Atherosclerosis MCQ — NEET PG Practice Question | NEETPGAI
Atherosclerosis
easy
microscope Pathology
A 58-year-old man with hypertension and dyslipidemia undergoes coronary angiography for unstable angina. Atherosclerotic plaques are identified in multiple coronary arteries. Which coronary artery is the most common site of atherosclerotic lesion formation?
A. Left anterior descending artery
B. Right coronary artery
C. Left main coronary artery
D. Left circumflex artery
Explanation
Most Common Site of Coronary Atherosclerosis
Key Point
The left anterior descending (LAD) artery is the most frequently affected coronary vessel in atherosclerotic coronary artery disease, accounting for approximately 40–50% of significant stenoses.
Anatomical and Hemodynamic Basis
The LAD is preferentially affected due to:
1.
Highest blood flow — carries the largest volume of blood among coronary arteries, resulting in greater shear stress and endothelial injury
2.
Longer course — extends from the left main coronary artery to the apex, providing a longer segment for plaque formation
3.
Bifurcation points — multiple branch points (diagonal and septal branches) create zones of disturbed flow where atherosclerosis preferentially develops
Frequency of Involvement by Vessel
Table
Coronary Artery
Frequency of Significant Stenosis
Typical Presentation
LAD
40–50%
Anterior wall MI, angina
RCA
30–40%
Inferior wall MI, RV involvement
LCx
20–30%
Lateral wall MI, posterolateral ischemia
LM
< 5%
Acute global ischemia, cardiogenic shock
High-YieldNEET PG
In angiographic studies, LAD stenosis is the single most common finding. RCA involvement is nearly as frequent, but LAD alone is more prevalent.
Clinical Pearl
LAD occlusion carries the worst prognosis among single-vessel disease because it supplies the largest territory of left ventricular myocardium (anterior wall, anterior septum, and apex). LAD-territory infarcts have the highest in-hospital mortality.
Mnemonic
LAD = Largest Area Delivered — the LAD supplies the largest myocardial territory and hence experiences the most atherosclerotic burden.
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