APP Module (GTown) - Cardiovascular Pathophysiology I (Hrs 1 and 2) Flashcards
What are the three layers of the vessel wall, from innermost to outermost?
1) tunica intima
2) tunica media
3) tunica adventitia
Where does the internal elastic membrane lie?
Between the tunica intima and the tunica media.
What is in the tunica intimia?
1) endothelial layer
2) basement membrane
What is in the tunica media?
1) smooth muscle
2) elastic fibers
What is in the tunica adventitia?
areolar connective tissue
Does the structure of the vessel wall differ between different vessels?
Yes, there is a difference in components in each varying according to the size and type of vessel
What are the three characteristics of vascular smooth muscle cells?
1) contractility
2) secretion
3) plasticity
What is a key concept in most endothelial injury?
normal vascular smooth muscle cells will be mainly contractile, but will turn into secretory cells when injured
What are the ways in which vascular smooth muscle cells demonstrate plasticity?
1) hypertrophy
2) proliferation (hyperplasia)
3) change in phenotype (metaplasia)
What are the types of secretory components given off by vascular smooth muscle cells?
1) matrix formation
2) growth factors
3) proteases
How do you define vascular tone?
State of contraction due to myogenic and neurogenic factors
What are the two types of factors which control the contractile state of VSMC?
1) intrinsic factors (myogenic tone)
2) extrinsic factors (neurogenic tone)
How do you differentiate between neurogenic and myogenic tone?
Myogenic factors are determined by components that are in the vascular system. Neurogenic factors are those that are controlled and determined by hormones or extrinsic mechanisms outside the blood vessels.
What is vasomotion?
Change in the caliber of a blood vessel?
What are three characteristics of the endothelium?
1) secretory or modulatory
2) metabolic
3) plasticity
What are some molecules released by the endothelium?
endothelin, nitric oxide, and prostacyclin (PGI2)
What is the endothelium’s metabolic function?
Processing of factors which affect vasomotion
What are two metabolic processes the endothelium undergoes?
1) ACE production of Ang II
2) breakdown of bradykinin
How is the endothelium plastic?
through angiogenesis
What causes angiogenesis?
injury and ischemia
What mainly governs flow through a region of tissue?
The resistance of the microcirculation
What role does radius play in the change in pressure in a vessel?
Change in pressure is inversely proportion to the fourth power of the radius
If you double the length of a tube, everything else being equal, what is the pressure change?
Double the pressure
What does vasoconstriction cause generally in a blood vessel?
Turbulent flow
`What are the three regulators of local blood flow?
1) metabolic regulation (local metabolites)
2) autoregulation (myogenic regulation)
3) shear stress-induced vasodilation
In the microcirculation, what determines whether fluid is exudated or absorbed?
Hydrostatic pressure as it falls along the length of the vessel as oncotic pressure is largely the same.
What amount of protein is lost to the lymphatics/interstitium?
0.5%
Thinking about Starling forces, why might transudative forces prevail in the lower extremities?
In relation to the heart and while standing, there is a larger venous pressure such that is may favor filtration
In what situations can compensatory mechanisms fail to make up for the pressure difference in the lower extremities?
1) hypoalbuminemia
2) shock
3) venous thrombosis
Where does the thoracic duct drain into?
Left subclavian vein
What does increased hydrostatic pressure in the capillary bed lead to?
bulk flow of fluid into the interstitial space and edema
What is another name for interstitial fluid?
Extravascular fluid
Why might somebody have “relative hypovolemia”?
They might have a normal net amount of fluid in their body, but the distribution between the intravascular and extravascular compartments is abnormal
What are some of the mechanisms which cause edema?
1) lymph obstruction
2) increased capillary hydrostatic pressure
3) decreased capillary oncotic pressure
4) increased capillary permeability
Why is edema clinically relevant?
1) points to an underlying pathology
2) impairs wound healing
3) impairs ability to fight infection