ATHEROSCLEROSIS

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Patients that have plaque rupture with embolization in atherosclerosis will have what in the center of the embolus?

Cholesterol

What is an initial step in atherosclerosis and is felt to be caused principally by loss of endothelium-derived nitric oxide?

Endothelial Vasodilator Dysfunction

What is the first sign of ACVD that can be first seen in adolescence with lesions progressing into atheromatous plaques that can accumulate in thrombotic occlusions and coronary events?

Fatty Streak

What arises early in life in patients with atherosclerosis that is often present in most teenagers?

Fatty Streaks

A 58-year old man is found to be dead in his home. Which section of determines the risk of plaque rupture which lead to acute myocardial infarctions in patients with atherosclerosis?

Fibrous Cap

What is the fibrocellular part of the plaque located between the necrotic core and the vessel lumen that is extremely thin in coronary plaque rupture?

Fibrous Cap

What part of the atherosclerotic plaque is formed by smooth muscle cells, macrophages, foam cells, lymphocytes, collagen, elastin, and proteoglycans?

Fibrous Cap

What separates blood from the highly thrombotic lipid core that is formed from smooth muscle cells?

Fibrous Cap

The buildup in fatty streaks of fibrous tissue formed by EC matrix and smooth muscle cells filled with lipids is known as _____

Fibrous Plaque

After a fatty streak is formed, what do smooth muscles create?

Fibrous plaque

What hallmark cell is evident in early atheroma and occurs when macrophages take up lipoprotein particles by receptor mediated endocytosis?

Foam Cells

Which type of cells play a key role in initiation, progression, and destabilization of atherosclerotic plaques?

Foam Cells

What are common in atherosclerotic plaques and increase in age?

Focal Calcifications

How does a woman's risk of atherosclerotic plaque formation change after menopause?

Increased risk after menopause (estrogen is protective)

A 48-year-old obese man visits his primary care physician and reports lower calf pain that occurs after he walks a few city blocks and is relieved with rest. He has no other symptoms. The patient admits to smoking 2 packs of cigarettes per day for the past 20 years. His blood pressure is 165/85 mm Hg, his pulse is 83/min, and his respiratory rate is 18/min. Which type of blood vessel is most likely affected in this patient's acute presentation?

Arteries

Which form of arteriosclerosis narrows small arterioles?

Arteriolosclerosis

Which pathological pattern of arteriosclerosis involves the walls and smooth muscle of the small arteries and arterioles that is related to hypertension and diabetes?

Arteriolosclerosis

What is the general term for "hardening of the arteries" due to arterial wall thickening and loss of elasticity?

Arteriosclerosis

What is the general term for "hardening of the arteries" that results from arterial wall thickening and loss of elasticity?

Arteriosclerosis

What can form when the amount of lipid accumulates leading to a fatty streak known as ______ that usually grows in an outward direction

Atheroma

What arises from plaque accumulation in arterial walls that involves macrophages that is a chronic inflammatory process that arises in medium sized and large arteries?

Atherosclerosis

What inflammatory finding affects large and moderate sized arteries all over the body leading to obstruction of blood flow?

Atherosclerosis

What is a chronic inflammatory response to the accumulation of lipid within the arterial wall leading to multifocal plaque development over years and subsequent obstruction of blood flow?

Atherosclerosis

What is by far the most common cause of in situ local disease within the large extracranial and intracranial arteries that supply the brain?

Atherosclerosis

What is the most frequent and clinically important pattern of arteriosclerosis that involves the intima of large and moderate-sized arterial walls due to the formation of cholesterol plaques?

Atherosclerosis

Which form of arteriosclerosis consists of a necrotic lipid core with a fibromuscular cap that often undergoes dystrophic calcification?

Atherosclerosis

Endothelial cell dysfunction Dyslipidemia oxidation of LDL Inflammatory and immunologic factors Plaque rupture and thrombosis are pathogenesis for the formation of which type of plaque?

Atherosclerotic Plaque

Stroke, transient ischemic attacks, angina, myocardial infarction, mesenteric ischemia, claudication, and critical limb ischemia are manifestations of which disease?

Cardiovascular Disease

What is the leading cause of death in middle-aged and older adults globally?

Cardiovascular Disease

In atherosclerosis, endothelial damage allows lipid to leak into the intima leading to lipid _____ which then become consumed by macrophages resulting the formation of foam cell

Lipid Oxidation

What accumulates early in fatty streak formation yielding both intracellular lipid and extracellular deposits, which produce the fatty streak?

Lipids

What molecules accumulate in the intima of the vessels that become oxidized by free radicals that are scavenged by macrophages leading to the formation of foam cells?

Lipids (LDL)

A 58-year old man is found to be dead in his home. Which cell type is most likely to be found within the area of the coronary plaque?

Macrophages

Which activated cells in the lipid core can release matrix metalloproteinases that can weaken the fibrous cap making it susceptible to rupture?

Macrophages

Which cells engulf lipids (e.g., LDL) leading to the formation of foam cells that along with recruitment of T lymphocytes form a fatty streak?

Macrophages

Elevated uric acid level Psychosocial stress Anxiety Sleep disturbances Elevated plasma homocysteine are emerging ______ for ASCVD

Risk Factors

Which type of plaque contains large and soft lipid-rich necrotic core covered by a thin and inflamed fibrous cap that occurs in 55-75% of symptomatic coronary thrombi?

Rupture-Prone Plaque

Which type of plaques have a larger necrotic core with more inflammation that has a high density of macrophages with a thin fibrous cap?

Rupture-Prone Plaque

A 64-year-old man comes to his primary care provider because of a 3-month history of chest pain on exertion that is relieved by rest. History is significant for hypertension, type 2 diabetes mellitus, and hypercholesterolemia. He had a 40-pack-year smoking history but quit 10 years ago. On physical examination, increased abdominal girth is noted. Waist circumference is 46 inches. BMI is 45 kg/m2. The patient admits to poor compliance with his medication regimen. Vital signs are within normal limits. Laboratory studies show: HDL: 30 mg/dL LDL: 178 mg/dL Glucose (fasting): 184 mg/dL HbA1c: 7% Coronary angiography shows 85% occlusion of the left main coronary artery. What cells are directly responsible for synthesis of the fibrous cap overlying this arterial lesion?

Smooth Muscle Cells

A 64-year-old man comes to his primary care provider because of a 3-month history of chest pain on exertion that is relieved by rest. History is significant for hypertension, type 2 diabetes mellitus, and hypercholesterolemia. He had a 40-pack-year smoking history but quit 10 years ago. On physical examination, increased abdominal girth is noted. Waist circumference is 46 inches. BMI is 45 kg/m2. The patient admits to poor compliance with his medication regimen. Vital signs are within normal limits. Laboratory studies show: HDL: 30 mg/dL LDL: 178 mg/dL Glucose (fasting): 184 mg/dL HbA1c: 7% Coronary angiography shows 85% occlusion of the left main coronary artery. What cell type is directly responsible for synthesis of the fibrous cap overlying this arterial lesion?

Smooth Muscle Cells

Which cells migrate from the media through the internal elastic membrane to accumulate in the expanding intima leading to the formation of a fibrous cap?

Smooth Muscle Cells

What vascular alteration refers to the narrowing of a vessel?

Stenotic / Occlusive

Atherosclerosis is a chronic _______ response to the accumulation of lipid in the arterial wall, leading to multifocal intimal plaque development over years (decades) and subsequent obstruction of blood flow.

Inflammatory

What grows over time setting off an inflammatory response that leads to the formation of a necrotic cap?

Lipid Core

Which large and medium sized arteries are most commonly involved with atherosclerosis?

1.) Abdominal Aorta 2.) Coronary Artery 3.) Popliteal Artery 4.) Internal Carotid Artery

What are non-modifiable risk factors for ASCVD?

1.) Age 2.) Sex (M>F until postmenopausal) 3.) Genetics

Patients that have retinal arteriolosclerosis should have a thorough fundoscopic exam that looks for which features of the arteriolar wall?

1.) Copper Wiring 2.) AV Nicking

Which findings might be present in a patient with retinal arteriolosclerosis that can be viewed on a fundoscopic exam?

1.) Copper Wiring 2.) AV Nicking

What are the two most common locations of the body that are affected by atherosclerotic cardiovascular disease?

1.) Heart (Coronary) 2.) Brain (Cerebrovascular)

What 2 factors are the leading cause of death that when combined fall under cardiovascular disease?

1.) Heart Attack 2.) Stroke

Which modifiable factors are estimated to be responsible for >50% of cardiovascular mortality?

1.) Hypercholesterolemia 2.) Diabetes 3.) Hypertension 4.) Obesity 5.) Smoking

What are modifiable risk factors for the development of atherosclerosis?

1.) Hypertension 2.) Diabetes 3.) Smoking 4.) Hypercholesterolemia

Patients who have already had a myocardial infarction are treated more aggressively. What other patients do you treat more aggressively (ie., as if they already had a MI?)

1.) Peripheral Vascular Disease 2.) Chronic Kidney Disease 3.) Diabetes Mellitus

What are the top modifiable risk factors for ASCVD?

1.) Smoking 2.) Hypertension 3.) Diabetes 4.) Hyperlipidemia / Dyslipidemia 5.) Obesity

Sudden Cardiac Death (collapse and die) is the initial clinical coronary event in what % of patients with CHD?

15%

Lifetime risk of overall cardiovascular disease (CVD) approaches what % for persons aged 30 years without known CVD?

50%

Which lipoproteins collect in the intima of arteries and bind to constituents of the extracellular matrix that assists with the oxidation of LDAL particles in the intima?

Apolipoprotein B-containing lipoproteins

A 61-year-old woman comes to her physician and reports chest pain that worsens during times of stress or increased exertion. She also reports multiple recent episodes of headaches, which are more prominent on the left side and are associated with intermittent vision loss. These symptoms are alleviated by rest in a dark room. Her medical history includes hypertension, poorly controlled type 2 diabetes, and hepatitis. She has no significant smoking or alcohol history. Her physician orders an angiogram, which reveals 95% blockage in the proximal left anterior descending coronary artery. What is the most likely underlying pathology of her chest pain?

Atherosclerosis

In patients that have had a stroke, what is the most common cause of in situ local disease within the large extracranial and intracranial arteries that supply the brain?

Atherosclerosis

Which type of plaque consists of an abundance of smooth muscle cells and proteoglycan matrix with the absence of surface endothelium lacking a prominent lipid core or necrosis?

Erosion-Prone

What is the first element of plaque formation?

Fatty Streak (intimal xanthoma)

Patients with diabetes mellitus are at an increased risk for hyaline arteriolosclerosis due to nonenzymatic _____ of the basement membrane that makes the vessel wall leaky allowing for proteins to leak in

Glycosylation

Which type of arteriolosclerosis is caused by proteins leaking into the vessel wall producing homogenous, eosinophillic arteriolar wall thickening leading to a narrowed vessel lumen that arises due to hypertension and diabetes mellitus?

Hyaline Arteriolosclerosis

What helps you determine the chances that your patient will have heart disease by the time they are in their 80s?

Lifetime Risk

Why would you obtain a fasting blood glucose and A1c when assessing a patient for risk of atherosclerotic coronary vascular disease?

Looking for diabetes

Why would you order a urinalysis when assessing a patient for the risk of atherosclerotic coronary vascular disease?

Looking for kidney disease

Why would you test for blood creatinine when assessing a patient for the risk of atherosclerotic coronary vascular disease?

Looking for kidney disease

What physiological response occurs relatively late in atherosclerosis?

Luminal Obstruction

Macrophages take up LDL particles by receptor mediated endocytosis. What is the name of this receptor?

Macrophage Scavenger Receptor

Which pattern of arteriosclerosis involves the internal elastic membrane of the blood vessel (media not intima) that can lead to calcification of the walls of muscular arteries?

Monckeberg Media Sclerosis

You do a fundoscopic exam on your hypertensive patient and observe "copper wiring and A-V nicking that indicates what type of arteriolosclerosis?

Retinal Arteriolosclerosis

What arises when the fibrous cap is thin?

Thin-Cap Fibroatheroma (TCFA)

Which molecule generates fibrin and stimulates protease-activated receptors that signal smooth muscle migration and proliferation and EC matrix production?

Thrombin

The contents of necrotic core of the plaque are highly _____ with the potential to cause infarction

Thrombogenic

A 56-year old man develops exertional chest pain. He is referred for a coronary angiogram. Coronary disease is identified at the branching of the left coronary artery. Which features of this location increased the likelihood of plaque formation?

Turbulent Flow

What is the lifetime risk for a person in the 3rd generation with no known symptoms of heart disease developing heart disease?

50%

A 56-year-old man with hypertension, hyperlipidemia, and type 2 diabetes mellitus comes to his primary care physician with complaints of chest pain. He reports that he intermittently has chest pain when walking up several flights of stairs or helping his wife in the garden. The pain goes away when he takes a break from such activities. What is the minimum suspected percentage of arterial stenosis in this patient?

75%

Growing atheroma does not encroach on arterial lumen until the burden of disease is greater than what % of area encompassed by internal elastic lamina?

>40%

What % of CHD events occur in individuals with at least one risk factor (hypertension, hypercholesterolemia, diabetes, smoking, and obesity)?

>90%

CBC (HGB, platlet) Creatinine and electrolytes FBS and HGBA1C Urinalysis ECG Lipid panel (TC, TG, HDL, LDL, non-HDL) Liver enzymes are labs you should obtain to assess patient for the risk of ______

ASCVD

Atherosclerosis is more predominant in what part of the aorta?

Abdominal Aorta

Which aorta is typically involved more with atherosclerosis?

Abdominal aorta

What ethnic group suffers the greatest mortality rates, in both male and female, for coronary heart disease?

African Americans

Patients with on-coronary atherosclerotic arterial disease, Diabetes mellitus, and chronic kidney disease should be managed as ______ as those with prior CHD.

Aggressively

Thinning of the fibrous cap increases the susceptibility of a patient having a ____________ rupture

Coronary Plaque

How does a patient's risk of atherosclerosis change with increases in HDL and increases in LDL?

Decrease risk with increases in HDL Increase risk with increases in LDL

What vascular alteration refers to the distension or dilation of a vessel?

Ectatic / Aneurysmal

Diabetes mellitus contributes to the pathogenesis of _____ arteriolosclerosis through glycosylation of basement membrane, making vessel wall leaky.

Hyaline

Hypertension contributes to the pathogenesis of _____ arteriolosclerosis by forcing protein into the vessel wall.

Hyaline

Which form of arteriolosclerosis arises due to hypertension and diabetes mellitus leading to proteins leaking into the vessel wall?

Hyaline Arteriolosclerosis

Which form of arteriolosclerosis is a long standing consequence of benign hypertension or diabetes?

Hyaline Arteriolosclerosis

Which form of arteriolosclerosis is caused by proteins leaking into the vessel wall leading to vascular thickening that is present as pink hyaline on microscopy?

Hyaline Arteriolosclerosis

Which form of arteriolossclerosis is caused by proteins leaking into the vessel wall leading to homogenous, eosinophilic arteriolar wall thickening resulting in a narrowed vessel lumen with the evidence of pink hyaline within the blood vessel?

Hyaline Arteriolosclerosis

Which type of arteriolosclerosis is caused by chronic essential hypertension, chronic diabetes, or normal aging that can show deposition of proteins below the endothelium through the formation of pink amorphous deposits within the arteriolar walls?

Hyaline Arteriolosclerosis

An elderly man has diabetes and essential hypertension. What pathological finding may be seen on examination of his arteries and arterioles?

Hyaline arteriolosclerosis

A patient with repeated episodes of malignant hypertension has an "onion-skin" of vessel walls on biopsy. What has happened?