Flashcards in ASCVD (Duval) Deck (69)
What are the 3 patterns of vascular disease manifested by the thickening and inelasticity of the arteries?
2) Monckeberg's medial calcific sclerosis
What is medial calcific sclerosis and who does it affect?
The calcification of the muscle wall (media) of the arteries that may ossify. There is NO narrowing of the vessel lumen. Affects patients older than 50 years
What is arteriosclerosis?
The thickening and narrowing of the vascular walls and arterioles. It's associated with HTN and DM.
What are the 2 variants of arteriolosclerosis?
What is atherosclerosis?
The build up of intimal fibro-fatty plaques that narrow the vascular lumen and weaken the atrial walls (media).
What are the major targets of atherosclerosis and what could they cause?
1) The aorta (AAA, PVD, intestinal ischemia
2) Coronary arteries (IHD and MI)
3) Cerebral arteries (stroke)
What is and what happens in the 3 phases of atherosclerosis?
Preclinical phase - when a normal artery becomes gets fibro-fatty plaques and endothelial dysfunction occurs
Clinical horizon - when the plaques get advanced and vulnerable. You see cell death, thrombus formation, calcification
Clinical phase - WHere you would see critical stenosis, aneurysm or plaque rupture
What has a significant reduction in IHD and stroke in the last 50 years been due to?
1) Life style changes
2) Improved IHD therapy
3) the prevention of reoccurrences
What is CRP, what does it correlate with and what reduces it
C-reactive Protein - a systemic marker of inflammation synthesized by the liver. It correlates with the risk of IHD, stroke, PVD and SCD. Its levels are reduced by smoking cessation, weight loss, exercise and statins
T/F Risk factors are additive?
False: Two risk factors correspond to 4x risk of MI
3 risk factors correspond to a 7x risk.
Outside of the normal, what are some other risk factors of atherosclerosis?
Type A personality, estrogen deficiency, chlamydia pneumonia, hyperhomocysteinemia and Lipoprotein (Lp(a))
What is hyperhomocystinemia?
An inborn error of metabolism resulting in high levels of circulating homocysteine. It can be caused by low folate and vitamin B intake. It correlates with CAD, PVD, stroke and venous thrombosis.
What is Lipoprotein Lp (a)
An altered form of LDL. There is a correlation btwn that and coronary and cerebral vascular disease
What is the 5 steps to the response to injury hypothesis?
1) Chronic endothelial injury
2) Endothelial dysfunction and monocyte adhesion/emigration
3) Smooth muscle cell emigration & macrophage activation
4) Macrophages and smooth muscle cells engulf lipids.
5) Proliferation of Smooth muscle cells , extra cellular matrix and extracellular lipid
What are the 2 most important contributors to endothelial injury?
What is hemodynamics?
Shear stress and turbulent flow to arteries where plaques occur at branch points and the posterior abdominal aorta
What are macrophages role in atherosclerosis?
The engulf lipoproteins to become foam cells. Also they rercruit WBC, oxidize LDL and elaborate growth factors.
Atherosclerosis starts off as a ______ _________?
Where are fatty streaks more commonly found?
The long axis of the aorta. The aortic valve ring, posterior thoracic aorta, coronary arteries and abdominal aorta
Where are fatty streaks most found
Abdominal aorta (most), coronary arteries 2nd, popliteal arteries 3rd, and thoracic artery 4th.
Name the 6 types of atherosclerosis lesions classified by the AHA
Type 1 - Fatty dot (precursor)
Type 2 - Fatty streak
Type 3 - Intermediate lesion
Type 4 - Atheroma
Type 5 - Fibroatheroma
Type 6 - Complicated plaque
What are 4 causes of an aneurysm?
1) congenial defect
2) local infection
4) systemic disease (AS syphilis)
What is the most common aortic aneurysm?
Where are most Atherosclerotic aneurysms found?
In the infrarenal aorta
what is the most common cause of Ischemic Heart disease?
What are the 4 syndromes associated with Ischemic Heart disease?
1) Angina pectoris
3) Sudden cardiac death
4) Chronic IHD
Who is more at risk for Ischemic Heart disease?
Men over women until 9th decade
Males over 60 and females over 70.
Those with HTN, DM, smoking, elevated LDL or genetic issues
What is critical stenosis defined as
75 percent narrowing.
What are some other causes of IHD?
Reduced blood supply issues - Emboli from vegetations, vasculitis and systemic HTN
Increased demand (LVH) - Systemic HTN, valvulopathy