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Mech Arterial Diseases


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What is temporal arteritis?
Progressive inflammatory disorder of cranial blood vessels, principally the temporal artery
What is another name for temporal arteritis?
Giant Cell Arteritis
What is a giant cell?
an abnormally large tissue cell; it often contains more than one nucleus and may appear as a merger of several normal cells
What is a coarctation?
A compression, shrivelling, or stricture of the walls of a vessel as the aorta
What is coarctation of the aorta?
Coarctation of the aorta is a congenital cardiac anomaly characterized by a localized narrowing of the aorta. It results in increased pressure proximal to the defect and decreased pressure distal to it.
What is the most common site for coarctation of the aorta?
The most common site for coarctation of the aorta is just beyond the origin of the left subclavian artery from the aorta.
In what part(s) of the body does a coarctation of the aorta cause HIGH blood pressure?
In the upper extremities and the head.
In what part(s) of the body does a coarctation of the aorta cause LOW blood pressure?
In the lower body and extremities.
What are the symptoms of coarctation of the aorta?
- fatigue in legs
- high blood pressure
- cold legs, feet
- decreased exercise performance
- heart failure
What is the most common type of coarctation?
Postductal coarctation, in which the constriction lies at or just distal to the obliterated ductus arteriousus (the ligamentum arteriosum)
What is pre-ductal coarctation?
Pre-ductal constriction lies in the aortic isthmus, i.e., the segment of aorta between the left subclavian artery and the point of entry of the ductus arteriosus.
When (at what age) does post-ductal coarctation usually present?
Late childhood or adulthood
When (at what age) does pre-ductal coarctation usually present?
In infancy
How often do coarctations occur alone vs. in association with other malformations, e.g., ASD, VSD
50% of the time
How does left ventricle hypertrophy appear on an ECG?
The depth of the downward S-wave in lead V1, plus the height of the upward R-wave in lead V5 equals more than 35 mm.
What does "strain" indicate in "left ventricular hypertrophy with strain"?
The left ventricle is working hard against something⬦(systemic hypertension, an aortic stenosis, coarctation of the aorta?)⬦and the chronic strain has caused it to hypertrophy
How is left ventricular strain diagnosed on an ECG?
There is asymmetric ST-segment depression in lead V5. The asymmetry of this inversion is a long and gradual downslope, followed by a shorter, more abrupt upslope.
How is right ventricular strain diagnosed on an ECG?
An asymmetric T-wave inversion would in lead V2 (instead of V5 for left ventricle).
What effect can a coarctation have on the ribs?
A coarctation can cause rib notching.
What ribs may be notched by a coarctation?
4th - 8th ribs
Is a coarctation the only thing that can cause rib notching?
No. There are other diseases, including neurofibromatosis, in which enlarged nerves erode the bone.
Below what artery does an aortic aneurysm frequently occur?
Below the renal artery.
What is an aneurysm?
An aneurysm is a localized dilation of the wall of a blood vessel.
What is an aortic aneurysm?
dilation of the wall of the aorta caused by atherosclerosis, hypertension, or, less commonly, syphylis.
What is aortic dissection?
Aortic dissection is a condition in which there is bleeding into and along the wall of the aorta. This most often occurs because of a tear or damage to the inner wall of the artery.
Who are the most common sufferers of aortic dissection?
40 - 70 yo men
Do symptoms of aortic dissection begin slowly or suddenly?
What is the chief complaint of a person with aortic dissection?
A "tearing" feeling in the middle of the chest.
Aortic dissection is common in patients with which two type of hereditary connective tissue diseases?
Marfan's syndrome and Ehler-Danlos syndrome
What is Marfan's syndrome?
a hereditary condition that affects the musculoskeletal system and is often associated with abnormalities of the cardiovascular system and of the eyes.
What is Ehlers-Danlos syndrome?
It is a hereditary disorder of conective tissue, marked by hyperplasticity of skin, tissue fragility, and hypermotility of joints.
What is atherosclerosis?
Narrowing and hardening of the arteries due to plaques of fats, cholesterol, and cellular debris
What are the risk factors for atherosclerosis?
- Age
- Sex - women more protected by estrogen
- Family, genetics
What is arteriosclerosis?
Pathologic thickening, hardening, and loss of elasticity of arteriolar walls (usually comes with age)
What is angina?
Intermittent chest pain due to myocardial ischemia due to less than normal coronary blood flow
What is intermittent claudication?
Cramplike pains in the calves caused at times by poor circulation of blood to the leg muscles. Commonly associated w/atherosclerosis.
When do angina and claudication occur, i.e., what's missing from the affected tissue?
The tissue has an insufficient supply of O2.
How is blood flow related to a blood vessel's radius.
Blood flow is directly proportional to the radius to the 4th power, r4.
Why is angina intermittent?
The supply of O2 to the tissue may be sufficient for resting conditions.
What is stable angina?
Angina in which attacks occur w/ predictable frequency and duration and are precipitated by circumstances, such as exercise or emotional stress, that increase myocardial O2 demands.
What is variant angina?
Chest pain caused by reversible, severe coronary artery spasm which causes temporary stenosis.
What is another name for variant angina?
Prinzmetal's angina
When does variant angina often occur?
At rest (may awaken patient at night).
Who is a typical sufferer of variant angina?
Women under 50 yo.
What is unstable angina?
Acute change in atherosclerotic plaque and adherent partial thrombosis which make stenosis worse.

Compared to stable angina:
1. less exertion causes more pain
2. pain lasts longer time
3. attacks are more frequent
What are 4 causes of stable angina?
1. fixed atherosclerotic stenosis of one or more coronary arteries
2. aortic stenosis
3. aortic regurgitation
4. myocardial hypertrophy
How long do stable angina attacks usually last?
3 - 20 minutes
What sort of terms does a patient use when describing the substernal sensation of stable angina?
- pressure
- crushing
- tightness
- burning
- squeezing
- vague pain
What % stenosis of a coronary artery qualifies as "critical stenosis"?
Where does the sensation of angina begin?
- Back of neck
- Lower jaw
- Interscapular area
Where may the sensation of angina radiate?
- left shoulder, upper arm
- inner aspect of elbow, forearm, wrist, or 4th & 5th fingers
When may threshold for pain of angina be lowered?
- After meals
- When excited
- When exposed to cold
What dermatomes are typically referred to by angina?
C8 - T4; however, jaw and neck are not in this range, but may be affected.
What are some differential diagnoses for anginal type pain?
- dissecting aortic aneurysm
- pulmonary embolism
- pneumothorax
- pneumonia
- esophageal spasm
- GERD, peptic ulcer, cholecystitis (gall bladder)
- chest wall pain (inflam of costochnodral joints)
- cervical or thoracic radiculopathy (disease involving a spinal nerve root)
What can be administered to (not) diagnose angina?
Nitrate will relieve the pain if it IS angina.
Does BP increase or decrease during an anginal attack?
BP may do either.
What unusual heart sound might you hear during an angina attack?
An apical systolic murmur
- due to mitral regurg
- due to papillary muscle ischemia
What are 4 historical signs of angina?
- diabetes
- xanthelasma (lipid plaques on eyelid)
What lab tests may be ordered for angina?
- serum (cardiac) lipids
- resting, anginal ECG's
- stress test
- coronary angiography
What will a coronary angiography of an anginal patient show?
Stenosis of left anterior descending (LAD) coronary artery and/or its branches
What is the treatment for an acute angina attack?
sublingual nitroglycerin
How do nitrates affect afterload?
They cause arteriolar dilation ->
decreased TPR ->
decreased afterload
How do nitrates affect preload?
They cause venous dilation ->
decreased venous return ->
decreased preload
How do decreased afterload and decreased preload affect ventricular work and O2 demand?
They decrease the demand for ventricular work and for O2.
What existing conditions should be treated in an angina patient?
HTN and high LDL
What types of drugs can be prescribed as prophylaxis for angina?
- long-lasting nitrates
- beta-blockers
- calcium-channel blockers
- antiplatelet agents
How do beta blockers work (against angina)?
They decrease heart rate and contractility which decreases the demand for O2.
How do calcium-channel blockers work (against angina)?
- They decrease heart rate and contractility

- They cause coronary dilation which allows for better blood flow.
What is a common antiplatelet agent and how is it used as a prophylaxis for angina?
Aspirin. It destroys platelets or inhibits their function (clotting) -> prevents coronary thrombosis
What are 2 coronary revascularization procedures that can be used in the treatment of angina?
1. coronary artery bypass grafting - CABG

2. percutaneous transluminal coronary angioplasty - PTCA
What is the cause of variant/prinzmetal angina?
The cause is unknown. It is NOT triggered by exertion.
How do the symptoms for variant/prinzmetal angina compare to those for stable angina?
The symptoms are the same.
What does an ECG show for variant/prinzmetal angina?
Usually ST segment elevation
What does a coronary angiography typically show for variant/prinzmetal angina?
- NO fixed stenoses

- Right coronary artery involvement (spasm)
What types of drugs are used to treat variant/prinzmetal angina -- acutely or prophylactically?
Calcium channel blockers and nitrates
What are two specific drugs that are used to treat variant/prinzmetal angina?
1. Cardizem (diltiazem)

2. Verelan (verapamil)
What are 2 other names for unstable angina?
Crescendo or preinfarction angina
What is unstable angina a warning for?
An impending, irreversible ischemic event
What does an ECG show for unstable angina?
Usually, ST segment depression during attacks.

Sometimes, ST segment elevation.
What are non-drug treatments for someone with unstable angina?
- hospitalization
- bed rest
- limited activity
- supplemental O2
What types of drugs are used to treat unstable angina?
- nitrates
- antiplatelet agents (aspirin)
- anticoagulation therapy:
nonfractionated (NL) heparin or
low molecular weight (fractionated) heparin
Compared to stable angina, how does unstable angina respond to nitrates.
Unstable angina does not respond to nitrates as well as stable angina.
What is the etiology of Acute Myocardial Infarction (AMI or heart attack)?
Fixed coronary atherosclerotic plaque causing critical stenosis +
acute plaque changes and/or
coronary artery thrombosis
What are some examples of acute plaque changes?
- fissuring
- hemorrhage into the plaque
- plaque rupture w/ embolization of debris
- thrombus from fissuring or hemorrhage
- complete occlusion w/angina so bad that it constitutes a heart attack
What accounts for AMI's in previously asymptomatic patients?
acute plaque changes
How is a coronary artery thrombosis formed?
By plaque fissuring or rupture, exposing platelets to thrombogenic plaque lipids and thrombogenic subendothelial collagen
How does a coronary artery thrombosis lead to unstable angina?
It partially occludes a blood vessel.
How does a coronary artery thrombosis lead to an AMI?
It completely occludes a blood vessel.

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