B2.006 Acute MI Underlying Pathology

Question 1

What is atherosclerosis?

Answer 1

intimal based lesion composed of a fibrous cap and atheromatous core (necrotic center)

Question 2

What are some inherited/constitutional risk factors for atherosclerosis?

Answer 2

genetic, age, gender

Question 3

What are some modifiable risk factors for atherosclerosis?

Answer 3

hyperlipidemia, hypertension, cig smoking, diabetes

Question 4

What are the 5 main steps of atherosclerosis?

Answer 4

1. chronic endothelial “injury”
2. endothelial dysfunction and emigration
3. macrophage activation, smooth muscle recruitment
4. macrophages and smooth muscle cells engulf lipid
5. smooth muscle proliferation, collagen, and other extracellular matrix deposition, extracellular lipid

Question 5

What causes hardening in plaques?

Answer 5

calcium deposits

Question 6

What is neovascularization?

Answer 6

blood vessels form within plaque, making the plaque susceptible to blood leakages and inflammation

Question 7

What are some major sources of endothelial “injury”?

Answer 7

hyperlipidemia, hypertension, smoking, toxins, hemodynamic factors, immune rxns, viruses

Question 8

What are the major structural components of a blood vessel?

Answer 8

lumen, endothelium, intima, internal elastic membrane, media, adventitia

Question 9

What makes a plaque unstable?

Answer 9

thin fibrous cap, neovascularization, calcium deposits

Question 10

What are the 3 primary clinical results of a vulnerable plaque?

Answer 10

aneurysm and rupture, occlusion by thrombus, and critical stenosis

Question 11

What can cause an aneurysm?

Answer 11

mural thrombosis, embolization, wall weakening

Question 12

What can cause occlusion by thrombus?

Answer 12

plaque rupture, plaque erosion, plaque hemorrhage, mural thrombosis, embolization

Question 13

What can cause critical stenosis?

Answer 13

progressive plaque growth

Question 14

What is the most common cause of death in the US?

Answer 14

atherosclerosis

Question 15

What are 3 types of CAD?

Answer 15

MI, angina pectoris, sudeen cardiac death

Question 16

What are consequences of atherosclerosis outside of the heart?

Answer 16

cerebrovascular disease, aneurysms, peripheral vascular disease

Question 17

What is an anabolic circuit?

Answer 17

More intake, less expenditure

Question 18

What is a catabolic circuit?

Answer 18

less intake, more expenditure

Question 19

What types of circuits are associated with obesity?

Answer 19

anabolic

Question 20

What are 3 major consequences of obesity?

Answer 20

metabolic syndrome, type 2 diabetes, proinflammatory state

Question 21

What is hyperinsulinemia and what is a risk factor and result of the condition?

Answer 21

persistently high level of insulin in the body, obesity is a risk factor, potent stimulation of cell proliferation is a result

Question 22

What are some consequences of being in a proinflammatory state?

Answer 22

insulin resistance, hyerinsulinemia, hypertension, CAD, nonalcoholic fatty liver disease

Question 23

How does insulin resistance affect free IGF?

Answer 23

increases availability

Question 24

How does insulin resistance affect apoptosis?

Answer 24

decreases

Question 25

What is inflammation?

Answer 25

response of vascularized tissue to infection or injury

Question 26

What are the two types of inflammation?

Answer 26

acute and chronic

Question 27

Describe acute inflammation.

Answer 27

initial rapid response to infection/tissue damage
increased blood flow
increased vascular permeability
emigration of primarily neutrophils to site
phagocytosis
results in healing by fibrosis, resolution, or progression to chronic inflammation

Question 28

Describe chronic inflammation.

Answer 28

prolonged inflammatory response
infiltration of mononuclear cells
tissue destruction
healing by connective tissue replacement and angiogenesis
cause by persistent infections, hypersensitivity diseases, and prolonged exposure to toxic agents