Week 10 - Metabolic syndrome and CAD

Question 1

Describe the basic pathophysiology of coronary atherosclerosis.

Answer 1

• Atherosclerosis begins as a tear in the endothelium (first wall of the artery), infiltrating the intima layer
• Inflammatory response occurs and macrophages ingest lipids (foam cells) making further damage by initiating clotting
• Smooth muscle cells reproduce forming a cap over the lipids and inflammation making the vessel misshapen
• Continued abnormal accumulation of lipids and tissue in the lining of the artery are called plaques
• Plaques create narrowing or blockages interrupting blood flow and, if it continues to grow, it could rupture creating a thrombus

Question 2

What are the different coronary arteries? Which is the widow maker?

Answer 2

RCA, LCA (widow maker), LADA (left anterior descending artery), PACA (posterio ascending)

Question 3

If you suspect someone has coronary atherosclerosis, what would be the next steps?

Answer 3

Dietary changes, exercise

Blood test for cholesterol level and maybe starting on statins

Question 4

What are symptoms of angina pectoris?

Answer 4

Pain (can be GERD-type pain), nausea, diaphoresis, cyanosis, pallor

Question 5

Who is at risk for atherosclerosis?

Answer 5

• Elevated blood lipid levels (cholesterol)
• Smoking
• HTN
• DM
• Obesity
• Family Hx

Question 6

What are the non-modifiable risk factors for Coronary atherosclerosis?

Answer 6

Family hx of CAD
Increased age
Gender (men develop CAD earlier than women)
Race - higher incidence in blacks

Question 7

What are the modifiable risk factors for CAD?

Answer 7

hyperlipidemia
Smoking
HTN
DM
Lack of estrogen in women
Obesity
Physical activity

Question 8

Why do women have higher rates of CAD after menopause?

Answer 8

Lose cardioprotective effects of estrogen

Question 9

A cluster of the most dangerous heart attack risk factors.

Answer 9

Metabolic syndrome = diabetes and raised fasting plasma glucose, abdominal obesity, high cholesterol, and high BP

Question 10

__-___% of the world’s population has metabolic syndrome, and these people are __-__ times more likely to have an MI or CVA, compared to those without the syndrome

Answer 10

20-25%

2-3x

Question 11

Metabolic syndrome is mostly related to what?

Answer 11

insulin resistance and central obesity

Question 12

Metabolic syndrome is secondarily related to what?

Answer 12

physical inactivity, ageing, a pro-inflammatory state, hormonal changes

Question 13

Central obesity is associated with what?

Answer 13

Insulin resistance, HTN, high serum cholesterol

Question 14

What is central obesity in men and women?

Answer 14

men >102cm

women >88cm

Question 15

Where does one measure to determine if a person has central obesity?

Answer 15

Above the iliac crest

Question 16

Describe the lipid panel for dyslipidemia and what findings would be expected.
When do men typically start getting this done? Women?

Answer 16

Total cholesterol < 5.2 is good
TGs < 1.7 is good
LDL < 3.0 is good
HDL > 1.0 is good
(men 40; women 50)

Question 17

What are some SDoH that impact dyslipedemia?

Answer 17

Food insecurity, poverty, unable to travel, shift work, housing, education and health literacy

Question 18

What meds are often given for dyslipidemia?

Answer 18

Statins

Question 19

What are the different risk categories for HTN?

Answer 19

Low risk - 120/80
medium risk - 121-139 /80-89
High risk 140+/90

Question 20

Why is HTN a risk factor for CAD or atherosclerosis?

Answer 20

HTN causes damage to vessel walls, which get stiffer and are predisposed to injury

Question 21

What role does stress play in HTN?

Answer 21

Stress releases catecholamines which increase BP, HR

Question 22

What diet is typically useful for HTN?

Answer 22

DASH diet - low salt

Question 23

What types of meds are given for HTN?

Answer 23

Beta blockers
ACEIs (e.g. sartans)
CCB (dipines)

Question 24

Which is the most common diabetes type?

Answer 24

T2D

Question 25

How has T2D contributed to death?

Answer 25

Major cause of premature illness and death, primarily through the increased risk for CVD (which is responsible for 80% of these deaths)

Question 26

What are some meds for T2D?

Answer 26

Insulin, metformin, gliptins (Januvia)

Question 27

In what kind of patient may a heart attack present without chest pain?

Answer 27

T2D patient with diabetic neuropathy - might not have chest pain.

Question 28

When the need for oxygen exceeds supply flowing physical or emotional stress due to poor blood flow – caused by atherosclerosis

Answer 28

Angina pectoris

Question 29

What is the difference between stable and unstable angina?

Answer 29

stable is relieved by rest/nitro

unstable is not

Question 30

What are some symptoms of angina pectoris?

Answer 30

chest pain (may mimic gerd), cyanosis, diaphoresis, anxiety, pain radiating down arm, scapular pain

Question 31

what is the MONA acronym?

Answer 31

Morphine, oxygen, nitro, aspirin

Question 32

What tests/BW would be ordered for an MI?

Answer 32

12 lead ECG
Trops, CK, CBC, lytes, blood gases, CRP
vitals

Question 33

What levels do we look for for trops and CK-mb?

Answer 33

trops >3 –> would do a second test to see if there is a change
CK-mb > 20 (muscle damage)

Question 34

What is CRP?

Answer 34

C-reactive protein - marker for endothelial damage

Question 35

What are some possible further interventions after an MI/angina?

Answer 35

Cath lab
tele
echo
CABG
angio