8.1 Cardiovascular Part 1 Flashcards
1
Q
Atherosclerosis
A
- The major cause of cardiovascular disease
2
Q
Lipids
A
- Organic fat, oils, hormones, and elements of certain membranes
- Does not interact significantly with water
- High levels of lipids is strongly related to atherosclerosis
3
Q
Triglycerides
A
- Fat in adipose tissue
- Serves as energy storage and provides thermal regulation
- Used as energy during metabolism
4
Q
Phospholipids
A
- They make up biological membranes
- They are part of lipoproteins, blood clotting components, myelin sheath, and cell membranes.
5
Q
Cholesterol
A
- Synthesized in body and taken in via diet
- The steroid nucleus of cholesterol is made up of fatty acids
- Hypercholesteremia correlates with atherosclerosis and increases risk of MI and CVA (strokes)
6
Q
Lipoproteins
A
- Fat carrying proteins that carry plasma transport and encapsulate cholesterol and triglycerides
- Categorized by density
7
Q
TYPES OF LIPOPROTEINS
A
8
Q
Chylomicrons (Least dense)
A
- Made in the small intestines wall
- Transport dietary triglycerides and cholesterol that have been absorbed in the GI tract to muscle and fat cells.
9
Q
Very Low-Density Lipoproteins (VLDL)
A
- Synthesized in liver
- Primary pathway of transport for endogenous triglycerides to muscle and fat cells produced in the liver.
10
Q
Intermediate Density Lipoproteins (IDL)
A
- Formed when triglycerides are removed from VLDL
- In the liver they are converted back to VLDL
- In the vascular compartment they are converted to LDL
11
Q
Low Density Lipoproteins (LDL)
A
- “Bad cholesterol”
- It is the main carrier of cholesterol
- The main target when patients are treated for cholesterol
12
Q
High-Density Lipoproteins (HDL)
A
- Made in the liver
- Transports cholesterol from the tissue back to the liver
- “Good cholesterol”
13
Q
Hyperlipidemia/Hypercholesterolemia/Hyperlipoproteinemia
A
- Increased lipids in the blood
- Caused by increase in lipoprotein
- Causes include nutrition, genetics, metabolic disease
14
Q
Primary Hyperlipidemia
A
- Genetic/Familial
- Extremely high LDL levels
- Xanthomas - Skin lesions containing cholesterol and fat
- Significant risk of MI before age 40
15
Q
Secondary Hyperlipedemia
A
- Associated with underlying health problems such as obesity, DM, hypothyroidism.
16
Q
LDL Lab Values
A
Ideal - <100 Good - 100-120 Borderline - 130-159 High - 160-189 Very High - 190+
17
Q
HDL Lab values
A
Low risk - >60 Men (average risk) - 40-50 Women (average risk) - 50-59 Men (increased risk) - <40 Women (increased risk) - <50
18
Q
Triglyceride Values
A
Best - <150
Borderline - 150-199
High - 200-499
Very High - >500
19
Q
Statistics
A
- Total cholesterol greater than 240 doubles risk of HD
- Low HDL is a risk for HD
- LDL goal is less than 160 if there is no history of DM or CHD (Coronary Heart Disease)
- With 2 or more risk factors LDL goal is 130
- With CHD or DM - Goal is less than 100
- High triglycerides can speed up atherosclerosis which increases risk of MI and CVA
20
Q
Atherosclerosis
A
- Presence of intra-arterial fibrofatty lesions in a vessel wall that hardens over time
- Leading cause of coronary artery disease and cardiovascular disease
- 1% increase in cholesterol leads to 3% increase risk for atherosclerosis
- Clinical manifestations can take 20-40 years to appear
21
Q
Modifiable Risk Factors (CAD and Atherosclerosis)
A
- Nicotine and Diet
- Hypercholesterolemia
- Hypertension
- Diabetes
- Obesity
- Stress
- Sedentary lifestyle
- C-Reactive Protein (marker of inflammation for atherosclerosis lesions)
- Hyperhomocysteinemia - Protein breaks down into homocysteine. Causes enhanced blood clotting and thrombus formation. Can be managed by assessing nutrition, smoking, alcohol, DM
22
Q
Nonmodifiable Risk Factors
A
- Age, Male, Family history of CAD
- Postmenopausal women
- Family pre-disposition
- Genetic disorders of lipid metabolism
23
Q
Pathophysiology
A
- Inflammation plays a major role in everything to do with atherogenesis
STEPS OF LESION DEVELOPMENT - Injury to endothelial cells
- Migration of inflammatory cells
- Accumulation of smooth muscle cell proliferation
- Development of plaque with lipid core
24
Q
Atherosclerosis Patho
A
- Lipid plaque form in arteries (arteriosclerosis)
- Lipid plaque causes arteries to narrow and harden
- Affects the coronary arteries that supply oxygen and nutrients to the heart. Blockage can cause MI
STEPS - Endothelial calls of arteries get damaged (HTN, Smoking, Hyperglycemia, Hypercholesterolemia)
- Damage increases permeability of walls allowing LDL to enter
- Monocytes also get stuck due to adhesion molecules released by damaged endothelial cells
- Monocyte (WBC) produces free radicals which oxidize with the LDL that is stuck inside the artery. Once WBC consume these oxidized LDL, more WBC comes and LDLs come in a continued cycle.
- Accumulation of cells and lipids form a plaque. The endothelial cells cover the plaque which can block the artery (atherosclerosis)
25
Q
Damaged Endothelium
A
- Injured endothelial cells become inflamed which causes macrophages to bind and release oxygen radicals that further injure the vessel wall
26
Q
Foam Cells
A
- Macrophages that have absorbed LDL’s that have penetrated the lining of the vessel.
27
Q
Fatty Streak
A
- This is when foam cells produce more vessel damage
28
Q
Fibrous plaque (basic lesion)
A
- Smooth muscle proliferate and rebuild over the fatty streak covering it in collagen.
- This causes necrosis in underlying tissue and narrowing of vessel lumen.
- ## This is what causes atherosclerosis
29
Q
Complicated Lesion
A
- Fibrous plaque that ulcerates causing platelets to adhere and initiate the coagulation cascade. This can cause total occlusion, ischemia, and infarction
30
Q
Clinical Manifestations Artherosclerosis
A
- Does not cause symptoms until 60%+ occlusion occurs
- Effects of narrowing of vessels produces ischemia, vessel obstruction, thrombus formation, emboli, aneurysms over weakened artery walls.
31
Q
Major Organs Affected by Decreased Perfusion
A
- Heart Vessels (myocardial ischemia and MI)
- Brain Vessels (CVA/Stroke and TIA)
- Kidney Vessels (Ischemia/Nephritis/Renal Failure)
- Lower Extremities (Peripheral Arterial Disease - PAD)
- Small Intestines (Ischemia and Infarction)
32
Q
Coronary Atherosclerosis and Coronary Artery Disease (CAD)
A
- Narrowing of coronary arteries reduces blood flow to myocardium
- ## Leading cause of death in US (CVD)
