NSG 533 Advanced Pathophysiology Exam 3 List the novel risk factors for CAD - correct answer 1) markers of inflammation, ischemia, and thrombosis (elevated high sensitivity C -reactive protein, troponin, fibrinogen) 2) adipokines (leptin, adiponectin) 3) CKD 4) air pollution and ionizing radiatio n 5) medications (NSAIDs) 6) coronary artery calcification and carotid wall thickness and 7) microbiome 8) small dense LDL particles and lipoprotein(a) 9) Hyperhomocysteinemia List nonmodifiable risk factors for CAD - correct answer Advanced age, male gender or woman after menopause, and family history (genetics, shared environmental exposure). List modifiable risk factors for CAD - correct answer Dyslipidemia, hypertension, cigarette smoking, diabetes and insulin resistance, obesity and sedentary lifestyle, and an atherogenic diet. How does dyslipidemia contribute to CAD? - correct answer High levels of LDL in the bloodstream leads to LDL oxidation, migration into the vessel wall, and phagocytosis by macrophages, all key steps in the pathogenesis of atherosclerosis. Atherosclerosis - correct answer A chronic inflammatory condition that results in damage to the arteries. Thickening and hardening of the vessels are caused by the accumulation of lipid -laden macrophages (foam cells) within the arterial walls, leading to t he formation of a plaque. Optimal lipid panal results - correct answer Total cholesterol (< 200), LDL (< 100), triglycerides (< 150) What is the response -to-injury hypothesis in the development of atherosclerotic lesions? - correct answer The earliest event in atherogenesis is injury to the endothelium, which could be triggered by hypertension, circulation of ROS (smoking, pollutants), dyslipidemia, and elevated A1C. When foam cells accumulate in a significant amount within the arterial wall, they form ______ . What is then released? - correct answer a lesion called a fatty streak; inflammatory cytokines, damaging enzymes, and growth factors. Growth factors released released in atherogenesis stimulate _______ , which ________ . - correct answer smooth muscle cell proliferation; produce collagen and migrate over the fatty streak to form a fibrous plaque. Plaques that have ruptured are called ______ . - correct answer complicated plaques Plaque rupture occurs because of the ______ . - correct answer inflammatory activation of proteinases, apoptosis of cells within the plaque, and bleeding within the lesion (plaque hemorrhage). What happens once a plaque ruptures? - correct answer The underlying tissue is exposed and causes platelet adhesion, initiation of the clotting cascade, and rapid thrombus formation that can suddenly occlude the vessel, resulting in ischemia and infarction . Stable atheromatous lesions - correct answer A fibrous plaque that has calcified, protruded into the vessel lumen, and obstructs blood flow, causing chest pain during exercise (stable angina) Unstable atheromatous lesions - correct answer Plaques that are prone to rupture even before they affect blood flow (clinically silent until rupture). The fibrous cap is typically thinner in an unstable plaque. List the acute coronary syndromes - correct answer Unstable angina, NSTEMI, and STEMI What are the clinical features and physical exam findings in unstable angina? - correct answer Chest pain at rest, new -onset, or increasing in severity or frequency. ST segment depression and T wave inversion that often resolves with relief of pain, transi ent abnormal heart sounds. Possible tachycardia and pulmonary congestion. Patient might be dyspneic, diaphoretic, or anxious. Troponin and CK are normal. What are the clinical features and physical exam findings in a NSTEMI? - correct answer ST depression and T wave inversion, early peak in CK level, and small elevation in troponin. What are the clinical features and physical exam findings in a STEMI? - correct answer ST elevation, T wave inversion, and pathological Q waves. Elevation of CK, CK -MB, myoglobin (peaks 1 -4 hrs), troponin (begins to rise at 3 hrs), and LDH. Patient has anx iety, cold perspiration and pallor, variable HR and BP response.