Arteriosclerosis and Hyptertension

Question 1

What is an atheroma

Answer 1

accumulation of degenerative material in the inner layer of artery walls

Question 2

Define arteriosclerosis

Answer 2

hardening of the arteries

they become thick and stiff

Question 3

How is atherosclerosis characterized?

Answer 3

by atheroma in large or medium arteries

-it’s a specific type of arteriosclerosis

Question 4

Monckeberg’s medial calcific sclerosis

Answer 4

medial calcification WITHOUT luminal narrowing or intimal disruption –> occurs when you get calcium deposits in muscle walls

Question 5

Hyaline arteriosclerosis

examples

Answer 5

thickening of the basement membrane

ie hypertension and diabetes mellitus

Question 6

Hyperplastic/proliferative arteriosclerosis

Answer 6

fibrocellular intimal thickening

i.e. - malignant hypertension and scleroderma (chronic hardening of skin and CT)

Question 7

Non-modifiable risk factors for atherosclerosis

Answer 7

age - risk of MI increases 5X in men 40-60 yrs old

gender - men > premenopausal women

genetics - MOST IMPORTANT FACTOR

Question 8

Potentially modifiable risk factors for atherosclerosis

Answer 8

smoking - 1 pack per day increases death rate by 200%
-once one stops, gradually decreases
diabetes mellitus
hypertension - no specific level identifies increased risk
hypercholesterolemia - higher LDL and cholesterol, the greater the risk. higher the HDL, the lower the risk

Question 9

Additional risk factors for atherosclerosis

Answer 9

inflammation (C-reactive protein)
hyperhomocysteinemia - inc in levels of homocysteine
lipoprotein (a) levels
metabolic syndrome (obesity)
type A personality (stress)
lack of exercise

Question 10

Common sites of atheroma formation

Answer 10

branches of main arteries
papliteal artery - knee
coronary arteries - heart
abdominal aorta
carotid arteries - head and neck
cerebral arteries - brain

Question 11

What does plaque contain?

Answer 11

collagen
lipid
macrophage
myofibroblasts
neovascularization (proliferation of bv in tissues not normally containing them)

Question 12

What makes up a fibrous cap?

Answer 12

myofibroblasts (smooth muscle cells) and collagen.

these cover a central core of lipid/cellular debris with CHOLESTEROL

Question 13

Plaque can progress into…

Answer 13

ulcerations
fissure formation
thrombosis
embolization of thrombus or debris from central core
calcification
hemorrhage into plaque from neovascularization

Question 14

What is a fatty streak?

Answer 14

the first grossly visible lesion in the development of atherosclerosis
-characterized by lipid-laden cells in the intimia

Question 15

Where do fatty streaks occur?

Answer 15

in infants and children in atherosclerotic or nonatherosclerotic areas

Question 16

What can result from a fatty streak?

Answer 16

they can regress
or
they can progress to atheromas

Question 17

complications of atherosclerosis

Answer 17

ischemic heart disease - reduced BF to <3

aneurysm formation due to pressure atrophy of the media with altered balance of collagen synthesis/degradation

Question 18

hypertension prevalence in adults from USA?

Answer 18

about 25%, prevalence increases with age

Question 19

guidelines for hypertension

Answer 19

BP < 140/90 –> normal
BP > 160/106 –> moderate to severe
BP = 140/90 to 159/104 –> mild

Question 20

What does essential hypertension mean?

It accounts for what % of hypertension?

Answer 20

hypertension without a known cause

90%

Question 21

Contributing factors to essential hypertension include:

Answer 21

genetics
obesity
stress
increased salt
inactivity
cigarette smoking

Question 22

Symptoms of essential hypertension

Answer 22

most patients have no symptoms until organ damage has occurred

Question 23

High BP causes:

Answer 23

headache
dizziness
fatigue
palpitations

Question 24

Concentric left ventricular hypertrophy (compensated)

Answer 24

LV thickens to adapt to inc in stress to wall. Provides normal CO

Question 25

LV hypertrophy (decompensated) occurs when?

Answer 25

when the LV is no longer able to adequately provide normal CO

Question 26

what does LV hypertrophy (decompensated) lead to?

Answer 26

dilation and CHF

Question 27

Atherosclerosis leads to…

Answer 27

ischemic heart disease
stroke
ischemic injury to other organs (nephrosclerosis)
gangrene - dead tissue

Question 28

Arteriosclerosis leads to…

Answer 28

retinal injury (visual disturbances) 
kidney damage or nephrosclerosis (renal failure)

Question 29

How does a dissecting hemotoma of the aorta occur?

Answer 29

a longitudinal tear in the media because of a complication from hypertension

Question 30

Pathogenesis of hypertension

Answer 30

BP = CO x peripheral resistance

1. peripheral vascular resistance (vasoconstriction)
2. reduced sodium excretion –> salt and water retention –> increased plasma volume and CO

Question 31

How is secondary hypertension controlled

Answer 31

it’s controlled when the underlying disease is controlled

Question 32

Relatively rapid onset of very high BP is….

Answer 32

malignant hypertension

Question 33

Complications stemming from malignant hypertension…

Answer 33

cerebral edema with papilledema ->blindness
cerebral hemorrhage
retinal hemorrhage
severe headache
vomiting
convulsions
encephalopathy - brain disease
renal failure
heart failure

Question 34

How does one treat malignant hypertension?

Answer 34

promptly, but being cautious of not decreasing BP too quickly