BASIC SCIENCE: BASIC SCIENCE: ATHEROSCLEROATHEROSCLERO

SISSIS2 February 20062 February 2006

St Luke’s-Roosevelt HospitalSt Luke’s-Roosevelt Hospital

Department of SurgeryDepartment of Surgery

Which of the following are risk factors Which of the following are risk factors for atherosclerosis?for atherosclerosis?

A.A. HypercholesterolemiaHypercholesterolemia

B.B. HypertensionHypertension

C.C. High HDL levelsHigh HDL levels

D.D. Cigarette smokingCigarette smoking

E.E. DiabetesDiabetes

F.F. HypohomocysteinemiaHypohomocysteinemia

Which of the following are risk factors Which of the following are risk factors for atherosclerosis?for atherosclerosis?

A.A. HypercholesterolemiaHypercholesterolemia

B.B. HypertensionHypertension

C.C. High HDL levelsHigh HDL levels

D.D. Cigarette smokingCigarette smoking

E.E. DiabetesDiabetes

F.F. HypohomocysteinemiaHypohomocysteinemia

Which of the following is/are true about the Which of the following is/are true about the pathogenesis of atherosclerosis?pathogenesis of atherosclerosis?

A.A. Atheromas are thought to be the result of Atheromas are thought to be the result of endothelial response to injury.endothelial response to injury.

B.B. Atherosclerotic plaques tend to form at Atherosclerotic plaques tend to form at vascular bifurcations.vascular bifurcations.

C.C. Atherosclerotic plaques progress with Atherosclerotic plaques progress with time.time.

D.D. The vascular smooth muscle cell changes The vascular smooth muscle cell changes from a secretory to contractile state from a secretory to contractile state during atherogenesis.during atherogenesis.

E.E. PDGF (platelet derived growth factor) is a PDGF (platelet derived growth factor) is a potent stimulator for migration and potent stimulator for migration and proliferation of macrophages.proliferation of macrophages.

Which of the following is/are true about the pathogenesis of Which of the following is/are true about the pathogenesis of atherosclerosis?atherosclerosis?

A.A. Atheromas are thought to be the result of endothelial Atheromas are thought to be the result of endothelial response to injury.response to injury.

B.B. Atherosclerotic plaques tend to form at vascular Atherosclerotic plaques tend to form at vascular bifurcations. bifurcations.

C.C. Atherosclerotic plaques progress with time. Atherosclerotic plaques progress with time. (FALSE, may regress, progress, or stay stable with time)(FALSE, may regress, progress, or stay stable with time)

D. D. The vascular smooth muscle cell changes from a secretory The vascular smooth muscle cell changes from a secretory to contractile state during atherogenesis. to contractile state during atherogenesis. (FALSE, changes from contractile to secretory.)(FALSE, changes from contractile to secretory.)

E.E. PDGF (platelet derived growth factor) is a potent PDGF (platelet derived growth factor) is a potent stimulator for migration and proliferation of macrophages. stimulator for migration and proliferation of macrophages. (FALSE, stimulator of vascular smooth muscle cells.)(FALSE, stimulator of vascular smooth muscle cells.)

Preservation of arterial luminal area occurs Preservation of arterial luminal area occurs by enlargement of the arterial wall until by enlargement of the arterial wall until what amount of plaque volume (beyond what amount of plaque volume (beyond which compensation fails and the lumen which compensation fails and the lumen progressively narrows with plaque progressively narrows with plaque enlargement)?enlargement)?

A.A. 20%20%

B.B. 40% 40%

C.C. 60%60%

D.D. 80%80%

E.E. 90%90%

Preservation of arterial luminal area occurs Preservation of arterial luminal area occurs by enlargement of the arterial wall until by enlargement of the arterial wall until what amount of plaque volume (beyond what amount of plaque volume (beyond which compensation fails and the lumen which compensation fails and the lumen progressively narrows with plaque progressively narrows with plaque enlargement)?enlargement)?

A.A. 20%20%

B.B. 40% 40%

C.C. 60%60%

D.D. 80%80%

E.E. 90%90%

Match the followingMatch the followinga.a. Buerger’s diseaseBuerger’s disease

b.b. Takayasu’s arteritisTakayasu’s arteritis

c.c. Temporal arteritisTemporal arteritis

d.d. Raynaud’s Raynaud’s phenomenonphenomenon

1.1. Involves aorta and major Involves aorta and major branches, may present as branches, may present as arm claudicationarm claudication

2.2. Involves superficial Involves superficial temporal art., vertebral temporal art., vertebral art., and aorta, may art., and aorta, may present with facial present with facial muscle claudicationmuscle claudication

3.3. Associated with smoking, Associated with smoking, arterial involvement arterial involvement progresses from distal to progresses from distal to proximalproximal

4.4. Associated with cold Associated with cold exposure or stress, exposure or stress, recurrent episodic recurrent episodic vasoconstriction of digitsvasoconstriction of digits

Match the followingMatch the followinga.a. Buerger’s diseaseBuerger’s disease

b.b. Takayasu’s arteritisTakayasu’s arteritis

c.c. Temporal arteritisTemporal arteritis

d.d. Raynaud’s Raynaud’s phenomenonphenomenon

1.1. Involves aorta and major Involves aorta and major branches, may present as branches, may present as arm claudicationarm claudication

2.2. Involves superficial Involves superficial temporal art., vertebral temporal art., vertebral art., and aorta, may art., and aorta, may present with facial present with facial muscle claudicationmuscle claudication

3.3. Associated with smoking, Associated with smoking, arterial involvement arterial involvement progresses from distal to progresses from distal to proximalproximal

4.4. Associated with cold Associated with cold exposure or stress, exposure or stress, recurrent episodic recurrent episodic vasoconstriction of digitsvasoconstriction of digits

Define ABI testing. Define ABI testing.

What are the accepted values for What are the accepted values for claudication and rest pain?claudication and rest pain?

Define ABI testing.Define ABI testing. Ankle-brachial index: DP/PT systolic blood Ankle-brachial index: DP/PT systolic blood

pressure/brachial systolic blood pressurepressure/brachial systolic blood pressure

What are the accepted values for What are the accepted values for claudication and rest pain?claudication and rest pain?

Normal 1.0 – 1.2Normal 1.0 – 1.2Claudication 0.5 - 0.7Claudication 0.5 - 0.7Rest pain < 0.4 (reflects critical ischemia)Rest pain < 0.4 (reflects critical ischemia)

Why might ABI measurements be Why might ABI measurements be inaccurate in diabetic patients?inaccurate in diabetic patients?

What further provocative testing can What further provocative testing can be done if a patient complains of be done if a patient complains of claudication but has a normal ABI claudication but has a normal ABI value?value?

Why might ABI measurements be inaccurate Why might ABI measurements be inaccurate in diabetic patients?in diabetic patients?

Vessel calcification may cause the vessels to Vessel calcification may cause the vessels to be difficult to compress, increasing ankle be difficult to compress, increasing ankle BP resulting in falsely elevated ABI.BP resulting in falsely elevated ABI.

What further provocative testing can be done What further provocative testing can be done if a patient complains of claudication but if a patient complains of claudication but has a normal ABI value?has a normal ABI value?

ABI post-exerciseABI post-exercise

Describe the location of the lesion seen on the PVRs.Describe the location of the lesion seen on the PVRs.

Occlusive Occlusive disease on the disease on the right right aortoiliac and aortoiliac and popliteal popliteal region.region.

Describe the location of the lesion seen on the PVRs.Describe the location of the lesion seen on the PVRs.

Doppler ultrasound can be used in surveillance of post-op grafts. Doppler ultrasound can be used in surveillance of post-op grafts. Which of the following is consistent with critical hemodynamic Which of the following is consistent with critical hemodynamic lesion?lesion?

A.A. Peak systolic velocity > 300cm/sec, velocity ratio Peak systolic velocity > 300cm/sec, velocity ratio (lesion/upstream) > 3.5, and overall graft velocity < 40cm/sec(lesion/upstream) > 3.5, and overall graft velocity < 40cm/sec

B.B. Peak systolic velocity < 150cm/sec, velocity ratio Peak systolic velocity < 150cm/sec, velocity ratio (lesion/upstream) < 1.5, and overall graft velocity < 40cm/sec(lesion/upstream) < 1.5, and overall graft velocity < 40cm/sec

C.C. Peak systolic velocity > 300cm/sec, velocity ratio Peak systolic velocity > 300cm/sec, velocity ratio (lesion/upstream) > 3.5, and overall graft velocity > 80cm/sec(lesion/upstream) > 3.5, and overall graft velocity > 80cm/sec

D.D. Peak systolic velocity < 150cm/sec, velocity ratio Peak systolic velocity < 150cm/sec, velocity ratio (lesion/upstream) < 1.5, and overall graft velocity > 80cm/sec(lesion/upstream) < 1.5, and overall graft velocity > 80cm/sec

E.E. Peak systolic velocity < 150cm/sec, velocity ratio Peak systolic velocity < 150cm/sec, velocity ratio (lesion/upstream) > 3.5, and overall graft velocity < 40cm/sec(lesion/upstream) > 3.5, and overall graft velocity < 40cm/sec

Doppler ultrasound can be used in surveillance of post-op grafts. Doppler ultrasound can be used in surveillance of post-op grafts. Which of the following is consistent with critical hemodynamic Which of the following is consistent with critical hemodynamic lesion?lesion?

A.A. Peak systolic velocity > 300cm/sec, velocity ratio Peak systolic velocity > 300cm/sec, velocity ratio (lesion/upstream) > 3.5, and overall graft velocity < 40cm/sec(lesion/upstream) > 3.5, and overall graft velocity < 40cm/sec

B.B. Peak systolic velocity < 150cm/sec, velocity ratio Peak systolic velocity < 150cm/sec, velocity ratio (lesion/upstream) < 1.5, and overall graft velocity < 40cm/sec(lesion/upstream) < 1.5, and overall graft velocity < 40cm/sec

C.C. Peak systolic velocity > 300cm/sec, velocity ratio Peak systolic velocity > 300cm/sec, velocity ratio (lesion/upstream) > 3.5, and overall graft velocity > 80cm/sec(lesion/upstream) > 3.5, and overall graft velocity > 80cm/sec

D.D. Peak systolic velocity < 150cm/sec, velocity ratio Peak systolic velocity < 150cm/sec, velocity ratio (lesion/upstream) < 1.5, and overall graft velocity > 80cm/sec(lesion/upstream) < 1.5, and overall graft velocity > 80cm/sec

E.E. Peak systolic velocity < 150cm/sec, velocity ratio Peak systolic velocity < 150cm/sec, velocity ratio (lesion/upstream) > 3.5, and overall graft velocity < 40cm/sec(lesion/upstream) > 3.5, and overall graft velocity < 40cm/sec

Which of the following is/are Which of the following is/are truetrue about about transcutaneous oximetry?transcutaneous oximetry?

A.A. Variables such as skin temperature, Variables such as skin temperature, sympathetic tone, and skin conditions may sympathetic tone, and skin conditions may effect this test.effect this test.

B.B. Values greater then 10mmHg are predictive Values greater then 10mmHg are predictive of healing of foot lesions.of healing of foot lesions.

C.C. Useful for the evaluation of diabetics with Useful for the evaluation of diabetics with extensive calcification to determine critical extensive calcification to determine critical ischemia.ischemia.

D.D. Measures oxygen tension in the skin to Measures oxygen tension in the skin to assess tissue perfusion.assess tissue perfusion.

Which of the following is/are Which of the following is/are truetrue about about transcutaneous oximetry?transcutaneous oximetry?

A.A. Variables such as skin temperature, Variables such as skin temperature, sympathetic tone, and skin conditions may sympathetic tone, and skin conditions may effect this test.effect this test.

B.B. Values greater then 10mmHg are Values greater then 10mmHg are predictive of healing of foot lesions. predictive of healing of foot lesions. (FALSE, greater then 40mmHg, less then (FALSE, greater then 40mmHg, less then 10mmHg consistent with critical ischemia.)10mmHg consistent with critical ischemia.)

C.C. Useful for the evaluation of diabetics with Useful for the evaluation of diabetics with extensive calcification to determine critical extensive calcification to determine critical ischemia.ischemia.

D.D. Measures oxygen tension in the skin to Measures oxygen tension in the skin to assess tissue perfusion.assess tissue perfusion.

List some potential complications of List some potential complications of angiography as related to angiography as related to catheterization and the injected catheterization and the injected contrast dye.contrast dye.

List some potential complications of List some potential complications of angiography as related to catheterization and angiography as related to catheterization and

the injected contrast dye.the injected contrast dye.

Puncture Site Puncture Site RelatedRelated

A.A. HematomaHematoma

B.B. HemorrhageHemorrhage

C.C. PseudoaneurysmPseudoaneurysm

D.D. AV fistulaAV fistula

E.E. AtheroembolizatiAtheroembolizationon

F.F. Local thrombosisLocal thrombosis

Contrast RelatedContrast Related

A.A. AnaphylaxisAnaphylaxis

B.B. Sensitivity Sensitivity reactionsreactions

C.C. Vasodilation / Vasodilation / hypotensionhypotension

D.D. NephrotoxicityNephrotoxicity

E.E. HypervolemiaHypervolemia

What is the most important measure What is the most important measure to protect the kidneys from to protect the kidneys from contrast induced nephropathy?contrast induced nephropathy?

What is the most important measure What is the most important measure to protect the kidneys from to protect the kidneys from contrast induced nephropathy?contrast induced nephropathy?

Maintain adequate hydration—before, Maintain adequate hydration—before, during, and after the angiography during, and after the angiography is done.is done.