10 - Atherosclerosis - How it all begins

Question 1

all of the following are risk factors for atherosclerosis except:
blood pressure > 140/90
elevated LDL
hx of smoking
age > 45 (male) >55 (female)
alcohol use

Answer 1

alcohol

Question 2

how early does clinical evidence of atherosclerosis usually occur in humans?

Answer 2

3rd-4th decade

Question 3

3 major consequences of CAD

Answer 3

sudden cardiac death
angina
MI

Question 4

first step in genesis of atherosclerotic plaque

Answer 4

endothelial cell injury

Question 5

4 main steps in formation of a plaque

Answer 5

endothelial injury
lipid rich monocytes (foam cells) invade
SMC proliferation and migration into tunica intima
platelet aggregation

Question 6

steps leading to development of unstable plaque / clot formation

Answer 6

plaque rupture/erosion
platelet adhesion/activation/aggregation
activation of platelet 2b/3a
thrombin production
fibrinogen converted to fibrin > clot

Question 7

why does smooth muscle proliferate in atherosclerotic plaques?

Answer 7

response to growth factors from platelets and monocytes

Question 8

what factors causes restenosis after balloon angioplasty?

Answer 8

SMC re-proliferation

Question 9

1 type of drug to prevent/slow atherosclerosis

Answer 9

statin

Question 10

LDL goals for pts w/ CAD, multiple risk factors, and 0-1 risk factors, and NEW recommendation for “very high risk” pts

Answer 10

CAD - <70

Question 11

what is the framingham risk score used for

Answer 11

estimates 10 yr risk for MI and coronary death

Question 12

what is the key diff btwn stable and unstable plaque?
endothelial cell injury
SMC proliferation
LDL oxidation
platelet aggregation and thrombus formation
monocyte adhesion

Answer 12

platelet aggregation

Question 13

optimal LDL goal for pt w/ unstable angina is

Answer 13

<70 mg/dl

Question 14

is this plaque stable or unstable:

thick fibrous cap, less lipid, less inflammatory cells

Answer 14

stable