Vascular Flashcards
1
Q
CHD risk factors
A
men >45, women >55 diabetes mellistus fam hx of premature CHD (male <55, female <65 first degree) HTN smoking dyslipidemia
2
Q
core of lipoproteins
A
non polar
TG and chol ester
3
Q
outer coat of lipoproteins
A
polar
unesterified chol, phospholipids, apolipoproteins
4
Q
apolipoproteins
A
stabilize lipoprotein particles
impart solubility to lipoproteins
catalyze changes in particle composition
facilitate entry/exit into/from cells
5
Q
daily dietary chol
A
200-300mg/day
6
Q
chol produced by liver daily
A
~800mg/day
7
Q
what does the LDL-R recognize?
A
apo B-100
8
Q
why do we have HDL?
A
anti inflam
host defense and immunity (protect from endotoxin, trypanosomes)
reverse chol transport
9
Q
Arcus corneus
A
grayish hazy stripe on inside of iris
any dyslipidemia
*hyperTG
10
Q
xanthelasmas
A
pale yellow fatty accumulations on medial aspects of eyelids
nonspecific marker of dyslipidemia
11
Q
eruptive xanthomas
A
pts w/ chylomicronemia
“chicken pox on butt”
12
Q
tendon, tuberous xanthomas
A
pts w/ FH
13
Q
2* causes of hypercholesterolemia
A
hypothyroidism DM chronic renal dz obstructive liver dz obesity
14
Q
hyperTG 2* causes
A
alcohol DM obesity estrogen use chronic renal dz
15
Q
2* causes of low HDL chol
A
obesity
DM
chronic renal dz
progestin use
16
Q
high risk CVD pts
A
established CHD, PAD, stroke
LDL-C >190
10 yr CVD risk >7.5% (1* prevention)
17
Q
medium risk CVD pts
A
CVD but over 75 yo
10 yr CVD risk 5-7.5%
18
Q
who should intake <1500 mg sodium/day?
A
HTN DM CKD Afri-Amer >51 yo
19
Q
normal awake home BP reading
A
<135/85
20
Q
ambulatory BP monitoring
A
provides readings every 20-30 minutes
HTN dx = 24hr BP >130/80
used to dx white coat, masked, nocturnal HTN
21
Q
BP goals for HTN tx
A
clinic <140/90
home <135/85
22
Q
HTN urgency
A
> 180/120 but no acute target organ damage
receive immediate tx w/ oral (+/- IV) meds
23
Q
HTN emergency
A
> 180/120 + acute target organ damage/sx
requires hospitalization and immediate parenteral meds
24
Q
goal for tx of HTN emergency/urgency
A
dec BP by no more than 25% in 2 hrs
dec BP to ~160/100
25
resistant HTN
failure to achieve guideline recommended gaol BP when a pt adheres to max doses of 3 meds (incl diuretic)
common w/ obesity, KD, DM, older age
26
uncontrolled HTN
all HTN pts who lack BP control under tx
| due to inadequate tx, resistant HTN, pt adherence, undetected 2* HTN
27
characteristics/conditions associated w/ resistant HTN (8)
```
older age
obesity
LVH
Na/V retention
females
Afr-Amer
DM
CKD
```
28
clinical manifestations of atherosclerosis
CHD/CAD (MI, unstable angine, ischemic cardiomyopathy)
cerebrovascular dz (ischemic stroke, transient ischemic attack)
PAD (claudication, AAA, RAS)
29
risk factors for atherosclerosis/CHD
```
age (men >45, women >55)
DM
fam hx (men <55, women <65)
HTN
cigarette smoking
dyslipidemia
```
30
functions of NO
```
controls shear stress
prevents leukocyte adhesion
promotes vasodil (GMP)
ing platelet adhesion
maintains normals t-PA:PAI-1
```
31
VCAM-1 (vascular cell adhesion molecule)
cytokine regulated mononuclear leukocytes adhesion molecule
binds monocytes and lymphocytes
expressed by endothelium over nascent fatty streaks
expressed by micro vessels of mature atheroma
32
MCP-1 (monocytes chemoattractant protein)
potent mononuclear cell chemoattractant
produced by endothelial cells and sm must cells
localizes in atheroma
33
M-CSF
potent monocytes activator and co-mitogen
produced by endothelial and sm musc cells
localizes in atheroma
augmented M-CSF expression in atherogenesis
34
what does a fatty streak consist of?
intact endothelium
foamy macs
some lymphocytes and sm musc cells in subendothel space
35
factors that cause MI or sudden cardiac death in relation to atherosclerotic plaque
```
areas of reduced shear stress, shear stress variability (turbulent flow/HTN, tachy)
plaque instability (inc inflam cells, thin fibrous cap w/ large lipid core)
```
36
why is impaired blood flow and thrombus formation worse in pts w/ endothelial dysfunction?
endothelial dysfunction leads to paradoxical vasoconstriction
37
when a plaque ruptures, what blocks the vessel?
mostly clot
| some cholesterol and fibrous cap
38
chronic risk factors for plaque rupture (5)
```
age
chol
HTN
smoking
DM
```
39
how can inflammation related to plaques be measured?
hs-CRP
| higher --> greater risk of vascular events
40
what is a vulnerable plaque
more likely to rupture
thin cap
large lipid core
inc inflam activity
41
causes of PAD (9)
```
tobacco
DM
HTN
hyperlipidemia (TC, TG, LDL)
inflam mediators (homocytseine, fibrinogen, CRP, lipoprotein (a), renal dz)
older
male
Af-Amer
obesity
physical inactivity
```
42
individuals at risk for LE PAD (4)
age <50 yrs + DM + 1 additional risk factor
age 50-60 + smoking or DM
age >70
known atherosclerotic coronary, carotid, o renal artery dz
43
what is the LDL chol goal for high risk PAD, coronary art dz, or DM pts?
<70mg/dl
44
what are the atypical features common w/ claudication? (3)
fatigue
heaviness
dysesthesia or cold sensation
45
what is a normal ABI?
resting >0.9
if <0.9 --> PAD
Lower = more severe dz
46
true vs false lumen
true: strong sys doppler velocity, thombus is rare
false: in media, slow doppler velocity, thombus is common
47
risk of AAA rupture related to size
<4cm: <1% risk/yr
4-5cm: 1% risk/yr
5-6cm: 11% risk/yr
>6cm: 25% risk/year
48
TAA surgical criteria (4)
diameter >5.5
growth >.5cm/year
>4.5cm in pts undergoing aortic valve surgery or w/ CT dz
sx
49
thoracic dissection complications
rupture through outer wall of false channel (pericardial tamponade, pleural/mediastinal, ongoing bleeding)
acute aortic regurgitation (aortic valve support undermined, acute and severe pulm congestion)
50
why is venous blood more susceptible to thrombosis?
low P
low flow
virchow's triad contributes
51
virchows triad
endothelia injury
stasis
hypercoag
52
paradoxical cardiac embolism
in presence of intracardiac shunt, thrombus bypass pulm circulation, passes from R to L atrium, and gains access to systemic circulation
53
endarterectomy
surgical excision and removal of arterial plaque
| often combined w/ patch plasty
54
embolectomy
removal of arterial or venous thrombus
| often performed in hybrid surgical/endovascular fashion
55
angioplasty
ballong catch to dilate a blocked artery
| long term limitation is restenosis
56
atherectomy
use of one of many different type of catheters to remove arterial plaque
57
amaurosis fugex
temporary monocular blindness caused by embolism to ophthalmic art (usually from carotid bifurcation)
58
transient ischemic attack
focal neurological deficit lasting sec to 24 hr
Mechanisms: 1) arterial spasm at site of stenosis
2) embolism
59
angina pectoris
pain or discomfort in the chest caused by insufficient blood supply to the heart muscles
- -typically brought on by exertion or emotional stress
- -typically lasts 1-15 min
- -relieved by rest, nitroglycerin
60
causes of chest pain
```
myocardial ischemia
pericarditis
GI probs
pulm dz
neuromuscular probs
```
61
what is most diagnostic of sig, obstructive CAD during exercise stress testing?
horizontal or down sloping depression or elevation of ST segment
62
FFR that suggests functionally sig stenosis that may warrant revasc?
FFR < .75-.80
63
survival in pts w/ CAD is related to what 2 major factors?
severity of CAD
| left vent function
64
triggers for plaques rupture? (4)
1. mechanical factors (shear stress)
2. catecholamines
3. inflam (--> inc CRP)
4. exogenous factors (smoking --> platelet activation)
65
why do coronary arteries thrombose? (3)
1. act intrinsic clotting (tissue factor --> act extrinsic clotting)
2. platelet activation (collagen, VWF, catecholamines, smoking)
3. endothelial dysfunction (dec NO, dec prostacyclin, vasocon)
66
platelet activation triggers and feedback
```
triggers
--catecholamines
--smoking
--collagen
--tissue factor
--VWF
feedback
--adenosine diP
--serotonin
--thromboxane A2
```
67
dx of metabolic syndrome
3+ of the following:
- -elev TG (>150 or on meds)
- -elev bl glugg (>100 or on meds)
- -elev BP (>130/85 or on meds)
- -dec HDL (<40 M, <50 F or on meds)
- -waist circumference >40in M, >35in F
68
combined dyslipidemia
often exists as part of MS
includes borderline high to high TG (150-499)
low HDL
moderately elev LDL and small dense LDL
69
high sodium diets inc risk of? (6)
```
HTN
stroke
LVH
osteoporosis
kidney stones
gastric cancer
```
70
factors associated w/ sodium sensitivity (8)
```
F
>40 yrs
abdom obesity
impaired glucose tolerance
DM
Af-Amer
HTN
fam hx of HTN
```
71
metabolic factors that vasodil?
```
adenosine
postaglandins
NO
K
O
```
72
metabolic factors that vasocon?
thromboxane
| endothelin
