Arteriosclerosis and Hypertension #8 (2/1/16) Flashcards
____ is responsible for more morbidity and mortality than any other disease.
Vascular disease
What are the 2 principle mechanisms of vascular disease?
- Narrowing or obstruction of vascular lumina
2. Weakening of vascular walls, leading to dilation and or rupture.
Describe medial calcific sclerosis….
Calcification in the muscular walls (No encroachment on the lumen, therefore usually clinically insignificant)
Describe arteriolosclerosis……
Affects arterioles and associated with diabetes and hypertension.
*Two types: Hyaline and Hyper plastic
_______ affects larger arteries.
Atherosclerosis
Atherosclerosis is associated with lesions called _____.
Atheromas, which protrude into the lumen and create a speed bump that will activate epithelial cells and cause a prothrombotic situation.
- Atheromas can grow to obstruct blood
- May weaken the underlying media of the artery
- plaques can rupture, resulting in catastrophic vessel thrombosis.
What are the major non-modifiable risk factors for atherosclerosis?
- Genetics (most important)
- Increasing age
- Male gender
What are the major Modifiable risk factors for atherosclerosis?
- Hyperchloesterolemia - high LDL, low HDL
- Diabetes Mellitus
- Hypertension
- Cigarette smoking
What are some additional risk factors for Atherosclerosis?
- Inflammation
- Lipoprotein (A) levels
- Metabolic syndrome (obesity)
- Type A personality (stress)
- Lack of Exercise
Atherosclerosis can occur in response to injury, how does this happen supposedly?
- Endothelial injury results in endotheilal dysfunction.
- Accumulation of lipoproteins - LDL and Cholesterol in the vessel wall.
- Monocyte adhesion - migration into intimate with differentiation into macrophages and “foam cells”
- Lipid accumulation in macrophages with release of inflammatory cytokines.
- Smooth muscle cell recruitment due to factors released form activated platelets.
- Smooth muscle proliferation and ECM collagen production.
- Fully developed plaque with collagen (fibers cap) and central lipid core.
What are fatty streaks?
Appear in children independent of geography, gender, race and environment.
Occur at sites both prone and not prone to develop atherosclerosis, but some may progress to atheromas.
What are some potential changes that can occur in atherosclerotic plaques?
- calcification
- Ulceration
- Fissure formation
- Thrombosis
- Embolization
- Hemorrhage into the plaque
- Medial weakening
What are some clinical complications of atherosclerosis?
- Ischemic heart disease (MI)
- Cerebral Infarct (stroke)
- Gangrene
- Renal Artery stenosis
- Aortic aneurysm
What is normal BP?
Less than 140/90
What is mild hypertension?
140/90 - 159/104
