PC705 - Module 5- Circulation and Heart
Atherosclerosis
- a chronic inflammatory disorder of the ____________ _____
- most common sites are (7) - answerAtherosclerosis
- a chronic inflammatory disorder of the vascular wall
- most common sites are abdominal aorta, coronary arteries, thoracic aorta, femoral and
popliteal arteries, carotid arteries, vertebral arteries
Atherosclerosis
Common cause of _______ and disease worldwide
- Can result in one of these 3 diseases: - answerAtherosclerosis
Common cause of death and disease worldwide
- Can result in one of these 3 diseases:
--- Myocardial infarction (MI), Stroke, Peripheral arterial disease
Atherosclerosis: Early stages
- Endothelial injury increases endothelial __________________
- Low-density lipoprotein (LDL) cholesterol particles enter the ______ from the blood
--- ________ blood levels of LDL cholesterol are associated with greater risk -
answerAtherosclerosis: Early stages
- Endothelial injury increases endothelial permeability
- Low-density lipoprotein (LDL) cholesterol particles enter the intima from the blood
--- greater blood levels of LDL cholesterol are associated with greater risk
Atherosclerosis: Early stages
- Monocytes are attracted into the region by ____________, differentiate into macrophages
- Macrophage activation increases __________ production, enhancing chemotaxis -
answerAtherosclerosis: Early stages
- Monocytes are attracted into the region by chemotaxis, differentiate into macrophages
- Macrophage activation increases cytokine production, enhancing chemotaxis
Atherosclerosis: Early stages
- Macrophages contribute to _____ oxidation and phagocytosis
- ________ laden macrophages become immobile foam cells - answerAtherosclerosis: Early
stages
- Macrophages contribute to LDL oxidation and phagocytosis
- Lipid laden macrophages become immobile foam cells
Atherosclerosis: Intermediate Stage
- Macrophage __________ recruit new cells to the growing lesion
--- states of acute or chronic _________________ are associated with greater atherosclerosis
risk - answerAtherosclerosis: Intermediate Stage
- Macrophage cytokines recruit new cells to the growing lesion
--- states of acute or chronic inflammation are associated with greater atherosclerosis risk
,Atherosclerosis: Intermediate Stage
- T lymphocytes, dendritic cells, mast cells, platelets swell the inflammatory lesion
- Initial growth swells vascular external diameter without appreciably __________ the lumen -
answerAtherosclerosis: Intermediate Stage
- T lymphocytes, dendritic cells, mast cells, platelets swell the inflammatory lesion
- Initial growth swells vascular external diameter without appreciably narrowing the lumen
Atherosclerosis: Late Stage
- Cells in plaque _____ die, leading to necrotic, avascular residue
- _________ deposits increase plaque rigidity and are visible on imaging -
answerAtherosclerosis: Late Stage
- Cells in plaque core die, leading to necrotic, avascular residue
- Calcium deposits increase plaque rigidity and are visible on imaging
Atherosclerosis: Late Stage
- Thick fibrous cap can protect the core from ____________
--- but overlying abnormal ECs can spur platelet adhesion and formation of small ________ -
answerAtherosclerosis: Late Stage
- Thick fibrous cap can protect the core from rupturing
--- but overlying abnormal ECs can spur platelet adhesion and formation of small thrombi
Atherosclerosis: Late Stage
- Thinner fibrous cap is at danger of rupturing, exposing procoagulant core and rapid
formation of massive ____________
- Growing plaque can encroach on vessel _________, causing distal signs of ________ and
ischemia - answerAtherosclerosis: Late Stage
- Thinner fibrous cap is at danger of rupturing, exposing procoagulant core and rapid
formation of massive thrombus
- Growing plaque can encroach on vessel lumen, causing distal signs of hypoxia and
ischemia
Atherosclerosis: Lesion Growth
- Initial growth expands vessel _________ diameter while preserving lumen
- Advanced lesions narrow lumen, resulting in progressive tissue ________
- Imaging shows increased ________________ thickness - answerAtherosclerosis: Lesion
Growth
- Initial growth expands vessel external diameter while preserving lumen
- Advanced lesions narrow lumen, resulting in progressive tissue ischemia
- Imaging shows increased intima-media thickness
Atherosclerosis:
Aneurysm Development Distal to Atherosclerotic Plaque
- Normal laminar flow maintains vessel ___________
- Turbulent flow distal to plaque increases wall _________
,- Over time, the vessel wall weakens and _______ distal to plaque, forming aneurysm -
answerAtherosclerosis:
Aneurysm Development Distal to Atherosclerotic Plaque
- Normal laminar flow maintains vessel integrity
- Turbulent flow distal to plaque increases wall tension
- Over time, the vessel wall weakens and dilates distal to plaque, forming aneurysm
Atherosclerosis: Risk Factors
Non-Modifiable (4) - answerAtherosclerosis: Risk Factors
Non-Modifiable (4)
- Older age
- Male sex
- Race/ethnicity
- Family history
Atherosclerosis: Risk Factors
Modifiable (5) - answerAtherosclerosis: Risk Factors
Modifiable (5)
- Elevated total and LDL cholesterol
- Decreased HDL cholesterol
- Hypertension
- Cigarette smoking
- Diabetes
Atherosclerosis:
Pathophysiological Determinants of Risk
- Endothelial ______________: damage by hypertension, dyslipidemia, hyperglycemia,
smoking, inflammatory mediators
- _______________: increases shear stress and wall tension
- ______________: increased LDL concentrations promote LDL invasion of intima -
answerAtherosclerosis:
Pathophysiological Determinants of Risk
- Endothelial vulnerability: damage by hypertension, dyslipidemia, hyperglycemia, smoking,
inflammatory mediators
- Hypertension: increases shear stress and wall tension
- Dyslipidemia: increased LDL concentrations promote LDL invasion of intima
Atherosclerosis:
Pathophysiological Determinants of Risk
- _________: increases oxidative stress, circulating irritant molecules
- _________: insults due to hyperglycemia, dyslipidemia
- ___________ syndrome—combination of hypertension, dyslipidemia, increased waist
circumference, diabetes or insulin resistance
- Chronic ________________ - answerAtherosclerosis:
Pathophysiological Determinants of Risk
, - Smoking: increases oxidative stress, circulating irritant molecules
- Diabetes: insults due to hyperglycemia, dyslipidemia
- Metabolic syndrome—combination of hypertension, dyslipidemia, increased waist
circumference, diabetes or insulin resistance
- Chronic inflammation
Atherosclerosis: Management
- Target behavioral change
--- ___________ cessation
--- Control ____
--- Manage cholesterol and _______________
--- Increase ___________ activity
--- Healthy, high-quality ______
--- _________ loss if indicated - answerAtherosclerosis: Management
- Target behavioral change
--- Smoking cessation
--- Control BP
--- Manage cholesterol and triglycerides
--- Increase physical activity
--- Healthy, high-quality diet
--- Weight loss if indicated
Non-ST elevation myocardial infarction (NSTEMI)
- Troponin levels ___crease
- Region of cell damage is __________________
- Electrical vector exists between ischemic region and ___________ region that has
maintained blood flow
- ST segment ________________ - answerNon-ST elevation myocardial infarction (NSTEMI)
- Troponin levels increase
- Region of cell damage is subendocardial
- Electrical vector exists between ischemic region and epicardial region that has maintained
blood flow
- ST segment depression
ST elevation myocardial infarction (STEMI)
- Troponin levels ___crease
- Region of cell damage is ____________ (full-thickness)
- Electrical vector exists between ischemic region and remaining ____________ with
maintained blood flow
- ST segment ____________ - answerST elevation myocardial infarction (STEMI)
- Troponin levels increase
- Region of cell damage is transmural (full-thickness)
Atherosclerosis
- a chronic inflammatory disorder of the ____________ _____
- most common sites are (7) - answerAtherosclerosis
- a chronic inflammatory disorder of the vascular wall
- most common sites are abdominal aorta, coronary arteries, thoracic aorta, femoral and
popliteal arteries, carotid arteries, vertebral arteries
Atherosclerosis
Common cause of _______ and disease worldwide
- Can result in one of these 3 diseases: - answerAtherosclerosis
Common cause of death and disease worldwide
- Can result in one of these 3 diseases:
--- Myocardial infarction (MI), Stroke, Peripheral arterial disease
Atherosclerosis: Early stages
- Endothelial injury increases endothelial __________________
- Low-density lipoprotein (LDL) cholesterol particles enter the ______ from the blood
--- ________ blood levels of LDL cholesterol are associated with greater risk -
answerAtherosclerosis: Early stages
- Endothelial injury increases endothelial permeability
- Low-density lipoprotein (LDL) cholesterol particles enter the intima from the blood
--- greater blood levels of LDL cholesterol are associated with greater risk
Atherosclerosis: Early stages
- Monocytes are attracted into the region by ____________, differentiate into macrophages
- Macrophage activation increases __________ production, enhancing chemotaxis -
answerAtherosclerosis: Early stages
- Monocytes are attracted into the region by chemotaxis, differentiate into macrophages
- Macrophage activation increases cytokine production, enhancing chemotaxis
Atherosclerosis: Early stages
- Macrophages contribute to _____ oxidation and phagocytosis
- ________ laden macrophages become immobile foam cells - answerAtherosclerosis: Early
stages
- Macrophages contribute to LDL oxidation and phagocytosis
- Lipid laden macrophages become immobile foam cells
Atherosclerosis: Intermediate Stage
- Macrophage __________ recruit new cells to the growing lesion
--- states of acute or chronic _________________ are associated with greater atherosclerosis
risk - answerAtherosclerosis: Intermediate Stage
- Macrophage cytokines recruit new cells to the growing lesion
--- states of acute or chronic inflammation are associated with greater atherosclerosis risk
,Atherosclerosis: Intermediate Stage
- T lymphocytes, dendritic cells, mast cells, platelets swell the inflammatory lesion
- Initial growth swells vascular external diameter without appreciably __________ the lumen -
answerAtherosclerosis: Intermediate Stage
- T lymphocytes, dendritic cells, mast cells, platelets swell the inflammatory lesion
- Initial growth swells vascular external diameter without appreciably narrowing the lumen
Atherosclerosis: Late Stage
- Cells in plaque _____ die, leading to necrotic, avascular residue
- _________ deposits increase plaque rigidity and are visible on imaging -
answerAtherosclerosis: Late Stage
- Cells in plaque core die, leading to necrotic, avascular residue
- Calcium deposits increase plaque rigidity and are visible on imaging
Atherosclerosis: Late Stage
- Thick fibrous cap can protect the core from ____________
--- but overlying abnormal ECs can spur platelet adhesion and formation of small ________ -
answerAtherosclerosis: Late Stage
- Thick fibrous cap can protect the core from rupturing
--- but overlying abnormal ECs can spur platelet adhesion and formation of small thrombi
Atherosclerosis: Late Stage
- Thinner fibrous cap is at danger of rupturing, exposing procoagulant core and rapid
formation of massive ____________
- Growing plaque can encroach on vessel _________, causing distal signs of ________ and
ischemia - answerAtherosclerosis: Late Stage
- Thinner fibrous cap is at danger of rupturing, exposing procoagulant core and rapid
formation of massive thrombus
- Growing plaque can encroach on vessel lumen, causing distal signs of hypoxia and
ischemia
Atherosclerosis: Lesion Growth
- Initial growth expands vessel _________ diameter while preserving lumen
- Advanced lesions narrow lumen, resulting in progressive tissue ________
- Imaging shows increased ________________ thickness - answerAtherosclerosis: Lesion
Growth
- Initial growth expands vessel external diameter while preserving lumen
- Advanced lesions narrow lumen, resulting in progressive tissue ischemia
- Imaging shows increased intima-media thickness
Atherosclerosis:
Aneurysm Development Distal to Atherosclerotic Plaque
- Normal laminar flow maintains vessel ___________
- Turbulent flow distal to plaque increases wall _________
,- Over time, the vessel wall weakens and _______ distal to plaque, forming aneurysm -
answerAtherosclerosis:
Aneurysm Development Distal to Atherosclerotic Plaque
- Normal laminar flow maintains vessel integrity
- Turbulent flow distal to plaque increases wall tension
- Over time, the vessel wall weakens and dilates distal to plaque, forming aneurysm
Atherosclerosis: Risk Factors
Non-Modifiable (4) - answerAtherosclerosis: Risk Factors
Non-Modifiable (4)
- Older age
- Male sex
- Race/ethnicity
- Family history
Atherosclerosis: Risk Factors
Modifiable (5) - answerAtherosclerosis: Risk Factors
Modifiable (5)
- Elevated total and LDL cholesterol
- Decreased HDL cholesterol
- Hypertension
- Cigarette smoking
- Diabetes
Atherosclerosis:
Pathophysiological Determinants of Risk
- Endothelial ______________: damage by hypertension, dyslipidemia, hyperglycemia,
smoking, inflammatory mediators
- _______________: increases shear stress and wall tension
- ______________: increased LDL concentrations promote LDL invasion of intima -
answerAtherosclerosis:
Pathophysiological Determinants of Risk
- Endothelial vulnerability: damage by hypertension, dyslipidemia, hyperglycemia, smoking,
inflammatory mediators
- Hypertension: increases shear stress and wall tension
- Dyslipidemia: increased LDL concentrations promote LDL invasion of intima
Atherosclerosis:
Pathophysiological Determinants of Risk
- _________: increases oxidative stress, circulating irritant molecules
- _________: insults due to hyperglycemia, dyslipidemia
- ___________ syndrome—combination of hypertension, dyslipidemia, increased waist
circumference, diabetes or insulin resistance
- Chronic ________________ - answerAtherosclerosis:
Pathophysiological Determinants of Risk
, - Smoking: increases oxidative stress, circulating irritant molecules
- Diabetes: insults due to hyperglycemia, dyslipidemia
- Metabolic syndrome—combination of hypertension, dyslipidemia, increased waist
circumference, diabetes or insulin resistance
- Chronic inflammation
Atherosclerosis: Management
- Target behavioral change
--- ___________ cessation
--- Control ____
--- Manage cholesterol and _______________
--- Increase ___________ activity
--- Healthy, high-quality ______
--- _________ loss if indicated - answerAtherosclerosis: Management
- Target behavioral change
--- Smoking cessation
--- Control BP
--- Manage cholesterol and triglycerides
--- Increase physical activity
--- Healthy, high-quality diet
--- Weight loss if indicated
Non-ST elevation myocardial infarction (NSTEMI)
- Troponin levels ___crease
- Region of cell damage is __________________
- Electrical vector exists between ischemic region and ___________ region that has
maintained blood flow
- ST segment ________________ - answerNon-ST elevation myocardial infarction (NSTEMI)
- Troponin levels increase
- Region of cell damage is subendocardial
- Electrical vector exists between ischemic region and epicardial region that has maintained
blood flow
- ST segment depression
ST elevation myocardial infarction (STEMI)
- Troponin levels ___crease
- Region of cell damage is ____________ (full-thickness)
- Electrical vector exists between ischemic region and remaining ____________ with
maintained blood flow
- ST segment ____________ - answerST elevation myocardial infarction (STEMI)
- Troponin levels increase
- Region of cell damage is transmural (full-thickness)
