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KIN 429 > 2.2a Pathophysiology > Flashcards

2.2a Pathophysiology Flashcards

1
Q

What is endothelial dysfunction?

A
  • like the wearing out of Teflon on a fry pan
  • condition where the endothelial layer (inner layer) of small arteries fails to perform all its important functions
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2
Q

What is the importance of the endothelium?

A

maintains proper dilation and constriction of blood vessels

protects tissues from toxic substances

regulates blood clotting mechanism

controls the fluid, electrolytes, and other substances that pass back and forth between blood and the tissues

regulates inflammation in the tissues

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3
Q

Is the initiation, progression, and subsequent regression and stabilization of atherosclerosis a random process?

A

No, it is a chaotic process

non-linear process, where the variables within the system interact in an exponential or multiplicative fashion rather than in a simple additive manner

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4
Q

What is the importance of nitric oxide?

A

plays a vital role in the maintenance of cardiovascular and endothelial homeostasis

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5
Q

What is oxidative stress?

A

the development of an imbalance between endogenous cellular ROS (during normal cellular functions) and the levels of antioxidants intended to mitigate their potentially destructive effects

ROS = reactive oxygen species

other CVD risk factors can accelerate the production of ROS within arterial walls

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5
Q

What is C-reactive protein?

A

it is being looked into as a non-direct indication that someone is likely to get heart disease

elevated levels of CRP are associated with endothelial dysfunction in patients with coronary artery disease; may predict adverse CVD events and CRP can induce the expression of vascular adhesion molecules that attract leukocytes and accelerate the atherosclerotic process

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6
Q

What is cardiovascular disease?

A
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7
Q

What is atherosclerosis?

A

the buildup of fats, cholesterol, and other substances in and on the artery walls

this buildup = plaque

plaque causes arteries to narrow, blocking blood flow

plaque can also burst and lead to a clot

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8
Q

What are the divisions of CVD?

A

macrovascular disease
microvascular disease

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9
Q

What are the 3 types of macrovascular disease?

A

Coronary artery disease
Peripheral vascular disease
Cerebral vascular disease

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10
Q

What are the 3 types of microvascular disease?

A

Retinopathy - damage to blood vessels of the eyes
Neuropathy - damage to nerves
Nephropathy - damage to kidneys

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11
Q

Why do we say “hardening of the arteries”?

A

the hardness of atherosclerotic arteries comes from the deposition of calcium within the vascular intima and media due to chronic inflammation

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12
Q

What likely drives chronic vascular inflammation?

A

oxidative stress

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13
Q

What causes oxidative stress?

A
  • usually driven by the traditional CVD risk factors
  • facilitates and propagates endothelial dysfunction
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14
Q

At what % of blockage will we typically intervene with stent or other technique?

A

70% or more blockage

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15
Q

What is a myocardial infarct?

A

A heart attack
occurs when a blood clot is lodged in the coronary artery

most are due to rupture of a plaque, leading to platelet activation and formation of a thrombus that blocks the artery

16
Q

What are the symptoms of a myocardial infarction?

A

most common = chest pain or discomfort, which may travel into the shoulder, arm, back, neck, or jaw

17
Q

What is ischemia?

A

Lack of oxygenated blood flow

18
Q

What are the 3 types of angina? Explain.

A

Stable angina: more or less a fixed blockage/plaque; symptoms will be fairly consistent
- NO symptoms at rest

Unstable angina: plaque is not as stable; changing symptoms according to exertion, sometimes symptoms at rest

Variant angina: no overt plaque; vasospasm (smooth muscle is spasming and that is what is causing the angina)

19
Q

What is hibernating myocardium?

A

Ischemia of longer duration that may lead to hibernation of myocardium - may last days to weeks.

20
Q

Macrovascular disease involves what vessels?

A

Large blood vessels, including coronary arteries, aorta, large arteries of the brain and the limbs

21
Q

Microvascular disease involves what vessels?

A

Small blood vessels, including the carotid arteries, renal arteries, and the small vessels in limbs

22
Q

What are the 3 acute coronary syndromes?

A

Unstable angina

NSTEMI
STEMI
(these two are myocardial infarction)

23
Q

What is NSTEMI?

What is seen in ECG?

A

non-ST elevation myocardial infarction
- an occluding thrombus that opens or has good collaterals

ST depression and/or T-wave inversion

24
Q

What is STEMI?

What is seen in ECG?

A

ST-elevation myocardial infarction (typically more severe)
100% occlusion

ST elevation (and Q waves later)

25
Q

What symptoms are needed to diagnose a heart attack?

A

Any 2 of these 3:
- Change in ECG - ST elevation or depression, or flip of T-wave
- Cardiac symptoms
- Elevated blood enzymes (troponin, CPK, creatine myoglobin)

26
Q

What is stunned myocardium?

A

Ischemia of 60min or less can cause stunned myocardium lasting hours or days

27
Q

What is ischemia?

A

an inadequate blood supply to an organ or part of the body, especially the heart muscles

28
Q

What is hibernating myocardium?

A

Ischemia of longer duration, which may lead to hibernation of myocardium
may last days to weeks

29
Q

Dead heart muscle forms scar tissue in how long?

A

3 to 6 weeks

30
Q

Does scar tissue change over time?

A

Scar tissue (necrosis) changes over time, particularly in large heart attacks - changes in geometry and contractile function

31
Q

What is infarct expansion?

A

dilation of the infarct site and surrounding tissue may occur

32
Q

Why are re-occlusion rates relatively high and much more rapid than in native vessels?

A

because these interventions can cause damage to the endothelial layer and cause endothelial dysfunction

33
Q

How can atherosclerosis regress?

A

significant lowering of blood cholesterol
often minor regression, but even mild regression leads to significant improvement in stability
reduced mortality and morbidity

KIN 429 (10 decks)

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