48 Questions
What is the primary function of fatty acids in the body?
Serving as an energy source for skeletal and heart muscle
What is the result of LDL particles becoming small enough to enter the endothelial wall?
Atherosclerosis occurs
Which of the following is a cause of coronary obstruction?
Idiopathic vasospasm of coronary arteries
What is the primary function of HDL particles?
Picking up excessive cholesterol from tissues and bringing it back to the liver
What is the result of the liver repackaging chylomicrons into VLDL?
VLDL uploads triglycerides and fatty acids to tissues
What is the primary reason why lipids are transported in lipoprotein particles?
Lipids are hydrophobic
What is the primary goal of using beta blockers in treating Acute Coronary Syndrome?
To decrease heart rate and prolong diastole
What is the main difference between Unstable Angina and Acute Myocardial Infarction?
Degree of thrombosis
What is the primary mechanism of ischemia in Acute Coronary Syndrome?
Disruption of blood supply due to thrombosis
What is the most common early complication of Acute Myocardial Infarction?
Arrhythmias
What is the primary mechanism of necrosis in Acute Myocardial Infarction?
Accumulation of lactate leading to calcium influx into cells
What is the primary role of macrophages in the healing process of Acute Myocardial Infarction?
Phagocytosing necrotic cells
What is the typical time frame for necrosis to complete in Acute Myocardial Infarction?
Within 6-12 hours
What is the late complication of Acute Myocardial Infarction that reflects inflammation and healing of necrotic tissues?
Pericarditis
What is the primary cause of atherosclerosis?
Familial dyslipidemia
What is the result of glucose binding to blood lipids and proteins in diabetes?
Formation of advanced glycation end products
What is the effect of high blood pressure on endothelial cells?
Vasoconstriction and increased endothelial permeability
What is the characteristic of an unstable atherosclerotic plaque?
Thin fibrotic cap
What is the result of the rupture of an atherosclerotic plaque?
Formation of a thrombus
What is the characteristic of stable ischemic heart disease?
Reversible ischemia with a predictable pattern of pain
What is the diagnosis of stable ischemic heart disease?
ST depression during stress test
What is the effect of high fat diet on lipoprotein metabolism?
Increased VLDL production
What is the result of oxidative stress on endothelial cells?
Damage to endothelial cells
What is the characteristic of complicated atherosclerotic plaques?
More lipids
What is the primary role of cholesterol in the body?
Component of cell membranes, steroid hormones, and bile
What is the purpose of lipoprotein particles in the body?
To transport lipids in the blood
What is the result of the liver repackaging VLDL into LDL?
The LDL particles become smaller and more dense
What is the primary function of triglycerides in the body?
Energy source for skeletal and heart muscle
What is the result of the accumulation of LDL particles in the endothelial wall?
The formation of atherosclerotic plaques
What is the primary function of HDL particles in the body?
To pick up excessive cholesterol from tissues and bring it back to the liver
What is the primary goal of aspirin therapy in Acute Coronary Syndrome?
To reduce platelet aggregation
What is the primary mechanism of ischemia in Unstable Angina?
Supply ischemia
What is the characteristic of an Acute Myocardial Infarction?
100% thrombosis
What is the typical ECG finding in Non-ST elevation MI?
ST depression
What is the primary role of beta blockers in treating Acute Coronary Syndrome?
To decrease heart rate
What is the primary mechanism of necrosis in Acute Myocardial Infarction?
Oxygen deprivation
What is the late complication of Acute Myocardial Infarction that reflects inflammation and healing of necrotic tissues?
Pericarditis
What is the primary mechanism of cardiac remodeling in Acute Myocardial Infarction?
Fibrosis
What is the primary cause of increased LDL particles in the bloodstream in individuals with familial dyslipidemia?
Defect in LDL receptors
Which of the following is a risk factor for atherosclerosis that leads to the formation of Advanced Glycation End products (AGEs)?
Diabetes
What is the primary mechanism by which high blood pressure contributes to atherosclerosis?
Decreased nitric oxide production by endothelial cells
Which type of atherosclerotic plaque is characterized by a thin fibrotic cap and a large lipid core?
Unstable plaque
What is the primary mechanism by which platelets contribute to the formation of atherosclerotic plaque?
Release of growth factors
What is the primary symptom of stable ischemic heart disease?
Chest pain with activity, relieved with rest
Which of the following is a characteristic of uncomplicated atherosclerotic plaques?
Slowly growing, asymptomatic
What is the primary mechanism by which oxidized LDL contributes to the formation of atherosclerotic plaque?
_activation of macrophages
Which of the following is a risk factor for atherosclerosis that leads to the formation of reactive oxygen species?
Smoking
What is the primary mechanism by which high intake of refined carbohydrates and sugars contributes to dyslipidemia?
Increased production of VLDL
Study Notes
Causes of Coronary Obstruction
- Atherosclerotic narrowing of coronary arteries
- Drug-induced coronary vasospasm (e.g., cocaine)
- Idiopathic vasospasm of coronary arteries (Prinzmetal angina)
- Inflammation of coronary arteries (e.g., vasculitis, Kawasaki disease)
Lipoproteins
- Lipids: cholesterol, free fatty acids, triglycerides
- Lipids are essential for life
- Fatty acids: energy source for skeletal and heart muscle
- Cholesterol: builds cell membranes, steroid hormones, and bile
- Lipids are hydrophobic, travel in blood inside lipoprotein particles
Metabolism of Lipoproteins
- Eating: fatty acids digested in intestinal wall, packaged in chylomicrons
- Liver: repackages into VLDL, travels around, uploads TG and fatty acids to tissue
- VLDL converted to LDL, circulates, eventually empties out, and returns to liver
- Liver clears LDL from circulation, recycles it
Atherosclerosis
- Building of atherosclerotic plaque in artery walls, narrowing the lumen
- Affects coronary, popliteal, carotid, and renal arteries
- Begins in childhood, develops slowly
- Most common causes of dyslipidemia: familial, high fat diet, high intake of refined carbs and sugars, obesity, and diabetes
Risk Factors of Atherosclerosis and Mechanism
- Smoking: production of reactive oxygen species, oxidative stress, damage to endothelial cells
- Diabetes: glucose binds to blood lipids and proteins, forming AGEs, damaging endothelial cells
- HTN: shear mechanical stress on endothelial cells, decrease in nitric oxide, vasoconstriction, and increased endothelial permeability
- Dyslipidemia (elevated LDL): increased LDL in blood, accumulation of lipoprotein in subendothelial space
Formation of Atherosclerotic Plaque
- Excessive LDL deposited in endothelium, oxidized inside, producing soft lipid-loaded core
- Platelets stick to endothelial cells, release growth factors, forming hard fibrotic cap
- Types of atherosclerotic plaques: uncomplicated, complicated, and unstable plaques
Unstable Plaques and Rupture
- Oxidized LDL attracts macrophages, secreting lytic enzymes, degrading collagen of cap, leading to rupture
- Rupture of cap: activation of platelets and clotting cascade, formation of thrombus, and ischemia
Ischemic Heart Disease Syndromes
- Stable ischemic heart disease (due to uncomplicated stable plaque)
- Acute coronary syndrome (due to complicated unstable plaque)
- Unstable angina (reversible ischemia)
- Acute myocardial infarction (irreversible infarction)
Stable Ischemic Heart Disease
- Chest pain, pressure, tightness with activity, relieved with rest
- Due to narrowing of coronary artery by stable slowly growing atherosclerotic plaque
- When demand increases, ischemia results (demand ischemia)
- Reversible when demand decreases (rest)
- Subendocardial area more prone to ischemia than epicardial
Acute Coronary Syndrome
- Unstable angina: acute onset of chest pain/pressure at rest or unrelieved by rest
- Due to rupture of atherosclerotic plaque with thrombosis
- Ischemia not related to demand (supply ischemia)
- Reversible ischemia if thrombus is broken down
- Infarction if thrombus keeps growing
Acute Myocardial Infarction
- Acute onset of chest pain/pressure at rest or unrelieved by rest
- Due to rupture of atherosclerotic plaque with 100% thrombosis
- Main artery occlusion > transmural infarct
- Distal branch occlusion > subendocardial infarct
- Arterial thrombosis produces MI (necrosis, irreversible damage), not related to demand
Causes of Coronary Obstruction
- Atherosclerotic narrowing of coronary arteries
- Drug-induced coronary vasospasm (e.g., cocaine)
- Idiopathic vasospasm of coronary arteries (Prinzmetal angina)
- Inflammation of coronary arteries (e.g., vasculitis, Kawasaki disease)
Lipoproteins
- Lipids: cholesterol, free fatty acids, triglycerides
- Lipids are essential for life
- Fatty acids: energy source for skeletal and heart muscle
- Cholesterol: builds cell membranes, steroid hormones, and bile
- Lipids are hydrophobic, travel in blood inside lipoprotein particles
Metabolism of Lipoproteins
- Eating: fatty acids digested in intestinal wall, packaged in chylomicrons
- Liver: repackages into VLDL, travels around, uploads TG and fatty acids to tissue
- VLDL converted to LDL, circulates, eventually empties out, and returns to liver
- Liver clears LDL from circulation, recycles it
Atherosclerosis
- Building of atherosclerotic plaque in artery walls, narrowing the lumen
- Affects coronary, popliteal, carotid, and renal arteries
- Begins in childhood, develops slowly
- Most common causes of dyslipidemia: familial, high fat diet, high intake of refined carbs and sugars, obesity, and diabetes
Risk Factors of Atherosclerosis and Mechanism
- Smoking: production of reactive oxygen species, oxidative stress, damage to endothelial cells
- Diabetes: glucose binds to blood lipids and proteins, forming AGEs, damaging endothelial cells
- HTN: shear mechanical stress on endothelial cells, decrease in nitric oxide, vasoconstriction, and increased endothelial permeability
- Dyslipidemia (elevated LDL): increased LDL in blood, accumulation of lipoprotein in subendothelial space
Formation of Atherosclerotic Plaque
- Excessive LDL deposited in endothelium, oxidized inside, producing soft lipid-loaded core
- Platelets stick to endothelial cells, release growth factors, forming hard fibrotic cap
- Types of atherosclerotic plaques: uncomplicated, complicated, and unstable plaques
Unstable Plaques and Rupture
- Oxidized LDL attracts macrophages, secreting lytic enzymes, degrading collagen of cap, leading to rupture
- Rupture of cap: activation of platelets and clotting cascade, formation of thrombus, and ischemia
Ischemic Heart Disease Syndromes
- Stable ischemic heart disease (due to uncomplicated stable plaque)
- Acute coronary syndrome (due to complicated unstable plaque)
- Unstable angina (reversible ischemia)
- Acute myocardial infarction (irreversible infarction)
Stable Ischemic Heart Disease
- Chest pain, pressure, tightness with activity, relieved with rest
- Due to narrowing of coronary artery by stable slowly growing atherosclerotic plaque
- When demand increases, ischemia results (demand ischemia)
- Reversible when demand decreases (rest)
- Subendocardial area more prone to ischemia than epicardial
Acute Coronary Syndrome
- Unstable angina: acute onset of chest pain/pressure at rest or unrelieved by rest
- Due to rupture of atherosclerotic plaque with thrombosis
- Ischemia not related to demand (supply ischemia)
- Reversible ischemia if thrombus is broken down
- Infarction if thrombus keeps growing
Acute Myocardial Infarction
- Acute onset of chest pain/pressure at rest or unrelieved by rest
- Due to rupture of atherosclerotic plaque with 100% thrombosis
- Main artery occlusion > transmural infarct
- Distal branch occlusion > subendocardial infarct
- Arterial thrombosis produces MI (necrosis, irreversible damage), not related to demand
This quiz covers the causes of coronary obstruction, including atherosclerosis, vasospasm, and inflammation, as well as the functions and types of lipoproteins and lipids in the body.
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