APP Module (GTown) - Cardiovascular Pathophysiology II (Hrs 3 and 4) Flashcards
What is the defining feature of disseminated intravascular coagulation?
its consumptive coagulopathy
Give a general outline of the steps in the progression of endothelial injury
1) endothelium ceases making normal antithrombic/vasodilatory substances
2) immune inflammatory response
3) oxidation and phagocytosis
4) fatty streak accumulates and smooth muscle proliferates
What are three clinical consequences of atherosclerosis?
1) aneurysm and rupture
2) occlusion by thrombosis
3) critical stenosis
What is the relationship of genetic factors, acquired factors, and age?
Genetic factors play a large role at an early age, but this transitions to acquired factors playing more of a role as time goes on
What are the four steps in thrombosis?
1) propagation thru platelet accumulation/fibrin
2) embolization
3) dissolution
4) organization and recanalization
Where do arterial thrombi usually begin?
at a site of turbulence or endothelial injury
In what direction do arterial thrombi grow?
retrograde, against the flow
What is a mural thrombus?
a thrombus that accumulates on the wall of the heart
What is a cause of a mural thrombus?
myocardial infarction which causes injury to the wall of the heart and thus stagnation of blood
What is a clinical consequence of rheumatic heart disease?
mitral valve stenosis
Mitral valve stenosis leads to left atrial enlargement which leads to the risk of what?
LAE predisposes to AFib which increases the risk of a thromboembolic event, especially a stroke
What are venous thrombi caused by?
usually stasis of blood flow and hypercoagulability
Which direction do venous thrombi grow?
anterograde, in the direction of flow
Why might venous stasis cause endothelial injury?
stasis of blood leads to accumulation of toxins and waste byproducts leading to a damaged endothelium
What are the two types of venous thrombi?
1) local or superficial venous thrombi
2) deep vein thrombi
What is an embolism?
a detached intravascular mass, whether solid, liquid, or gas, e.g. fibrin clot, fat, or air
What is a primary cause of the thrombus in a pulmonary embolism?
deep veins of the leg
What percentage of the pulmonary circulation must be occluded to cause sudden death?
> 60%
What is the worst type of PE?
saddle embolus
Where is a saddle embolus located?
Bifurcation of the pulmonary trunk
What are some examples of systemic thromboemboli?
intracardiac or mural thrombi, ulcerated atherosclerotic plaques
What is the first step in atherosclerosis?
intimal thickening
What is atherosclerosis defined as?
a hyperinflammatory state
What are the factors in plaque formation?
1) endothelial dysfunction
2) monocyte adhesion and emigration
3) smooth muscle cell migration to intima
4) smooth muscle cell proliferation
5) ECM elaboration
6) lipid accumulation
What is an atheroma?
an accumulation of degenerative material, usually foam cells, LDL, lipids, and fibrous tissue in the inner layer of an artery wall.
What is the difference between a vulnerable plaque and a stable plaque?
A stable plaque has a stable fibrous cap and more overlying fibrotic tissue whereas a vulnerable plaque will have a larger necrotic center and less extensive fibrous cap vulnerable to rupture
What are the two factors that are imbalanced in the initiation of myocardial ischemia?
1) coronary artery blood supply
2) myocardial oxygen demand
What are some factors that affect coronary artery blood supply?
1) presence of coronary plaques
2) perfusion pressure
3) arterial blood oxygen content
What are some factors that affect myocardial oxygen demand?
1) preload
2) heart rate
3) afterload
4) contractility
What are the two factors in the regulation of blood pressure?
1) cardiac output
2) peripheral vascular resistance
What two factors affect cardiac output?
cardiac factors
blood volume
What are the three factors which mediate peripheral resistance?
1) local factors
2) humoral factors
3) neural factors
What are the two major influences of hypertension?
1) genetic factors
2) environmental factors
What three genetic and environmental influences lead to an individual with hypertension?
1) defects in renal sodium homeostasis
2) functional vasoconstriction
3) defects in vascular smooth muscle growth and structure
What is an aneurysm?
abnormal dilation of a blood vessel
What is a true aneurysm and what are the two types?
A true aneurysm is actual dilation of the entire vessel wall. The two types of true aneurysm are the 1) saccular aneurysm, and the 2) fusiform aneurysm.
What is a false aneurysm?
A false aneurysm is a tear in the inner layer of a blood vessel causing an extravasation into the outer layers and thus dilation into the adventitia
What is a dissection?
A tearing of the vessel wall so that blood enters the space between the intima and media
What are the most common cause of abdominal aortic aneurysms?
atherosclerosis