Is the following description unstable or stable plaque? 1. Fibrous cap is gonna decrease the lumen 2. If you have a plaque rupture, you’ll have the plaque formation at the thrombus, wherein there is a complete obstruction 3. Distal to the obstruction, there will be a deprivation of blood flow, which will give the potential heart attack, myocardial infarction, myocardial death, or myocardial necrosis

1. Stable 2. Unstable 3. Unstable

S2 L2.3: Atherosclerosis Flashcards by Mind Med

LDL ( ___ cholesterol) will find its way into the ______ and it will be causing the migration of the smooth muscles bc ____ _____ will form

LDL (bad cholesterol) will find its way into the endothelium and it will be causing the migration of the
smooth muscles bc foam cell will form

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T/F:

Foam cell makes up the bulk of lipid clots, and
these clots may rupture and cause a heart attack

False

Foam cell makes up the bulk of CHOLESTEROL clots, and
these clots may rupture and cause a heart attack

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Medical term for cholesterol plaque

Atheroma

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EVOLUTION OF ATHEROMA

Arrange the following in order from 1 - 10:

Calcification and fibrosis continues

SMCs in the intima divide and migrate into the intima
from the media

Accumulation of lipoprotein particles in the intima

Increase expression of adhesion molecules

Expression of scavenger receptors

Extracellular matrix accumulation in the growing
atherosclerotic plaque.

Oxidative stress can induce local cytokine elaboration

Development of foam cells

Accumulation of lipoprotein particles in the intima
Oxidative stress can induce local cytokine elaboration
Increase expression of adhesion molecules
Expression of scavenger receptors
Development of foam cells
SMCs in the intima divide and migrate into the intima
from the media
Extracellular matrix accumulation in the growing
atherosclerotic plaque.
Calcification and fibrosis continues

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Covers the plaque

Cap

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SIMPLIFIED VERSION OF ATHEROMA EVOLUTION

Arrange the following from 1 - 4

Atheroma Formation

Fibrosis Healing

Clot Formation

Plaque Rupture

A. Atheroma Formation
B. Plaque Rupture
C. Clot Formation
D. Fibrosis or Healing (reduced lumen, limitation of blood flow)

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EVOLUTION OF ATHEROMA

Thin caps can be ruptured easily due to ____,
____, ____, _______ _____

smoking,
htn, alcohol, inflammatory events

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T/F regarding EVOLUTION OF ATHEROMA:

Cap ruptures → blood clot formation due to bleeding → Injures the endtholeium → clot too
big which obstructs the artery completely

False

Cap ruptures → Injures the endothelium →
blood clot formation due to bleeding → clot too
big which obstructs the artery completely

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Modified T/F regarding EVOLUTION OF ATHEROMA:

The amount of clot formation will tell how severe the
situation is.
A resolved clot but has thickened cap leads to reduced lumen which will result in limitation of blood flow

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Arrange the following in accordance with the ATHEROSCLEROSIS TIMELINE (from 1 to 6)

Complicated lesion/rupture

Foam cells

Fatty streak

Atheroma

Intermediate lesion

Fibrous plaque

Foam cells
Fatty streak
Intermediate lesion
Atheroma
Fibrous plaque
Complicated lesion/rupture

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Match the following items:

1.Growth mainly by lipid accumulation
2. Thrombosis, hematoma
3. Smooth muscle and collagen
4. 0 days - 10 years old
5. 21 - 30 years old
6. 31 - 40 years old

A. From first decade
B. From third decade
C. From fourth decade

A and B
C
C
A
B
C

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Is a life threatening disease that may have begun to develop during childhood

Atherosclerosis

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Is a process in which deposits of fatty
material called plaque, build up inside the walls of
arteries reducing or completely blocking blood flow

Atherosclerosis

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Give me at least three (3) risk factors for atherosclerosis

Risk factors for atherosclerosis:
○ High blood pressure
○ High cholesterol
○ Tobacco smoke
○ Diabetes
○ Obesity
○ Physical inactivity
○ Hyperlipidemia

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T/F:
1. Scientists are sure that it begins with damage to endothelium, inner
wall of an artery
2. Over time, substances traveling in the blood such as
cholesterol, fats, and cellular wastes products
accumulate inside the damaged area the arterial wall

F. Although exact causes are not clear, many scientists think that it begins with damage to endothelium, inner
wall of an artery
T

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Arrange the folllowing in order of the sequence of the formation of atherosclerosis from 1 to 11 (this is from atheroscleorsis (2009) nucleus medical media):

Chemical reactions occurring within the build up of
material cause cholesterol molecules to oxidize which will initiate an inflammatory response wherein
endothelial cells at the damaged site release
chemicals that signal call for help. In response, monocytes from the bloodstream travel
to the damaged site

Stimulation from the oxidized cholesterol converts
monocytes into macrophages

As the plaque increases in size, the arterial wall thickens and hardens

Most of the smooth muscle cells move to the
surface of the plaque

The macrophages then eat and digest the cholesterol
molecules which changes these macrophages
into foam cells. Such foam cells would eventually accumulate to form plaque

Smooth muscle cells within the arterial
wall begin to multiply

The smooth muscle cells contribute to the formation of a firm, fibrous cap, covering the plaque

Over time, the cap may erode and break open, releasing plaque into bloodstream

Limited blood supply is available to the area
surrounding the partially blocked artery degrading and potentially killing the neighboring tissue

The plaque can flow downstream and contribute to the formation of a blood clot, which can stop blood flow

Significant damage in organs such as the heart or brain can result in a heart attack or stroke

Chemical reactions occurring within the build up of
material cause cholesterol molecules to oxidize which will initiate an inflammatory response wherein
endothelial cells at the damaged site release
chemicals that signal call for help. In response, monocytes from the bloodstream travel
to the damaged site
Stimulation from the oxidized cholesterol converts
monocytes into macrophages

3.The macrophages then eat and digest the cholesterol
molecules which changes these macrophages
into foam cells. Such foam cells would eventually accumulate to form plaque

As the plaque increases in size, the arterial wall thickens and hardens
Smooth muscle cells within the arterial
wall begin to multiply
Most of the smooth muscle cells move to the
surface of the plaque
The smooth muscle cells contribute to the formation of a firm, fibrous cap, covering the plaque
Over time, the cap may erode and break open, releasing plaque into bloodstream
The plaque can flow downstream and contribute to the formation of a blood clot, which can stop blood flow
Limited blood supply is available to the area
surrounding the partially blocked artery degrading and potentially killing the neighboring tissue
Significant damage in organs such as the heart or brain can result in a heart attack or stroke

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ATHERSCLEROSIS TO ATHEROTHROMBOSIS

Modified T/F:
1. It is not the plaque but the rupture of the plaque that predisposes one to have an Acute myocardial infarction

Over time, if you don’t get to control the cholesterol
plaque formation, it will just progressively diminish the
lumen of the arteries making chest pains progressive

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Is the following description unstable or stable plaque?

Fibrous cap is gonna decrease the lumen
If you have a plaque rupture, you’ll have the plaque
formation at the thrombus, wherein there is a
complete obstruction
Distal to the obstruction, there will be a deprivation of blood flow, which will give the potential heart attack, myocardial infarction, myocardial death, or myocardial necrosis

Stable
Unstable
Unstable

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Give me the three (3) acute risk factors that is rooted from certain triggers for the formation of disruption/thrombosis from a vulnerable plaque

Hemodynamic
Vasoconstrictive
Prothrombotic

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Arrange the following into the correct sequence using arrows:

Atherosclerosis Chronic risk factors

Triggers

Acute risk factors (hemodynamic, vasconstrictive, prothrombotic)

Vulnerable plaque

Non-vulnerable plaque

Disruption, thrombosis

Plaque progression (Unstable angina, myocardial infarction, sudden cardiac death)

SAMPLE ANSWER:
Disruption → Non-vulnerable plaque → Plaque progression

Atherosclerosis Chronic risk factors →Non-vulnerable plaque → vulnerable plaque → triggers → acute risk factors (hemodynamic, vasconstrictive, prothrombotic) → Disruption, thrombosis → Plaque progression (Unstable angina, myocardial infarction, sudden cardiac death)

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A plaquet hat is strong becomes vulnerable plaque over time if you cannot control risk factors

Non-vulnerable plaque

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What is being described?

Fluctuation in blood pressure (It goes up and down vice versa)

Hemodynamic triggers

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What is being described?

Blood becomes thicker with hypertension (especially
when you are already predisposed to Htn)

Study These Flashcards

Prothrombotic

Means that you are predisposed to
blood clot

Study These Flashcards

Prothrombotic

Due to this: disruption of blood flow, thrombosis occurs, myocardial infarction, plaque progression occurs

Prothrombic

ISCHEMIC TRIGGERS Classify the following: 1. Exercise 2. Pulse pressure 3. Assuming upright posture 4. Cigarette smoking 5. Cold exposure 6. heart rate 7. Systolic BP 8. Increased vascular resistance 9. Catecholamine levels A. Trigger B. Mediator

1. A 2. B 3. A 4. A 5. A 6. B 7. B 8. B 9. B

The following are included under ischemic triggers, EXCEPT: A. Exercise B. Assuming upright posture C. Cigarette smoking D. Cold exposure E. None of the Above

Selec the items that are included under mediators for ischemic triggers? A. Exercise B. Pulse pressure C. Assuming upright posture D. Cigarette smoking E. Cold exposure F. heart rate G. Systolic BP H. Increased vascular resistance I. Catecholamine levels

B and F to I

Arrange the following items regarding ischemic triggers in sequence using arrows: Trigger Plaque fissure, thrombin and platelet activation, and vasospasm Mediator

Trigger → Mediator → Plaque fissure, thrombin and platelet activation, and vasospasm

What are the three (3) possible result fron ischemic triggers?

Plaque fissure, thrombin and platelet activation, and vasospasm

T/F Exercise can increase heart rate, blood pressure; So when doing exercises for patients with heart diseases, you want to be watchful over heart rates and blood pressure because you do not want wide swings on them

True

T/F PTs do not need to be careful when it comes to positioning when it comes to cardiac patients

False We have to be careful when making patients assume upright posture; This is why in PT sessions, they would train the pt and not make patient stand right away as circulatory system cannot adjust yet

What possible factors and/or activities causes vasconstriciton?

Cigarette smoking and cold environment When applying cold packs → could have a negative impact on CAD pts

Difference of SBP and DBP, ____ pulse pressure (___/___) = more dangerous, ____ pulse pressure (___/___) = also can be dangerous

Difference of SBP and DBP, higher pulse pressure (160/60) = more dangerous, lower pulse pressure (100/80) = also can be dangerous

Modified T/F: 1. You want your patients stress free during treatments; don’t want them to be too excited 2. Monitor BP and HR; cannot measure vascular resistance during sessions

T/F Not all CADs are brought upon by atherosclerotic lesions

True

NON-ATHEROSCLEROTIC CAUSES OF CAD Give me at least four (4) fixed lesions for Non-Atherosclerosis Causes of CAD

● Congenital Anomalies ● Myocardial Bridges ● Aortic Dissection ○ Coming from a weak artery (aorta) it bulges (aneurysmal) and is torn d/t HTN ● Granulomas ● Tumors ● Scarring from trauma, radiation

MYOCARDIAL BRIDGING Normally, the _____ arteries are called _____

Normally, the coronary arteries are called epicardial (epi - on top & outside the epicardium) ● Normal left anterior descending artery or epicardial artery is just on top and outside the muscle wall

MYOCARDIAL BRIDGING It could be called bridging because the ____ bridged over the _____

It could be called bridging because the muscle bridged over the artery

What is the role of myocardial bridging in CAD?

It is one of the fixed lesions under non-atherosclerotic causes of CAD

Match the following items about myocardial bridging: 1. The artery dove deep into the muscle such that when the muscle contracts, the blood vessel gets constricted (like an obstruction). Causes chest pain when heart contracts more (i.e. exercise, tachycardia) 2. Part of the arteries penetrates into the myocardium such that when the heart contracts, they pinch the myocardial arteries 3. When the heart contracts during systole, the patient may feel chest pain 4. Slightly buried into the muscle; not embedded into the myocardium (no symptoms) A. Deep bridging B. Shallow bridge

1-3. A 4. B

DEEP BRIDGING in myocardial bridging The artery dove deep into the muscle such that when the muscle contracts, the blood vessel gets _____ (like an ______). Causes _____ ______ when heart ______ _____ (i.e. exercise, tachycardia)

The artery dove deep into the muscle such that when the muscle contracts, the blood vessel gets constricted (like an obstruction). Causes chest pain when heart contracts more (i.e. exercise, tachycardia)

DEEP BRIDGING in myocardial bridging Part of the arteries ______ into the myocardium such that when the heart contracts, they _____ the myocardial arteries

Part of the arteries penetrates into the myocardium such that when the heart contracts, they pinch the myocardial arteries

DEEP BRIDGING in myocardial bridging When the heart contracts during ______, the patient may feel _____ _______

When the heart contracts during systole, the patient may feel chest pain

What do you call the event wherein the aorta is torn which leads to compromised aortic branches?

AORTIC DISSECTION: Aorta is torn, can compromise its branches

What is the role of aortic dissection in CAD?

It is one of the fixed lesions under non-atherosclerotic causes of CAD

Match the following items regarding aortic dissection: 1. Proximal aorta involvement (L) 2. Distal aorta involvement (R) 3. All dissections involving the ascending aorta 4. Anything outside the proximal portion 5. All dissections NOT involving the ascending aorta 6. More dangerous 7. Patient may die instantly since it is near the heart 8. Tear in the proximal portion of aorta A. Type A B. Type B

1. A 2. B 3. A 4. B 5. B 6. A 7. A 8. A

The following describes Type A aortic dissection, EXCEPT (there can be more than one answer): A. Anything outside the proximal portion B. All dissections NOT involving the ascending aorta C. More dangerous D. Patient may die instantly since it is near the heart E. Tear in the proximal portion of aorta

A and B

Which of the following describes Type B aortic dissection? (there can be more than one answer): A. Distal aorta involvement (R) B. All dissections NOT involving the ascending aorta C. Anything outside the proximal portion D. Patient may die instantly since it is near the heart E. Proximal aorta involvement (L)

A, B, C

T/F regarding Aortic Dissection: 1. R & L coronary artery came from the sinuses of the aorta 2. Dissection of one of the arteries produces a functional obstruction = myocardial infarction 3. From the true lumen, blood enters through the tear creating another lumen (the false lumen) 4. False lumen impinges on RCA and creates an obstruction 5. Deadly case, straight to emergency operation (OR)

All are TRUE

AORTIC DISSECTION Dissection of one of the arteries produces a_____ _____ that leads to ______ ______

Dissection of one of the arteries produces a functional obstruction that leads to myocardial infarction

AORTIC DISSECTION How is a false lumen created?

From the true lumen, blood enters through the tear creating another lumen (the false lumen)

AORTIC DISSECTION The formed false lumen impinges on ______ ____ _____ (hint: an artery) and creates an _______

The formed false lumen impinges on right coronary artery or RCA and creates an obstruction

T/F regarding Aortic Dissection: 1. Dissection of one of the arteries is a deadly case (straight to emergency operation (OR)) and a difficult case 2. Death rate is >50% 3. In all cases, the patients always suffer from ischemia

1-2. True 3. False. If there is still blood flow, the patient may not suffer from ischemia

Give me the three (3) transient causes under non-atherosclerotic causes of CAD

1. Vasospasm 2. Embolus 3. Thrombus in situ

TRANSIENT CAUSES under non-atherosclerotic causes of CAD Match the following items: 1. Vasoconstriction in blood vessels causes angina pectoris 2. From the Situ*, there’s clot formation there and then 3. Patients who are in hypercoagulable states 4. Not necessarily cholesterol 5. Any blood clot that can enter in coronary arteries can obstruct 6. In patients with Raynaud’s disease, they can also have chest pain most likely caused by vasospasm (Prinzmetal Angina) 7. Patients who take contraceptive pills 8. Patients whose blood is very sticky (high platelet count), the can develop thrombus A. Vasospasm B. Embolus C. Thrombus in situ* *In situ means "in the normal location" or "in its original place" (source: google)

1. A 2. C 3. C 4. B 5. B 6. A 7. C 8. C

S2 L2.3: Atherosclerosis Flashcards

(56 cards)