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PHYSL 404 - Cardiovascular Physiology > 19 Vascular Pathophysiology > Flashcards

19 Vascular Pathophysiology Flashcards

1
Q

6 types of vascular diseases

A
  1. Hypertension
  2. Atherosclerosis
  3. Aortic Aneurysm
  4. Peripheral Arterial Disease
  5. Coronary Artery disease
  6. Stroke
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2
Q

What is Atherosclerosis?

A

Arteriosclerotic Vascular Disease, ASVD

  • Thickening of the arterial wall as a result of build-up of fatty material (eg cholesterol)
  • Chronic inflammatory response in the arterial wall
  • Can affect arteries ANYWHERE in the body
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3
Q

Clinical description of atherosclerosis:

  • Develops _______ in most ______
  • Asymptomatic until
  • Not always accompanied with _____
A

Clinical description of atherosclerosis:

  • Develops gradually in most major arteries
  • Asymptomatic until it causes an artery to become significantly narrowed or clogged, causing ischemia of the down stream tissue
  • Not always accompanied with obesity
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4
Q

2 risks of atherosclerosis

A
  • Can narrow down the arterial lumen and restrict the blood flow
  • Can burst/rupture causing a blood clot (vulnerable plaque)
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5
Q

4 complications of atherosclerosis

A
  • Myocardium/heart - heart attach (chest pain)
  • Brain - Stroke (numbness of one or more limbs, slurred speech, drooping facial muscle)
  • Arms or legs - peripheral artery occlusive disease (PAOD), pain when using arms or legs/walking
  • Aortic aneurysm
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6
Q

How might atherosclerosis cause heart attack

A

Enlarged atherosclerotic plaques in the coronary artery(ies) can cause heart attack by interrupting blood supply to the myocardium

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7
Q

Plaque rupture can cause _____, ______ and/or ______

A

Plaque rupture can cause thrombosis, blood clot formation and/or embolism

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8
Q

Label the arterial wall and the vulnerable atherosclerotic plaque

A

A. Tear in artery wall

B. Macrophage cell

C. Cholesterol deposits

D. Red blood cell

E. Macrophage foam cell

F. Fat Deposits

The Vulnerable Atherosclerotic plaque:

G. Large lipid core

H. thin fibrous cap

I. Rich in macrophages

J. Increased MMPs

K. Poor in smooth muscle cells

L. low-grade stenosis

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9
Q

8 stages of development of an atherosclerotic plaque:

A
  1. Damage to the endothelial layer (due to high BP, high cholesterol, nicotine, diabetes)
  2. Entry and accumulation of lipoproteins (LDL, low density lipoprotein) in the sub-intimal (sub-endothelium) region
  3. LDL is oxidized, attracts monocyte adhesion to endothelial cells, and crossing the endothelial layer
  4. Release of growth factors and cytokines attracts more monocytes
  5. Macrophages take up fat (ox-LDL) and become foam cells
  6. / 7. Smooth muscle cells proliferate and deposit matrix proteins (collagen, proteoglycans)
  7. Accumulation of foam cells, SMCs and matrix proteins leads to plaque growth
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10
Q

Describe the image of stages of development of an atherosclerotic plaque (recall: 8 stages)

1) Damage to the ________ (due to ________).
2) Entry and accumulation of ______ (_______) in the ________ (_______) region.
3) LDL is _____, attracts _______ to endothelial cells, and crossing the endothelial layer.
4) Release of ______ and _______ attracts more ______.
5) Macrophages take up fat (_____) and become _____

6, 7) Smooth muscle cells proliferate, and deposit _______ (_______).

8) Accumulation of _______, ______, and ______ leads to plaque growth.

A

1) Damage to the endothelial layer (due to high BP, high cholesterol, nicotine, diabetes).
2) Entry and accumulation of lipoproteins (LDL, low density lipoprotein) in the sub-intimal (sub-endothelium) region.
3) LDL is oxidized, attracts monocyte adhesion to endothelial cells, and crossing the endothelial layer.
4) Release of growth factors and cytokines attracts more monocytes.
5) Macrophages take up fat (ox-LDL) and become foam cells.

6, 7) Smooth muscle cells proliferate, and deposit matrix proteins (collagen, proteoglycans).

8) Accumulation of foam cells, SMCs and matrix proteins leads to plaque growth.

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11
Q

4 Non-modifiable factors that contribute to atherosclerosis formation:

A
  • old age
  • Male gender
  • Family hx of atherosclerosis (eg coronary artery disease or stroke)
  • Genetic abnormalities (familial hypercholesterolemia)
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12
Q

10 Modifiable factors that contribute to atherosclerosis formation:

A
  • Diabetes (or impaired glucose tolerance)
  • Dyslipoproteinemia (eg high serum concentration of LDL; low serum levels of HDL ; LDL/HDL ration >3:1)
  • Elevated serum insulin levels (hyperinsulinemia)
  • Tobacco smoking
  • High BP
  • Obesity (although not a necessity for atherosclerosis development)
  • Sedentary life style
  • Post-menopausal estrogen deficiency
  • High Carb intake
  • Stress or symptoms of clinical depression
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13
Q

How is atherosclerosis treated?

Medications?

Surgical Procedures?

A

Best tx is PREVENTION (life-style, habits, etc)

  • Medications
    • Cholesterol (LDL)-lowering drugs can stop or reverse the build up of fatty deposits in arterial walls (eg statins, fibrates)
    • Medications to control risk factors (eg hypertension, diabetes, or anti-coagulants, anti-platelet drugs)
  • Surgical Procedures:
    • Angioplasty
    • Bypass surgery
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14
Q

Medications to treat atherosclerosis

A

Best tx is PREVENTION (life-style, habits, etc)

  • Medications
    • Cholesterol (LDL)-lowering drugs can stop or reverse the build up of fatty deposits in arterial walls (eg statins, fibrates)
    • Medications to control risk factors (eg hypertension, diabetes, or anti-coagulants, anti-platelet drugs)
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15
Q

Surgical procedures to treat atherosclerosis:

A
  • Surgical Procedures:
    • Angioplasty
    • Bypass surgery
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16
Q

What is angioplasty?

A

A long, thin catheter is inserted into the blocked or narrowed part of the artery, balloon or stent (mesh tube) therapy, to open the arterial lumen

17
Q

What is bypass surgery?

A

CABG - Coronary Artery Bypass Graft

Often performed in the heart

A vessel from another part of your body (usually the leg) is used to create a bypass around the clogged (coronary) artery

18
Q

What happens if multiple blockages exist in the heart?

A

Multiple CABG will be performed (coronary artery bypass graft)

19
Q

3 functions of the aorta:

A
  • Conduit function
    • carries blood from the heart to the branch vessels without loss of energy (through turbulence or resistance)
  • Cushion/Capacitor Function
    • Receives the blood ejected by the heart - at a physiological pressure
    • Healthy aorta can distend about 4% with systole
    • Stores the potential energy resulting from its stretching during systolic distension
  • Pump function
    • Releases the potential energy stored within the wall (by systolic distension) through recoil of the elastic layers
20
Q

Label the anatomic segments of the aorta:

A

A - Arch

B - Ascending

C - Sinotubular Junction

D - Root (sinuses)

E - Descending Thoracic

F - Abdominal

21
Q

What is an aneurysm?

A

A localized, pathological, blood-filled dilation of a blood vessel caused by a disease or weakening of the vessels wall

22
Q

Label the types of aortic aneurysm based on location:

A

Recall: Aneurysm: A localized, pathological, blood-filled dilatation of a blood vessel caused by a disease or weakening of the vessel’s wall.

23
Q

What is required for the aorta to be considered aneurysmal?

A

A focal enlargement of the aortic diameter by more than 50% is considered aneurysmal

24
Q

Aortic aneurysm is associated with __________

A

Aortic aneurysm is associated with structural degradation (elastin/collagen in the lamellar structure)

25
Q

What is aortic dissection (acute aortic syndrome)?

A

Bleed into the aortic wall (intramural hemorrhage)

Aortic rupture (death or lower body paralysis if AAA)

26
Q

Aneurysm growth and risk of rupture:

What two properties of the aorta are associated with a higher risk of rupture?

A
  • Larger aortic diameter and/or a greater rate of dilation are associated with a higher risk of rupture
27
Q

Aneurysm growth of ______ is considered high risk for aortic

A

Aneurysm growth of 0.5cm in six months is considered high risk for aortic

28
Q

Rate of growth:

  • Ruptured AAA
    • Mean rate of expansion ______
  • Non-ruptured AAA
    • Mean rate of expansion ______
A

Rate of growth:

  • Ruptured AAA
    • Mean rate of expansion 0.82cm/year
  • Non-ruptured AAA
    • Mean rate of expansion 0.42cm/year
29
Q

What is open surgical repair and who is eligible?

A
  • patients with a high risk of aortic rupture are approved to undergo surgical repair
  • Open surgical repair:
    • Aneurysmal aorta is opened
    • Graft is sutured in, connecting one end of the aorta at the site of aneurysm to to the other end of the aorta
    • Aorta is wrapped and closed around the graft
30
Q

What is Endovascular Repair (EVAR)

A
  • somewhat similar to stent angioplasty
31
Q

The top image is _________

The bottom is:

A

The top image is endovascular repair (EVAR) of an abdominal aortic aneurysm

The bottom image is endovascular repair (EVAR) of a Thoracic aortic aneurysm

32
Q

Two risk factors for thoracic aortic aneurysm (TAA):

A
  • Genetic conditions (eg marfan syndrome, BAV, Loeys-Dietz syndrome)
  • Inflammation of the aorta
33
Q

Three risk factors for Abdominal aortic aneurysm (AAA)

A
  • Age/sex (males >60)
  • Smoking
  • Atherosclerosis
34
Q

Is there a relationship between atherosclerosis and aortic aneurysm?

A

Studies have shown a very weak, or lack of causal relationship betweena therosclerosis and aortic aneurysm

  • Atherosclerosis risk factors and aortic atherosclerotic plawues are weakly associated with distal aortic dilation
    • suggesting that atherosclerosis plays a minor role in aortic dilation in the population
35
Q

The lack of consistent dose-response between atherosclerosis and abdominal aortic diameter suggests that:

A

The lack of consistent dose-response between atherosclerosis and abdominal aortic diameter suggests that:

Atheroscerosis may not be a causal event in AAA but develops in parallel with or secondary to aneurismal dilation

36
Q

Fill in the chart about the different theories on the causes of abdominal aortic aneurysm

A
37
Q

Composition of the _____ is one of the factors in determining the site of aortic aneurysm formation

A

Composition of the ECM is one of the factors in determining the site of aortic aneurysm formation

Lamellar unit: both the structural and functional unit of the aorta, observed in the aorta of all mammal

38
Q

Composition of the ECM is one of the factors in determining the ___________

A

Composition of the ECM is one of the factors in determining the site of aortic aneurysm formation

Lamellar unit: both the structural and functional unit of the aorta, observed in the aorta of all mammal

PHYSL 404 - Cardiovascular Physiology (17 decks)

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