Cv Labs

Front 1

What does a normal endothelial cell release?

Back 1

- EDRF: Endothelium-derived relaxing factor
- t-PA:PAI-1: Tissue plasminogen activator

Front 2

What is the normal action of EDRF (endothelium-derived relaxing factor)? Normal or dysfunctional?

Back 2

Normal endothelial cell function:
- Inhibits platelet adhesion
- Promotes vasodilation
- Controls shear
- Prevents leukocyte adhesion

Front 3

What is the normal action of t-PA:PAI-1 (tissue plasminogen activator)? Normal or dysfunctional?

Back 3

Normal endothelial cell function:
- Promotes fibrinolysis

Front 4

What does a dysfunctional endothelial cell release in hypercholesterolemia and atherosclerosis?

Back 4

- Decreased EDRF: Endothelium-derived relaxing factor
- Decreased t-PA:PAI-1: Tissue plasminogen activator
- Increase in Adhesion Molecules

Front 5

What are the results of a dysfunctional endothelial cell d/t hypercholesterolemia and atherosclerosis?

Back 5

- ↓EDRF → platelet adhesion, vasoconstriction, ↑shear, leukocyte adhesion
- ↓t-PA:PAI-1 → promotes thrombosis
- ↑Adhesion molecules → monocyte and macrophage retention

Front 6

What causes endothelial dysfunction?

Back 6

Cardiac Risk Factors → ↑Reactive Oxygen Species and ↑Inflammation

Front 7

What does endothelial dysfunction cause?

Back 7

Vascular remodeling and atherosclerosis → ↑risk of coronary events and stroke

Front 8

What are some invasive ways to measure vascular health?

Back 8

- Intra-coronary measures
- Peripheral venous plethysmography

Front 9

What are some non-invasive ways to measure vascular health?

Back 9

- Brachial artery reactivity
- Carotid IMT (intima media thickness)
- Vascular tonometry

Front 10

Is brachial artery reactivity an invasive or non-invasive measure? What are you looking at in this screening?

Back 10

- Non-invasive
- Use ultrasound to measure cross-section of brachial artery and can determine flow w/ doppler
- Changes in vessel diameter after cuff release are measured to determine percent flow mediated dilation

Front 11

How do you do the brachial artery reactivity testing?

Back 11

- Inflate BP cuff so that no blood can get through for 5 minutes
- Arm gets ischemic so the vessels dilate
- When you release cuff, flow velocity will be extremely fast, causing shear forces on vessel
- This should cause more dilation (peak 1-2 minutes after release)
* Measure absolute change in diameter and relative change in diameter: determines percent Flow Mediated Dilation (FMD)

Front 12

How does the % Flow Mediated Dilation (FMD) change with BP?

Back 12

- Optimal BP, greater FMD
- As BP worsens, FMD decreases

Front 13

How does your risk score (takes into account age, BP, CV disease, etc) predict your Flow Mediated Dilation (FMD)?

Back 13

The higher your risk score, the lower your FMD

Front 14

Does improving your Flow-Mediated Dilation with therapy affect your risk of having an adverse event?

Back 14

- Improved FMD increases your chances of living adverse event free
- A persistently impaired FMD is associated with more adverse events

Front 15

What are the advantages of measuring Flow-Mediated Dilation?

Back 15

- Non-invasive
- Uses a pervasive technology
- Correlates w/ function in coronary bed
- Correlates w/ CV outcomes
- Shows changes w/ therapy
- High sensitivity

Front 16

What are the challenges of measuring Flow-Mediated Dilation?

Back 16

- Technically difficult to perform (requires training)
- Protocol variations
- Requires significant off-line analysis
- No clear cut-off points for risk
- Minimal data with respect to clinical improvements w/ alteration
- Relatively low specificity

Front 17

What does Carotid IMT measure?

Back 17

Structural changes in intima-media thickness

Front 18

What are some independent determinants of carotid IMT?

Back 18

- Age
- Pulse pressure
- Diabetes
- LDL cholesterol
- Cigarette smoking

Front 19

What are the advantages of measuring Carotid IMT?

Back 19

- Relative ease of performance
- Pervasive technology
- Correlates w/ CV outcomes
- High sensitivity
- Correlates w/ presence and extent of coronary atherosclerosis

Front 20

What are the challenges of measuring Carotid IMT?

Back 20

- Variations by age, sex, and race
- Study heterogeneity
- Lack of specificity
- Minimal data with respect to improvements with alteration also improve outcomes