Atheroma

Question 0

What is atherosclerosis?

Answer 0

Progressive narrowing and hardening of the artery - result of atheroma. Potentially resulting in a complete blockage.

Question 1

What is the definition of atheroma?

Answer 1

Build up of fatty material on the inside wall of an artery

Question 2

Which 5 parts of the body does atheroma affect the most?

Answer 2

Lower abdominal aorta, coronary arteries, internal carotid arteries, popliteal arteries and vessels of circle of Willis.

Question 3

What initiates atheroma?

Answer 3

Chronic injury to the endothelium resulting in chronic inflammation.

Question 4

Give 4 causes of endothelium injury

Answer 4

Hyperlipidaemia, disturbed flow, smoking, hypertension.

Question 5

How many stages of atheroma are there?

Answer 5

6

Question 6

What happens during type 1 atheroma

Answer 6

Initial legion - isolated macrophage foam cells (from first decade)

Question 7

Describe type 2 atheroma

Answer 7

Fatty streak lesion - mainly intracellular accumulation.

Question 8

Describe type 3 atheroma

Answer 8

Intermediate lesion - lipid pools (third decade)

Question 9

Describe type 4 atheroma

Answer 9

Fatty changes and core of lipid pool

Question 10

Describe type 5 atheroma

Answer 10

Fibrotic and calcific layers form ( fourth decade)

Question 11

What is type 6 atheroma

Answer 11

Surfaced defect - haemorrhage or thrombus.

Question 12

What could atherosclerosis in he coronary artery cause?

Answer 12

Heart attack, angina ischaemic heart disease.

Question 13

What could atherosclerosis in the aorta cause?

Answer 13

Aneurysm

Question 14

What could atherosclerosis in the carotid arteries cause?

Answer 14

Stroke

Question 15

What could atherosclerosis in the popliteal’s cause?

Answer 15

Peripheral vascular disease

Question 16

List 5 complications of atherosclerotic plaques

Answer 16

Aneurysm and rupture
Thrombosis
Haematoma formation
Embolisation
Development of critical narrowing of artery (stenosis)

Question 17

What does chronic ischaemia result in?

Answer 17

Redness and loss of skin

Question 18

List 3 other complications of atherosclerosis

Answer 18

Bowel ischaemia
Renal artery stenosis
Emboli

Question 19

How would you treat atherosclerosis?

Answer 19

Revasculisation

Secondary prevention

Question 20

How many deaths from ischemic heart disease are there a year?

Answer 20

60 deaths per 100 000

Question 21

How much does one MI increase your risk of developing heart failure and stroke by?

Answer 21

3-6 fold

Question 22

What happens during ischaemic heart disease?

Answer 22

In balance between supply (perfusion) and demand of the heart for oxygenated blood.

Question 23

As well as a decrease in oxygen in heart failure there is also…

Answer 23

Decrease in nutrient substrates and inadequate removal of metabolites.

Question 24

What might cause a decreased flow of oxygenated blood to the heart?

Answer 24

Atheroma Embolism Spasms

Question 25

What can cause an increase in demand for oxygen?

Answer 25

Thyrotoxicosis | Myocardial hypertrophy eg hypertension

Question 26

List four fixed risk factors for developing ischaemic heart disease

Answer 26

Age Gender Genetics Positive family history

Question 27

List 7 reversible (with treatment) risk factors of IHD.

Answer 27

``` Obesity High cholesterol Lack of exercise Smoking Hypertension Diabetes ```

Question 28

Where is the common area for narrowing of the coronary arteries?

Answer 28

Left main coronary artery

Question 29

Who might have a silent MI?

Answer 29

Elderly and diabetic

Question 30

What are five signs and symptoms of an MI?

Answer 30

``` Chest pain - crushing radiating down left arm and jaw Shortness of breath Palpitations Syncope Nauseous, sweating, pale ```

Question 31

What is stable angina?

Answer 31

Chest pain on exertion, relieved by GTN

Question 32

What is unstable angina?

Answer 32

Chest pain at rest as well as exercise can lead to MI

Question 33

Name the 2 different types of heart attacks

Answer 33

STEMI | NSTEMI

Question 34

Which is more severe NSTEMI or STEMI?

Answer 34

STEMI

Question 35

Stable angina is caused by?

Answer 35

Plaque disruption and spasm

Question 36

Unstable angina is caused by

Answer 36

Plaque disruption and spasm and partial thrombosis, possible emboli

Question 37

What investigations would you carry out on someone believed to have an MI?

Answer 37

Observations - pulse, BP, sats, resps Bloods - trop Chest x ray - fluid on lungs? ECG

Question 38

What would you perform to find the location of the clot?

Answer 38

An angiogram

Question 39

List 7 complications of an MI

Answer 39

``` Cardiac arrest Arrhythmias Pericarditis Valvular defects Ventricular wall rupture DVT PE ```

Question 40

What three treatments would you give to someone believed to be having an MI?

Answer 40

Oxygen Pain relief Aspirin

Question 41

What would you use to treat angina?

Answer 41

Nitrates Lifestyle Beta blockers

Question 42

What are 12 risk factors for developing atherosclerosis

Answer 42

``` Hypertension Obesity Diabetes mellitus Smoking Hyperlipidemia Family history Low HDLS age Male Physical inactivity Emotional stress Homocystinuria ```

Question 43

What is LDL cholesterol?

Answer 43

Bad cholesterol delivered to peripheral tissue

Question 44

What is HDL cholesterol?

Answer 44

Good cholesterol removes bad cholesterol from tissues and takes to liver where it is excreted as bile.

Question 45

How can we prevent/modify atheroma?

Answer 45

``` Stop smoking Control hypertension Weight reduction Increase exercise Moderate alcohol Increase HDL and lower LDL. ```