Atherosclerosis

Question 1

3 layers of the artery

Answer 1

Intima, Media, Externa

Question 2

2 parts of the tunica intima

Answer 2

Endothelium and Elastic membrane

Question 3

Inner lining of tunica intima

Answer 3

Endothelium - Clot resistant!!

Question 4

Tunica media

Answer 4

Smooth muscle that constricts and dilates

Question 5

Tunica externa

Answer 5

Adventitia that holds arteries in place

Question 6

5 Steps of atherosclerosis

Answer 6

Fatty Streak
Fibrous Cap
Disruption of vasa vasorum (neovascularization)
Fibrous plaque
Intraplaque hemorrhage

Question 7

Foam cells

Answer 7

Macrophages that have eaten lots of LDL
Form fatty streak
Smooth muscle migrates to the site

Question 8

Vasa vasorum disruption

Answer 8

Blood flow created to fatty streak making it grow

Question 9

Fibrous cap

Answer 9

Collagen layed down over streak - more collagen=more stable

Question 10

Fibrous plaque

Answer 10

Smooth muscle cells take up LDL and make the clot more stable

Question 11

Positive remodeling

Answer 11

Increased vessel size d/t plaque making it UNSTABLE

Question 12

Negative remodeling

Answer 12

Body constricts the vessel to stabilize plaque - STABLE angina

Question 13

Interplaque hemorrhage

Answer 13

Critical event - Leads to an MI

Question 14

2 things needed for atherosclerosis

Answer 14

Lipids and Inflammation

Question 15

Four endothelial trauma etiologies with common mechanism

Answer 15

Turbulent blood flow - HTN
Diabetes
HLD
Cigarette smoking

Occurs due to loss of endothelial-derived nitric oxide

Question 16

Inflammation in atherosclerosis

Answer 16

Worse if acute
Many immune cells migrate to the site

Question 17

Plaque rupture and erosion

Answer 17

Plaque asymptomatic until 70-80% occlusion
Treat before erosion and rupture occurs

Question 18

Vasculopath

Answer 18

All arteries affected by atherosclerosis

Question 19

Percent of adults presenting with sudden death as first sign of heart attack

Answer 19

40-50%

Question 20

Number of heart attacks that are silent

Answer 20

1 in 5

Question 21

2 populations with abnormal heart attack symptoms

Answer 21

Females and Diabetics

Question 22

Coronary artery disease risk equivalents - 6

Answer 22

Clinical CHD
Symptomatic carotid artery disease
Peripheral arterial disease
AAA
Diabetes mellitus
Chronic kidney disease

Question 23

Concerning family history for heart disease

Answer 23

1st degree relative under 55 in men and under 65 in women had an event

Question 24

Age and sex risk factors for CHD

Answer 24

Men 45+, women 55+
Males in general have higher prevalence

Question 25

6 additional risk factors for CHD

Answer 25

High serum C reactive protein High triglycerides (esp. in women) Sleep apnea Stress Persistent heavy alcohol use Elevated homocysteine levels

Question 26

6- Major modifiable risk factors for CHD

Answer 26

Cigarette smoking Dyslipidemia (High LDL and Low HDL) HTN DM Obesity Sedentary lifestyle

Question 27

2 high intensity statins

Answer 27

Atorvastatin and Rosuvastatin

Question 28

6 factors used to calculate 10-year-ASCVD risk

Answer 28

Age and Gender Race Cholesterol - LDL and HDL Diabetes Smoking Blood Pressure

Question 29

AAA screening recommendation from USPSTF

Answer 29

1 time screening in men 65-75 who have ever smoked with ultrasonography Class B

Question 30

Aspirin use USPSTF recommendation

Answer 30

40-59 low dose aspirin if ASCVD risk is greater than 10 Class C

Question 31

BP recommendation screening for HTN from USPSTF

Answer 31

Anyone over 18 Class A

Question 32

Prediabetes screening from the USPSTF

Answer 32

Screen in patients 35-70 who are overweight or obese

Question 33

Statin use recommendations from USPSTF

Answer 33

40-75 years with 1 risk factor and ASCVD of 10%+ Class B 40-75 with 1 risk factor and 7.5-9.9% ASCVD risk Class C

Question 34

Healthy diet and exercise USPSTF recommendation

Answer 34

Class B for adults with any cardiovascular risk factors

Question 35

Tobacco sensation for CV risk prevention USPSTF recommendation

Answer 35

Class A