Snapshot A 54-year-old man presents to the emergency department 30 minutes after developing crushing sternal chest pain that radiates down the left arm and to the jaw. His symptoms are accompanied by anxiety. Medical history is significant for hypertension, hypercholesterolemia, and type II diabetes mellitus. On physical exam, the patient appears restless and is diaphoretic. An electrocardiogram is performed, which shows ST-segment elevated in leads V1-4. The cardiac catheterization lab is activated and the patient is awaiting stenting after appropriate acute management for acute coronary syndrome. Introduction Definition a pathological process that causes damage to the aorta cerebrovasculature coronary arteries peripheral arteries Epidemiology risk factors modifiable login to view 4 more bullets nonmodifiable login to view 4 more bullets Pathophysiology background LDL transports cholesterol into peripheral tissues and HDL mobilizes cholesterol from the periphery and into the liver for excretion via bile pathogenesis injury (e.g., smoking, hypertension, and hypercholesterolemia) to the endothelium leads to endothelial dysfunction resulting in login to view 2 more bullets macrophages become activated within the vessel intima and smooth muscles are recruited login to view 1 more bullet smooth muscle cells and macrophages engulf lipids (e.g., LDL), forming foam cells, along with recruitment of T lymphocytes forming a fatty streak login to view 2 more bullets location abdominal aorta > coronary artery > popliteal artery > carotid artery Presentation Symptoms angina if > 75% obstruction myocardial demand ischemia login to view 4 more bullets claudication can be asymptomatic Complications Aneurysms Myocardial infarction Ischemic stroke Peripheral vascular disease Atheromatous plaque disruption can result in thrombosis thrombus fragments can break off and result in an embolism