Atherosclerosis and Arterial Disease Flashcards by Laura Bunce

What are the two divisions of the ANS

Sympathetic and Parasympathetic

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Which nerve is responsible for decreasing heart rate

Vagus nerve

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Which nerves are responsible for increasing heart rate

sympathetic cardiac nerves

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Where is the cardio-respiratory control centre located (brain)

medulla oblongata

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Where do the sympathetic nerve fibres originate

originate in the reticular formation of the brain stem and innervate the SA & AV nodes and myocardium.

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Where does the vagus nerve originate from?

vagal nucleus of the medulla

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Define tonic activity (of sympathetic nerve fibres)

tonic contraction in this case is a constant level of activation from both branches of the ANS

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What does blood vessel tone dictate

the ability to vasoconstrict and vasodilate blood vessels

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What neurotransmitters are present in sympathetic neurons

Norepinephrine- epinephrine and dopamine aka noradrenaline and adrenaline

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Which cells help control blood flow to all vessels via the release of vasodilators (e.g., nitric oxide) and constricting factors.

endothelial cells

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How can haemodynamic/ANS function be assessed?

An orthostatic challenge wherein the assessment of central and peripheral blood pressures can provide a valid and reliable clinical indication of cardiovascular health

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True or false: Heart disease is currently the leading cause of death in developed countries.

True

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What (simply) is heart disease caused by?

impaired coronary blood flow i.e. caused by things such as atherosclerosis

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why is a measurement of our blood pressure important?

gives a valid and reliable clinical indication of cardiovascular health can predict future cardiovascular disease

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Why is earlier detection of non-communicable disease good

-prevent the illness -can continue to work etc -improves financial economy -improves mental health

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define atheroscelrosis

Chronic inflammatory condition affecting large- and medium sized vessels (e.g., aorta, coronary arteries, and large vessels supplying the brain) Characterised by ‘hardening’ of the arteries due to the formation of fibrofatty legions in the intimal lining.

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State 3 risk factors for atherosclerosis

ØAge (Men: ≥45 y; Women: ≥55 y or premature menopause without oestrogen replacement therapy)

ØFamily history of premature CHD (MI or sudden death before 55 y in male first-degree relative, or before 65 y in female first-degree relative)

ØCurrent cigarette smoking

ØHypertension (≥140/90 mmHg [confirmed on several occasions] or on antihypertensive medication)

ØLow HDL cholesterol (<40mg/dL)

ØDiabetes Mellitus

ØHigh HDL cholesterol (≥ 60mg/dL)

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State the basic pathophysiology process of atherosclerosis

Endothelial Dysfunction (Injury) à Increased permeability & leucocyte adhesion, with monocyte emigration and platelet adhesion.
Smooth muscle cell migration from media to intima
Lipid accumulation in intima, and macrophage engulfment of lipids à Foam Cells
Smooth muscle proliferation, and deposition of collagen & other extracellular matrix
Development of fibrous plaque with lipid core

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State 4 causes of Endothelial dysfunction?

ØNormal microvascular wear and tear

ØFibrinogen

ØFree radicals

ØTurbulent flow

ØViral attack

ØCarbon monoxide

ØSmoking

ØHyperlipidaemia

ØHypertension

ØInsulin Resistance

ØDiabetes Mellitus

ØAgeing

suggest 3 likely causes of atherosclerosis

obesity
poor diet
smoking
excess alchohol
genetic predisposition
reduced physical activity
pollutants (i.e. air)

Examples of diseases related to disease of the coronary arteries

Angina,
myocardial infarction (MI),
dysrhythmias,
conduction defects,
heart failure
sudden death.

What are the two types of atherosclerotic lesions:

–Stable Plaque

Obstructs blood flow; associated with chronic ischaemic heart disease (e.g., stable angina)

–Unstable Plaque

Can rupture causing platelet adhesion and thrombus formation; associated with unstable angina and MI.

What are the three acute coronary syndromes

(1) Unstable Angina,
(2) Non-ST segment elevation MI
(3) ST segment elevation MI

describe briefly unstable angina:

–Characterised by symptoms (usually prolonged: >20 minutes) at rest

–No serum markers for myocardial damage

describe briefly non-ST segment elevation MI:

–Characterised by symptoms (usually prolonged: \>20 minutes) at rest –Serum markers for myocardial damage present – indicating severe ischaemia and damage to the myocardial tissues

Describe briefly ST segment elevation MI:

–Acute MI (heart attack) characterised by ischaemic death of myocardial tissue. –Serum markers detectable –Area of infarct = vessel affected: * •30-40 % Right Coronary Artery * •40-50 % Left Anterior Descending Artery * •15-20 % Left Circumflex Artery –Sudden death from Acute MI à death occurs within 1h symptom onset –Usually attributed to fatal dysrhythmias (ventricular fibrillation) –Early hospitalisation greatly improves chances of survival

Define chronic ischaemic heart disease

Inability of the coronary arteries to supply blood to meet the metabolic demands of the heart.

What are the three classifications of chronic ischaemic heart disease

–**Chronic Stable Angina** is associated with a fixed atherosclerotic obstruction and pain that is precipitated by increased work demands on the heart but which is relieved by rest. –**Variant Angina** results from spasms of the coronary arteries or other dysfunctions. --**Silent Myocardial Ischaemia** occurs without symptoms.

What does the following definition refer to? 'Involves vessels occlusions or rupture leading to focal or localised brain damage, or global hypoxia-ischaemia that causes widespread brain injury'

Cerebrovascular Disease

the carotid artery supplies which arteries of the brain initially

anterior and middle cerebral arteries

where is the most common site for a thrombosis in the brain

the middle cerebral artery

what are the three types of stroke

* thrombotic * embolic * haemorrhagic

describe a thrombotic stroke

blood clot (thrombus) blocks an artery in the area of the brain where it is formed

describe an embolic stroke

a plaque/clot breaks off and blocks an artery elsewhere in the brain to where it formed

describe a haemorrhagic stroke

aneurysm due to increase BP in the meniges or cerebrum of the brain

outline some common symptoms of a stroke

* weakness/paralysis * decreased sensation * aphasia * dysphasia * dysphagia * Sight problems

define the ischaemic core

an area of severe ischemia (blood flow below 10% to 25%), the loss of oxygen and glucose results in rapid depletion of energy stores.

define an ischaemic penumbra

he area surrounding an ischemic event such as thrombotic or embolic stroke. Immediately following the event, blood flow and therefore oxygen transport is reduced locally, leading to hypoxia of the cells nearby

Define TIA

transient ischaemic attack is an ischaemic brain attack with focal cerebral or retinal symptoms that last \<24 h, usually \<1 h

True or False: ## Footnote Approximately 40% of all strokes are heralded by a TIA

False 15% of strokes are Meta-analyses have demonstrated the short-term risk of stroke after TIA to be between 3-10% at 2 days, and 9-17% at 90 days

Outline peripheral arterial disease

PAD refers to an obstruction of the large arteries that supply the body’s periphery Causes acute or chronic ischaemia

What are 2 risk factors for PAD

ØAge (men aged 60+ y) ØSmoking ØDiabetes Mellitus

3 symptoms of PAD

* Pain and cramping with walking (particularly calf pain) * Tingling / aching / numbness in legs or feet * Atrophic changes (thinning skin & subcutaneous fat) * Cool foot * Popliteal pulse weak or absent * Blanched limb colour when leg elevated à gravitational effects on perfusion pressure * Ischaemic pain at rest * Ulceration * Gangrene development

What are the three factors you can medically measure to detect atherosclerosis (and how)

1. endothelial dysfunction (flow mediated dilation- ultrasound) 2. vascular stiffness (pulse wave velocity analysis) 3. vessel morphology (CT/MRI)

How can exercise help to reduce the liklihood of stroke/atherosclerosis

* reduces BP, * improve blood lipid profile (increases HDL cholesterol) * improves aerobic fitness, both in the acute and long-term * improves coronary artery endothelial function * reduces risk of other diseases i.e. T2 diabetes * Improves BMI/weight