________ particularly when the vascular radius is large (e.g. aorta) and the wall thickness is low.

Answer 26

increasing pressure (e.g. hypertension)

Question 27

Wall tension is reduced by ______

Answer 27

increased blood vessel wall thickness.

Question 28

Laplace’s law on risk of anuerysm

Answer 28

Risk of aneurysm rupture increases with size due to Laplace’s law

Question 29

Defined as 50% or greater increase in diameter of vessel

Answer 29

arterial aneurysm

Question 30

Ascending thoracic aortic aneurysm risk factors (4)

Answer 30

Hypertension Marfan Ehlors-Danlos Bicuspid aortic valve associated aneurysm

Question 31

Descending thoracic aortic aneurysm risk factors | 2

Answer 31

Atherosclerosis | Hypertension

Question 32

Abdominal aortic aneurysm | 3

Answer 32

Infrarenal: 95% Atherosclerosis Hypertension

Question 33

best imaging test for pre-operative planning. The thrombus seen adherent to the vessel wall in the aneurysmal aorta is common, and has no clinical significance.

Answer 33

CT

Question 34

Spontaneous disruption of intima “False channel” created within wall of aorta Propagation of tear distally May occlude branch vessels (viscera, extremities) May lead to vascular rupture Aorta, carotid arteries and coronary arteries are often sites

Answer 34

arterial dissection

Question 35

``` Lipid infiltration and into vascular wall Macrophage activation Lipid oxidation Cellular proliferation Calcification, atheroma formation Responsive to LDL-C lowering ```

Answer 35

atherosclerosis

Question 36

``` Plaque rupture Mural thrombus Arterial disease often platelet-dependent thrombus formation Responsive to anti-platelet therapy Aspirin P2Y12 blockers ```

Answer 36

thrombosis

Question 37

ASCVD Pathogenesis: 1-2 Punch

Answer 37

1. abnormal lipid metabolism | 2. systemic inflammation

Question 38

``` Atherogenic lipoproteins LDL VLDL/IDL Cholesterol Triglycerides ```

Answer 38

abn. lipid metabolism

Question 39

``` Diabetes Obesity Tobacco Hypertension Age ```

Answer 39

systemic inflammation

Question 40

Abnormal lipids (Dyslipidemia) Elevated low density lipoprotein cholesterol (LDL-C) Decreased high density lipoprotein cholesterol (HDL-C) Elevated triglycerides, particularly with low HDL-C Diabetes mellitus Hypertension Smoking tobacco products Family history of premature coronary artery disease (CAD) First degree male relatives < 55 years or females < 65 years. Obesity and lack of exercise particularly in relation to Diabetes Male sex Advanced age Others: Lipoprotein a (Lp(a))

Answer 40

risk factors for atherosclerotic CAD

Question 41

Women develop ASCVD approximately 10 years after men following ______

Answer 41

menopause

Question 42

Aspirin may be less effective at preventing ASCVD in women

Answer 42

true

Question 43

The onset of ASCVD following menopause may be caused by the ______

Answer 43

loss of estrogen - no benefits in replacement trials

Question 44

monogenetic lipid disorders

Answer 44

1. familial hyercholesterolemia | 2. familial combined hyperlipidemia- Elevated triglycerides and LDL-C

Question 45

_____ are remnant particles that started as VLDL and IDL and transport cholesterol and some triglycerides to tissues (forward cholesterol transport

Answer 45

Low Density Lipoproteins (LDL)

Question 46

_______ transport cholesterol back to liver for disposal in bile (reverse cholesterol transport)

Answer 46

High Density Lipoproteins (HDL)

Question 47

Derived from VLDL->IDL Rich in esterified and non-esterified cholesterol Protein: Apo B-100 Hydrophobic Core Bind LDL-Receptor as well as scavenger receptors Toxin to endothelium that incite blood vessel wall inflammation “Bad Cholesterol”

Answer 47

LDL

Question 48

Synthesized empty Protein: Apo-A-I and –A-II HDL particles pick-up cholesterol from tissues Reverse cholesterol transport CETP exchanges cholesterol between different lipoproteins “Good cholesterol”

Answer 48

HDL

Question 49

Genetic studies support a strong causal relationship between LDL-C levels ASCVD

Answer 49

yep

Question 50

HMG-CoA Reductase Inhibitors

Answer 50

Statins:

Question 51

High Intensity Statin used for

Answer 51

Secondary Prevention of ASCVD

Question 52

Moderate Intensity Statin used for

Answer 52

Primary Prevention of ASCVD

Question 53

aspirin

Answer 53

platelet inhibition