S2 L2.3: Atherosclerosis Flashcards
LDL ( ___ cholesterol) will find its way into the ______ and it will be causing the migration of the smooth muscles bc ____ _____ will form
LDL (bad cholesterol) will find its way into the endothelium and it will be causing the migration of the
smooth muscles bc foam cell will form
T/F:
Foam cell makes up the bulk of lipid clots, and
these clots may rupture and cause a heart attack
False
Foam cell makes up the bulk of CHOLESTEROL clots, and
these clots may rupture and cause a heart attack
Medical term for cholesterol plaque
Atheroma
EVOLUTION OF ATHEROMA
Arrange the following in order from 1 - 10:
Calcification and fibrosis continues
SMCs in the intima divide and migrate into the intima
from the media
Accumulation of lipoprotein particles in the intima
Increase expression of adhesion molecules
Expression of scavenger receptors
Extracellular matrix accumulation in the growing
atherosclerotic plaque.
Oxidative stress can induce local cytokine elaboration
Development of foam cells
- Accumulation of lipoprotein particles in the intima
- Oxidative stress can induce local cytokine elaboration
- Increase expression of adhesion molecules
- Expression of scavenger receptors
- Development of foam cells
- SMCs in the intima divide and migrate into the intima
from the media - Extracellular matrix accumulation in the growing
atherosclerotic plaque. - Calcification and fibrosis continues
Covers the plaque
Cap
SIMPLIFIED VERSION OF ATHEROMA EVOLUTION
Arrange the following from 1 - 4
Atheroma Formation
Fibrosis Healing
Clot Formation
Plaque Rupture
A. Atheroma Formation
B. Plaque Rupture
C. Clot Formation
D. Fibrosis or Healing (reduced lumen, limitation of blood flow)
EVOLUTION OF ATHEROMA
Thin caps can be ruptured easily due to ____,
____, ____, _______ _____
smoking,
htn, alcohol, inflammatory events
T/F regarding EVOLUTION OF ATHEROMA:
Cap ruptures → blood clot formation due to bleeding → Injures the endtholeium → clot too
big which obstructs the artery completely
False
Cap ruptures → Injures the endothelium →
blood clot formation due to bleeding → clot too
big which obstructs the artery completely
Modified T/F regarding EVOLUTION OF ATHEROMA:
- The amount of clot formation will tell how severe the
situation is. - A resolved clot but has thickened cap leads to reduced lumen which will result in limitation of blood flow
TT
Arrange the following in accordance with the ATHEROSCLEROSIS TIMELINE (from 1 to 6)
Complicated lesion/rupture
Foam cells
Fatty streak
Atheroma
Intermediate lesion
Fibrous plaque
- Foam cells
- Fatty streak
- Intermediate lesion
- Atheroma
- Fibrous plaque
- Complicated lesion/rupture
Match the following items:
1.Growth mainly by lipid accumulation
2. Thrombosis, hematoma
3. Smooth muscle and collagen
4. 0 days - 10 years old
5. 21 - 30 years old
6. 31 - 40 years old
A. From first decade
B. From third decade
C. From fourth decade
- A and B
- C
- C
- A
- B
- C
Is a life threatening disease that may have begun to develop during childhood
Atherosclerosis
Is a process in which deposits of fatty
material called plaque, build up inside the walls of
arteries reducing or completely blocking blood flow
Atherosclerosis
Give me at least three (3) risk factors for atherosclerosis
Risk factors for atherosclerosis:
○ High blood pressure
○ High cholesterol
○ Tobacco smoke
○ Diabetes
○ Obesity
○ Physical inactivity
○ Hyperlipidemia
T/F:
1. Scientists are sure that it begins with damage to endothelium, inner
wall of an artery
2. Over time, substances traveling in the blood such as
cholesterol, fats, and cellular wastes products
accumulate inside the damaged area the arterial wall
- F. Although exact causes are not clear, many scientists think that it begins with damage to endothelium, inner
wall of an artery - T
Arrange the folllowing in order of the sequence of the formation of atherosclerosis from 1 to 11 (this is from atheroscleorsis (2009) nucleus medical media):
Chemical reactions occurring within the build up of
material cause cholesterol molecules to oxidize which will initiate an inflammatory response wherein
endothelial cells at the damaged site release
chemicals that signal call for help. In response, monocytes from the bloodstream travel
to the damaged site
Stimulation from the oxidized cholesterol converts
monocytes into macrophages
As the plaque increases in size, the arterial wall thickens and hardens
Most of the smooth muscle cells move to the
surface of the plaque
The macrophages then eat and digest the cholesterol
molecules which changes these macrophages
into foam cells. Such foam cells would eventually accumulate to form plaque
Smooth muscle cells within the arterial
wall begin to multiply
The smooth muscle cells contribute to the formation of a firm, fibrous cap, covering the plaque
Over time, the cap may erode and break open, releasing plaque into bloodstream
Limited blood supply is available to the area
surrounding the partially blocked artery degrading and potentially killing the neighboring tissue
The plaque can flow downstream and contribute to the formation of a blood clot, which can stop blood flow
Significant damage in organs such as the heart or brain can result in a heart attack or stroke
- Chemical reactions occurring within the build up of
material cause cholesterol molecules to oxidize which will initiate an inflammatory response wherein
endothelial cells at the damaged site release
chemicals that signal call for help. In response, monocytes from the bloodstream travel
to the damaged site - Stimulation from the oxidized cholesterol converts
monocytes into macrophages
3.The macrophages then eat and digest the cholesterol
molecules which changes these macrophages
into foam cells. Such foam cells would eventually accumulate to form plaque
- As the plaque increases in size, the arterial wall thickens and hardens
- Smooth muscle cells within the arterial
wall begin to multiply - Most of the smooth muscle cells move to the
surface of the plaque - The smooth muscle cells contribute to the formation of a firm, fibrous cap, covering the plaque
- Over time, the cap may erode and break open, releasing plaque into bloodstream
- The plaque can flow downstream and contribute to the formation of a blood clot, which can stop blood flow
- Limited blood supply is available to the area
surrounding the partially blocked artery degrading and potentially killing the neighboring tissue - Significant damage in organs such as the heart or brain can result in a heart attack or stroke
ATHERSCLEROSIS TO ATHEROTHROMBOSIS
Modified T/F:
1. It is not the plaque but the rupture of the plaque that predisposes one to have an Acute myocardial infarction
- Over time, if you don’t get to control the cholesterol
plaque formation, it will just progressively diminish the
lumen of the arteries making chest pains progressive
TT
Is the following description unstable or stable plaque?
- Fibrous cap is gonna decrease the lumen
- If you have a plaque rupture, you’ll have the plaque
formation at the thrombus, wherein there is a
complete obstruction - Distal to the obstruction, there will be a deprivation of blood flow, which will give the potential heart attack, myocardial infarction, myocardial death, or myocardial necrosis
- Stable
- Unstable
- Unstable
Give me the three (3) acute risk factors that is rooted from certain triggers for the formation of disruption/thrombosis from a vulnerable plaque
- Hemodynamic
- Vasoconstrictive
- Prothrombotic
Arrange the following into the correct sequence using arrows:
Atherosclerosis Chronic risk factors
Triggers
Acute risk factors (hemodynamic, vasconstrictive, prothrombotic)
Vulnerable plaque
Non-vulnerable plaque
Disruption, thrombosis
Plaque progression (Unstable angina, myocardial infarction, sudden cardiac death)
SAMPLE ANSWER:
Disruption → Non-vulnerable plaque → Plaque progression
Atherosclerosis Chronic risk factors →Non-vulnerable plaque → vulnerable plaque → triggers → acute risk factors (hemodynamic, vasconstrictive, prothrombotic) → Disruption, thrombosis → Plaque progression (Unstable angina, myocardial infarction, sudden cardiac death)
A plaquet hat is strong becomes vulnerable plaque over time if you cannot control risk factors
Non-vulnerable plaque
What is being described?
Fluctuation in blood pressure (It goes up and down vice versa)
Hemodynamic triggers
What is being described?
Blood becomes thicker with hypertension (especially
when you are already predisposed to Htn)
Prothrombotic
Means that you are predisposed to
blood clot
Prothrombotic
Due to this: disruption of blood flow, thrombosis
occurs, myocardial infarction, plaque
progression occurs
Prothrombic
ISCHEMIC TRIGGERS
Classify the following:
- Exercise
- Pulse pressure
- Assuming upright posture
- Cigarette smoking
- Cold exposure
- heart rate
- Systolic BP
- Increased vascular
resistance - Catecholamine levels
A. Trigger
B. Mediator
- A
- B
- A
- A
- A
- B
- B
- B
- B
The following are included under ischemic triggers, EXCEPT:
A. Exercise
B. Assuming upright posture
C. Cigarette smoking
D. Cold exposure
E. None of the Above
E
Selec the items that are included under mediators for ischemic triggers?
A. Exercise
B. Pulse pressure
C. Assuming upright posture
D. Cigarette smoking
E. Cold exposure
F. heart rate
G. Systolic BP
H. Increased vascular
resistance
I. Catecholamine levels
B and F to I
Arrange the following items regarding ischemic triggers in sequence using arrows:
Trigger
Plaque fissure, thrombin and platelet activation, and vasospasm
Mediator
Trigger → Mediator → Plaque fissure, thrombin and platelet activation, and vasospasm
What are the three (3) possible result fron ischemic triggers?
Plaque fissure, thrombin and platelet activation, and vasospasm
T/F
Exercise can increase heart rate, blood pressure; So when doing exercises for patients with heart diseases, you want to be watchful over heart rates and blood pressure because you do not want wide swings on them
True
T/F
PTs do not need to be careful when it comes to positioning when it comes to cardiac patients
False
We have to be careful when making patients assume upright posture; This is why in PT sessions, they would train the pt and not make patient stand right away as circulatory system cannot adjust yet
What possible factors and/or activities causes vasconstriciton?
Cigarette smoking and cold environment
When applying cold packs → could have a negative impact on CAD pts
Difference of SBP and DBP, ____ pulse pressure (___/___) = more dangerous, ____ pulse pressure (___/___) = also can be dangerous
Difference of SBP and DBP, higher pulse pressure (160/60) = more dangerous, lower pulse pressure (100/80) = also can be dangerous
Modified T/F:
- You want your patients stress free during treatments; don’t want them to be too excited
- Monitor BP and HR; cannot measure vascular resistance during sessions
TT
T/F
Not all CADs are brought upon by atherosclerotic lesions
True
NON-ATHEROSCLEROTIC CAUSES OF CAD
Give me at least four (4) fixed lesions for Non-Atherosclerosis Causes of CAD
● Congenital Anomalies
● Myocardial Bridges
● Aortic Dissection
○ Coming from a weak artery (aorta) it bulges
(aneurysmal) and is torn d/t HTN
● Granulomas
● Tumors
● Scarring from trauma, radiation
MYOCARDIAL BRIDGING
Normally, the _____ arteries are called _____
Normally, the coronary arteries are called epicardial (epi - on top & outside the epicardium)
● Normal left anterior descending artery or epicardial
artery is just on top and outside the muscle wall
MYOCARDIAL BRIDGING
It could be called bridging because the ____ bridged
over the _____
It could be called bridging because the muscle bridged
over the artery
What is the role of myocardial bridging in CAD?
It is one of the fixed lesions under non-atherosclerotic causes of CAD
Match the following items about myocardial bridging:
1. The artery dove deep into the muscle such
that when the muscle contracts, the blood vessel gets
constricted (like an obstruction). Causes chest pain when heart contracts more (i.e.
exercise, tachycardia)
2. Part of the arteries penetrates into the
myocardium such that when the heart contracts, they pinch the myocardial arteries
3. When the heart contracts during systole, the patient
may feel chest pain
4. Slightly buried into the muscle; not
embedded into the myocardium (no symptoms)
A. Deep bridging
B. Shallow bridge
1-3. A
4. B
DEEP BRIDGING in myocardial bridging
The artery dove deep into the muscle such
that when the muscle contracts, the blood vessel gets
_____ (like an ______). Causes _____ ______ when heart ______ _____ (i.e.
exercise, tachycardia)
The artery dove deep into the muscle such
that when the muscle contracts, the blood vessel gets
constricted (like an obstruction). Causes chest pain when heart contracts more (i.e.
exercise, tachycardia)
DEEP BRIDGING in myocardial bridging
Part of the arteries ______ into the
myocardium such that when the heart contracts, they _____ the myocardial arteries
Part of the arteries penetrates into the
myocardium such that when the heart contracts, they pinch the myocardial arteries
DEEP BRIDGING in myocardial bridging
When the heart contracts during ______, the patient
may feel _____ _______
When the heart contracts during systole, the patient
may feel chest pain
What do you call the event wherein the aorta is torn which leads to compromised aortic branches?
AORTIC DISSECTION:
Aorta is torn, can compromise its branches
What is the role of aortic dissection in CAD?
It is one of the fixed lesions under non-atherosclerotic causes of CAD
Match the following items regarding aortic dissection:
- Proximal aorta involvement (L)
- Distal aorta involvement (R)
- All dissections involving the ascending aorta
- Anything outside the proximal portion
- All dissections NOT involving the ascending aorta
- More dangerous
- Patient may die instantly since it is near the heart
- Tear in the proximal portion of aorta
A. Type A
B. Type B
- A
- B
- A
- B
- B
- A
- A
- A
The following describes Type A aortic dissection, EXCEPT (there can be more than one answer):
A. Anything outside the proximal portion
B. All dissections NOT involving the ascending aorta
C. More dangerous
D. Patient may die instantly since it is near the heart
E. Tear in the proximal portion of aorta
A and B
Which of the following describes Type B aortic dissection? (there can be more than one answer):
A. Distal aorta involvement (R)
B. All dissections NOT involving the ascending aorta
C. Anything outside the proximal portion
D. Patient may die instantly since it is near the heart
E. Proximal aorta involvement (L)
A, B, C
T/F regarding Aortic Dissection:
- R & L coronary artery came from the sinuses of the aorta
- Dissection of one of the arteries produces a functional obstruction = myocardial infarction
- From the true lumen, blood enters through the
tear creating another lumen (the false lumen) - False lumen impinges on RCA and creates an
obstruction - Deadly case, straight to emergency operation (OR)
All are TRUE
AORTIC DISSECTION
Dissection of one of the arteries produces a_____ _____ that leads to ______ ______
Dissection of one of the arteries produces a functional obstruction that leads to myocardial infarction
AORTIC DISSECTION
How is a false lumen created?
From the true lumen, blood enters through the
tear creating another lumen (the false lumen)
AORTIC DISSECTION
The formed false lumen impinges on ______ ____ _____ (hint: an artery) and creates an _______
The formed false lumen impinges on right coronary artery or RCA and creates an obstruction
T/F regarding Aortic Dissection:
1. Dissection of one of the arteries is a deadly case (straight to emergency operation (OR)) and a difficult case
2. Death rate is >50%
3. In all cases, the patients always suffer from ischemia
1-2. True
3. False. If there is still blood flow, the patient may not suffer from ischemia
Give me the three (3) transient causes under non-atherosclerotic causes of CAD
- Vasospasm
- Embolus
- Thrombus in situ
TRANSIENT CAUSES under non-atherosclerotic causes of CAD
Match the following items:
- Vasoconstriction in blood vessels causes angina
pectoris - From the Situ*, there’s clot formation there and then
- Patients who are in hypercoagulable states
- Not necessarily cholesterol
- Any blood clot that can enter in coronary arteries can obstruct
- In patients with Raynaud’s disease, they can also
have chest pain most likely caused by vasospasm
(Prinzmetal Angina) - Patients who take contraceptive pills
- Patients whose blood is very sticky (high platelet
count), the can develop thrombus
A. Vasospasm
B. Embolus
C. Thrombus in situ*
*In situ means “in the normal location” or “in its original place” (source: google)
- A
- C
- C
- B
- B
- A
- C
- C
