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What is the pathophysiologic “event” that causes majority of myocardial infarctions? (p.27-28)
- MI occurs when plaque is unstable, ruptures, and a thrombus forms
- Result is total obstruction of arterial lumen at affected site
- Or, segment of thrombus breaks away, travels to more distal site in coronary microcirculation, and obstructs vessel at that point
- Thrombosis = cause for MI
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Why do patients with MI often develop lactic acidosis?
- Poor delivery of oxygen to tissues greatly diminishes oxidative metabolism
- Cells obtain most of their energy by anaerobic process of glycolysis, which leads to tremendous quantities of excess lactic acid in blood
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Review complications of heart failure. (p.30)
- Occurs when heart can no longer maintain adequate cardiac output to meet metabolic needs of the body
- Pump failure = myocardium can no longer contract normally, therefore stroke volume decreases
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Review lipoprotein transport and metabolism.
Know where various lipoproteins are synthesized and major component (TG, cholesterol, protein) of each lipoprotein. (p.18)
- Lipids and proteins transported in circulation via dynamic particles called lipoproteins.
- Primary function of lipoprotein and transport lipid components in blood
- Exogenous fat transport
- Endogenous fat transport
- Reverse cholesterol transport
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What is the role of lipoprotein lipase (LPL) in lipid metabolism?
- Hydrolyzes chylomicron TG and fat stored in adipose tissue and liver cells
- Both adipose tissue and liver can gain large quantity of enzyme lipoprotein lipase
- Hydrolyzes TG of chylomicrons as they come in contact with endothelial wall, releasing FA and glycerol
- Causes hydrolysis of PL
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Will insulin influence synthesis of LPL? (p.18)
Insulin plays role in synthesis of LPL
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Know where various lipoproteins are synthesized and major component (TG, cholesterol, protein) of each lipoprotein. (p.16)
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What types of fatty acids increase blood cholesterol levels? (p.19)
- Saturated fatty acids
- o C12 – Lauric acid
- o C14 – Myristic acid
- o C16 – Palmitic acid
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Would these fatty acids have greater or lesser effect on increasing blood cholesterol levels than intake of dietary cholesterol per se?
Synergistic effect on elevating plasma cholesterol levels
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What lifestyle recommendations would you suggest to reduce risk of heart disease and why?
- Decrease LDL-C <200 mg/dL
- Increase HDL-C >60 mg/dL
- Decrease TG <150 mg/dL
- Control BP
- Stop smoking
- Control diabetes
- Lose weight
- Decrease alcohol
- Increase exercise
- Good diet – whole grains, high fiber, fruits, vegetables, low cholesterol, omega-3 fatty acids
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