Arteriosclerosis and Hypertension Flashcards
True or False: Vascular Disease is responsible for more morbidity and mortality than any other category of disease.
True
What are the two principal mechanisms of vascular disease?
- Narrowing or obstruction of lumina
2. Weakening of vascular walls
True or False: Weakening of vascular walls can lead to dilation and or rupture.
True
True or False: The low pressure side of circulation is arterial.
False
True or False: Vascular disease effects both the low pressure and high pressure sides.
True
On which side of circulation is the blood pressure controlled?
Arterial
*which is why vascular disease effects the high pressure (artery) side more often
______ is “hardening of the arteries”
arteriosclerosis
Medial calcific sclerosis is a ________ in the ______.
calcification in the muscle walls with no encroachment on the lumen
What is Monckeberg’s?
medial calcific sclerosis that is usually asymptomatic because there is no encroachment on the lumen
______ is “hardening of the arterioles”
arteriOLOsclerosis
With which two conditions is arteriolosclerosis often associated?
- hypertension
2. diabetes mellitus
What are the two types of arteriolosclerosis?
- Hyaline
2. Hyperplastic
______ arteriolosclerosis is associated with hypertension and diabetes.
Hyaline
Hyperplastic arteriolosclerosis is associated with _____ ______
malignant hypertension
Which form of arteriolosclerosis is associated with fibrocellular proliferation (more cells)?
Hyperplastic
Hyaline arteriolosclerosis is narrowing/hardening of arterioles by _______.
collagen
Hyperplastic arteriolosclerosis is narrowing/hardening of arterioles by _________.
smooth muscle and collagen
Which condition affects “larger arteries?”
atherosclerosis
_______ are the intimal lesions associated with atherosclerosis.
atheromas (atherosclerotic plaques)
True or False: Atheromas are protrusive.
True, they protrude into the lumen of the vessel
Atheromas create a ______ flow of blood and activate ________.
non-laminar
endothelial cells
What are the possible complications that may arise from atherosclerosis?
- enlargement and obstruction of blood flow
- weakening of underlying media of the artery
- rupturing of plaques that results in catastrophic vessel thrombosis
What is the basic structure of an atheromatous plaque (3 layers)?
- Media
- Necrotic Center
- Fibrous Cap (most superficial)
True or False: There is a high prevalence of atherosclerosis in Africa and the far East.
False, Low prevalence there…HIGH prevalance in the USA and western Europe
When did the death rate for MI peak at 54%?
1960s
What is the current death rate for all atherosclerosis-related complications?
50%
25% from MI
What are the three “non-modifiable” (constitutional) risk factors for atherosclerosis?
Genetics (most importantly)
Age increase
Male Gender
What are the major modifiable risk factors of atherosclerosis?
Hypercholesterolemia
Diabetes Mellitus
Hypertension
Cigarette Smoking
When do women have an increased risk for atherosclerosis?
after menopause
________ protein levels (sometimes associated with perio disease) lead to inflammation and are considered a risk factor for atherosclerosis.
C-reactive protein (CRP)
Hyper_________emia is a risk factor for atherosclerosis.
homocysteine
True or False: Obesity, Lipoprotein A levels, Type A personality, and lack of exercise are all risk factors for atherosclerosis.
True
What are the steps involved in the “Response to Injury Hypothesis” for atherosclerosis?
- Endothelial injury
- accumulation of lipoproteins
- Monocyte adhesion
- Lipid accumulation
- Smooth muscle cell recruitment
- Smooth muscle cell proliferation
- Developed plaque with collagen, fibrous cap and lipid core
What are “foam cells?”
macrophages that have ingested lipids
When monocytes adhere to the vessel wall, they will migrate into the _____ and differentiate into ______ and ______.
intima
macrophages and foam cells
The ECM in atherosclerotic plaque is made up mostly of ______.
collagen
True or False: Fatty Streaks appear in children regardless of geography, gender, race, and environment.
True
Where do fatty streaks occur?
at sites both prone to and not prone to develop atherosclerosis
What are potential changes that occur in plaques?
- calcification
- ulceration
- fissure formation
- thrombosis
- embolization
- hemorrhage
- medial weakening
What is the danger associated with central lipid accumulation in a vessel?
formation of a necrotic core weakens wall and increases potential for thrombosis
True or False: Fatty streaks occur at an early age.
True, before age 30; usually around age 11 or 12
What are “stable” plaques?
plaques that consist of a thick fibrous cap over a small fatty core. These plaques are rich in collagen that strengthens and stabilizes the plaque and makes it unlikely to rupture.
What are “vulnerable” plaques?
plaques that possess a thin fibrous cap over a large fatty core. They develop as large amounts of LDL cholesterol accumulate in the plaque. The fatty core expands and the thin fibrous cap begins to erode. At the same time, inflammatory cells (macrophages) within the plaque release enzymes that break down collagen in the cap. The result is a weak fibrous cap that is highly susceptible to rupture
What are complications associated with atherosclerosis?
- ischemic heart disease (MI)
- cerebral infarct (stroke)
- gangrene (blockage of flow to the extremities)
- renal artery stenosis
- aortic aneurysm
According to Dr. Kalmar, what is normal BP? Mild? Moderate to Severe?
Normal: less than 140/90 mmHg
Mild: between 140/90 and 159/104
Mod to Severe: greater than 160/106
How much of the US population is affected by hypertension?
25%
True or False: Hypertension may have no symptoms.
True-ish, sometimes no symptoms when at low and moderate hypertension
True or False: Headache, fatigue, dizziness, and palpitations are symptoms of hypertension.
True
Most patients (90-95%) with hypertension have what form?
essential hypertension
What are the contributing factors to Essential Hypertension?
genetics stress obesity high salt intake inactivity smoking
True or False: Many diseases (such as kidney disease) will cause secondary hypertension.
True
There is a(n) _______ peripheral vascular resistance associated with Essential Hypertension.
increased
How does Essential Hypertension affect sodium excretion, plasma volume, and cardiac output?
REDUCED sodium excretion
INCREASED plasma volume
INCREASED cardiac output
Blood pressure = ________ x ________
cardiac output (blood volume, HR, contractility) Peripheral Resistance
True or False: Hypertension can cause retinal injury.
True (pressures!)
True or False: Hypertension can cause nephrosclerosis.
True
What is concentric hypertrophy?
thickening of the left ventricular wall at the expense of the left ventricular chamber with little or no increase in the outside cardiac dimensions
Concentric Left Ventricular Hypertrophy (LVH) is considered ______ hypertension.
compensated (provides normal cardiac output!)
What is decompensated hypertension?
LVH + ventricular DILATION
- hypertrophy is no longer adequate to provide normal cardiac output due to decreased myocardial contractility= results in LV dilation with gradual onset of congestive heart failure
True or False: Left ventricular concentric hypertrophy provides normal cardiac output.
True
What kind of Hypertension is relatively rapid-onset and is often superimposed on previous hypertension?
Accelerated (Malignant) Hypertension
What kind of systolic and diastolic pressures are associated with Accelerated Malignant Hypertension?
VERY HIGH!
systolic >220
diastolic >140
True or False: Cerebral edema, renal failure, papilledema, encephalopathy, and cerebral hemorrhage are possible complications of accelerated hypertension.
True
