19 Vascular Pathophysiology Flashcards
6 types of vascular diseases
- Hypertension
- Atherosclerosis
- Aortic Aneurysm
- Peripheral Arterial Disease
- Coronary Artery disease
- Stroke
What is Atherosclerosis?
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
Clinical description of atherosclerosis:
- Develops _______ in most ______
- Asymptomatic until
- Not always accompanied with _____
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
2 risks of atherosclerosis
- Can narrow down the arterial lumen and restrict the blood flow
- Can burst/rupture causing a blood clot (vulnerable plaque)
4 complications of atherosclerosis
- 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
How might atherosclerosis cause heart attack
Enlarged atherosclerotic plaques in the coronary artery(ies) can cause heart attack by interrupting blood supply to the myocardium
Plaque rupture can cause _____, ______ and/or ______
Plaque rupture can cause thrombosis, blood clot formation and/or embolism
Label the arterial wall and the vulnerable atherosclerotic plaque
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
8 stages of development of an atherosclerotic plaque:
- Damage to the endothelial layer (due to high BP, high cholesterol, nicotine, diabetes)
- Entry and accumulation of lipoproteins (LDL, low density lipoprotein) in the sub-intimal (sub-endothelium) region
- LDL is oxidized, attracts monocyte adhesion to endothelial cells, and crossing the endothelial layer
- Release of growth factors and cytokines attracts more monocytes
- Macrophages take up fat (ox-LDL) and become foam cells
- / 7. Smooth muscle cells proliferate and deposit matrix proteins (collagen, proteoglycans)
- Accumulation of foam cells, SMCs and matrix proteins leads to plaque growth
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.
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.
4 Non-modifiable factors that contribute to atherosclerosis formation:
- old age
- Male gender
- Family hx of atherosclerosis (eg coronary artery disease or stroke)
- Genetic abnormalities (familial hypercholesterolemia)
10 Modifiable factors that contribute to atherosclerosis formation:
- 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
How is atherosclerosis treated?
Medications?
Surgical Procedures?
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
Medications to treat atherosclerosis
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 to treat atherosclerosis:
- Surgical Procedures:
- Angioplasty
- Bypass surgery
What is angioplasty?
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
What is bypass surgery?
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
What happens if multiple blockages exist in the heart?
Multiple CABG will be performed (coronary artery bypass graft)
3 functions of the aorta:
- 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
Label the anatomic segments of the aorta:
A - Arch
B - Ascending
C - Sinotubular Junction
D - Root (sinuses)
E - Descending Thoracic
F - Abdominal
What is an aneurysm?
A localized, pathological, blood-filled dilation of a blood vessel caused by a disease or weakening of the vessels wall
Label the types of aortic aneurysm based on location:
Recall: Aneurysm: A localized, pathological, blood-filled dilatation of a blood vessel caused by a disease or weakening of the vessel’s wall.
What is required for the aorta to be considered aneurysmal?
A focal enlargement of the aortic diameter by more than 50% is considered aneurysmal
Aortic aneurysm is associated with __________
Aortic aneurysm is associated with structural degradation (elastin/collagen in the lamellar structure)
