ACS and atherosclerosis

Question 1

Young people have positive or negative troponin?

Answer 1

Negative

Question 2

What does it mean when troponin increases?

Answer 2

Heart injuries

Question 3

For CAD what tests do you do?

Answer 3

Troponin test or EKG

Question 4

Does the presentation need to match the labs?

Answer 4

Yes !!

Question 5

ST elevations mean?

Answer 5

Poor prognostic—full MI-> can develop cardiomyopathy

Question 6

Death is much higher in westernized or developing countries?

Answer 6

Death is much higher in developing countries but incidence is lower

Question 7

What are the non modifiable risk factors?

Answer 7

Genes, age, gender, family history

Question 8

What are the modifiable risk factors?

Answer 8

Smoking, high cholesterol, HTN, DM, physical inactivity-do 300 min per week

Question 9

Majority of patients with CAD are ?

Answer 9

Obese and HTN

Question 10

Which artery provides the majority of O2 blood supply?

Answer 10

Left main artery provides 70-80%

Question 11

What happens when the left anterior descending artery is obstructed?

Answer 11

Significant decrease in O2 for the rest of the body

Question 12

What are the characteristics of stable angina?

Answer 12

Chest pain with exertion (physical activity)
EKG normal but can have ST changes
It is a precursor to unstable angina

Question 13

What are the characteristics of unstable angina?

Answer 13

Chest pain at rest (sitting/ talking) - no exertion
Troponin -
EKG changes may happen to show St depression or T wave inversion or may not

Question 14

What are the characteristics of NSTEMI?

Answer 14

Troponin +
No elevation of ST waves
ST depression
T-waves can be inverted
Looks like unstable

Question 15

What are the characteristics of STEMI?

Answer 15

ST elevations (full thickness injury)
Troponin +
Have all the symptoms

Question 16

In stable angina what type of plaque do you have?

Answer 16

Stable plaque - hard plaque and won’t rupture

Question 17

What happens if the plaque ruptured?

Answer 17

Can cause acute coronary syndrome

Question 18

What are the characteristics of vasospastic disease?

Answer 18

Usually young women, anxiety can cause the spasm->focal/transient vasospasm

Question 19

How do you treat vasopastic disease?

Answer 19

Need vasodilator (ccb)
Not BB

Question 20

What is microvascular dysfunction?

Answer 20

When collateral circulations start closing -> can develop long term ischemic cardiomyopathy or takotsubo syndrome

Question 21

What is takotsubo?

Answer 21

Broken heart syndrome

Question 22

If <20% coronary stenosis , then you have:

Answer 22

No significant CAD

Question 23

If left main closes 20-50%, then you have:

Answer 23

Non-obstructive CAD

Question 24

If other coronary arteries close 20-70%, then you have:

Answer 24

Non-obstructive CAD

Question 25

If left main closes more than 50%, then you have:

Answer 25

Obstructive CAD

Question 26

If other coronary arteries close more than 50%, then you have:

Answer 26

Obstructive CAD

Question 27

In moderate CAD, how much closure do you have?

Answer 27

>65%

Question 28

In severe CAD, how much closure do you have?

Answer 28

Lumen is 90% closed -this is the time they have symptoms/ signs

Question 29

If testing for luminal obstruction, is that a good predictor of CAD?

Answer 29

No

Question 30

Stable Angina things to know:

Answer 30

Smooth muscle over plaque is strong enough still. Can start a stent especially if in left main—-Aggressive treatment Narrow arteries EKG usually shows acute MI instead of silent MI

Question 31

When does type 1 lesions happen?

Answer 31

Within the first 10 years of life -silent 40-50 years old can still be silent

Question 32

Type 5 and 6 lesions?

Answer 32

Can develop thrombosis and dislodge

Question 33

What do statins do?

Answer 33

Stabilize endothelium membrane

Question 34

What is so important about the endothelium?

Answer 34

It is resistant to thrombosis

Question 35

Endothelium dysfunction/ injury means?

Answer 35

An thrombosis can occur

Question 36

What happens when LDL is oxidized?

Answer 36

Inflammatory response -enters lumen and macrophages and monocytes go inside endothelium-this forms foam cells, making a lipid rich necrotic core plaque

Question 37

What happens as endothelium thickens?

Answer 37

Forms fibroatheroma and now becomes vulnerable plaque

Question 38

Vulnerable plaque can —— and —— thrombosis

Answer 38

Dislodge and activate They dislodge and cause platelet aggregation causing a thrombosis

Question 39

The more thrombosis and platelet aggregation is you have ——

Answer 39

The more endothelium dysfunction you have

Question 40

If plaque is stable you still have….

Answer 40

Some perfusion

Question 41

Best treatment for CAD?

Answer 41

Management of lipids-statin

Question 42

Endothelium is known as

Answer 42

Thrombo resistant barrier

Question 43

In the arterial wall, what happens if endothelium is damaged?

Answer 43

Stops penetrating/ filtering to connective tissue and thickening of the intima

Question 44

Thickening of the intima causes ?

Answer 44

Endothelium barrier to decrease and making it lose its thrombo resistant barrier

Question 45

Patho of pre-atherosclerosis?

Answer 45

Overtime calcifications increase Replaces smooth muscle in intima with core plaques-more lipids penetrate and arteriosclerosis gets bigger Starts the minute you’re born

Question 46

Increased intima thickening means

Answer 46

Closure of the lumen

Question 47

What is the driving factor of atherosclerosis?

Answer 47

Inflammation

Question 48

Can you develop atherosclerosis even if LDL is low?

Answer 48

Yes because in combo with other risk factors like smoking, lupus, RA, it still can develop

Question 49

What is a cause of atherosclerosis?

Answer 49

Increased ApoB containing LDL

Question 50

Endothelium functions as :

Answer 50

A barrier Decreased inflammation Prevents vessel remodeling and growth Lipoprotein ApoB does not penetrate Prevents platelet aggregation and adhesion of monocytes, thrombosis

Question 51

atherosclerosis usually occurs in a ———

Answer 51

High pressure area

Question 52

Where does atherosclerosis usually occur?

Answer 52

Left main (ostia can form here) and is most susceptible

Question 53

Most of coronary perfusion comes from?

Answer 53

Left main

Question 54

Where is it much harder to put a stent?

Answer 54

Left anterior descending (bifarctions) separation

Question 55

Inner curvatures happen when?

Answer 55

When driving or making a sharp turn

Question 56

The more turbulent flow you have , the more…..

Answer 56

Injury you have

Question 57

What are focal lessons?

Answer 57

Abnormal shears with retracted cells

Question 58

What causes cells to retract?

Answer 58

Smoking (vasoconstriction)

Question 59

When retracted cells become smaller….?

Answer 59

It is easier for LDL to penetrate and start the activation process -> once entered macrophages kick in and foam cells are created -> pick up all cholesterol and form fatty streaks in vasculatures

Question 60

What does the necrotic core do?

Answer 60

The matrix degrades, inflammation, and activates fibrin, thrombin and causes break down of endothelium—- expansive remodeling

Question 61

What do you do if you think it is a heart attack?

Answer 61

Give aspirin (we have to stop the platelet activation)

Question 62

What if the plaque hemorrhages?

Answer 62

More thrombin and platelet forms-> causes extravasation of plasma proteins and erythrocytes->inflammation So need heparin and aspirin

Question 63

Thrombosis is from?

Answer 63

Mostly plaque ruptures, some erosion and calcifications

Question 64

Vulnerable plaque has a

Answer 64

Thin capped fibroatheroma