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Drug Action I > Block 2 - Atherosclerotic CD Physiology > Flashcards

Block 2 - Atherosclerotic CD Physiology Flashcards

1
Q

What is perfusion?

A

Passage of blood through the cardiovascular

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2
Q

Why is perfusion important?

A
  1. Cells need continuous supply of nutrients
  2. Metabolic waster which is removed
  3. Tissue ischemia or necrosis from hypoxia
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3
Q

What is central perfusion?

A

Blood flow pumped by heart to entire vascular system

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4
Q

What is local perfusion?

A

Microvascular perfusion where volume of blood flowing through a specific tissue

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5
Q

What determines central perfusion?

A
  1. CO and BP
  2. Pathologic processes
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6
Q

What affects local perfusion?

A
  1. Capillaries
  2. Changes in dynamic activities
  3. Pathologic processes
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7
Q

What cause vasodilation?

A

EDHF, NO, PGI2, BK

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8
Q

What stimulated vasoconstriction?

A

ENT1, ANGII, Thrombaxane A2

Atherosclerosis

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9
Q

What is the purpose of arteries?

A

Carry oxygen rich blood away from the heart to other parts of the body (high pressure system)

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10
Q

What is the purpose for capillaries?

A

Deliver O2 and nutrients to organs and tissue

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11
Q

What is the purpose for veins?

A

Carry oxygen poor blood back to heart (low pressure system)

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12
Q

What is caused when there is lack of sufficient of blood flow?

A
  1. Hypoxia
  2. Build up in waste
  3. Organ damage
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13
Q

What are layers of vasculatures?

A
  1. Tunica intima
  2. Tunica media
  3. Tunica externa
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14
Q

What is the tunica intima?

A
  1. Single lay of epithelium
  2. Found only on capillaries
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15
Q

What is the tunica media?

A
  1. Vascular smooth muscle → changes diameter of vessel
  2. Responsible for BP
  3. Thickest in arteries
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16
Q

What is tunica externa (adevntitia)

A
  1. Connective tissue
  2. Anchors vessels to organs and tissue
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17
Q

Wall thickness depends on presence of ____ layers

A

3

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18
Q

What is PVD?

A

Condition affecting circulation in tissues other than brain or heart

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19
Q

What are examples of PVD?

A
  1. Chronic venous insuffiecney
  2. DVT
  3. Leg ulcer
  4. Varicose veins
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20
Q

What is PAD?

A

PVD affecting arteries

Caused by artheriosclerosis and HTN

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21
Q

What are topics that are affected by vascular disorders?

A
  1. Cognition
  2. Comport pain
  3. Fluids and electrolytes
  4. Acid-base balance
  5. Nutrition
  6. Oxygenation
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22
Q

How does vascular disorders cause impairments in cognition?

A
  1. Ischemia → drop in cerebral perfusion
  2. Altered mental status → decreased cerebral BF
  3. Cessation of energy dependent brain processes and irreversible brain injury
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23
Q

How does vascular disorders cause impairments in comfort?

A
  1. Pain
  2. PVD impair heart → peripheral edema and local redness
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24
Q

How does vascular disorders cause impairments in fluid an electrolytes?

A

Multiple organ failure

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25
Q

What is arteriosclerosis?

A

Thickening, loss of elasticity, and calcification of walls of artery, common in PAD

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26
Q

What are the characteristics of a healthy blood vessel?

A

Very lasts, allows rapid changes in CO and BP

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27
Q

What are the characteristics of a aging blood vessel?

A

Calcify and lose elasticity → prevents changes when it comes to BP

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28
Q

What is plaque?

A

Substances (cholesterol and calcium) that harden arterial walls → narrowing

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29
Q

Risk factors of PAD?

A
  1. Familial hypercholesteremia
  2. Lifestyle factors
  3. Control of most lifestyle factors
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30
Q

What is homozygous familial hypercholesteremia?

A

Development of CVD at chidhood

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31
Q

What is abnormally high or low lipid levels in blood?

A

Dyslipidemia

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32
Q

What is elevated blood lipids?

A

HLD

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33
Q

What are high cholesterol? High TG?

A

Hypercholesteremia; Hypertriglyceridemia

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34
Q

What is a lipoprotein?

A

Carrier protein that carries cholesterol, TG, phospholipids

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35
Q

What is the primary carrrier of cholesterol?

A

Low-density lipoproteins (LDLs):

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36
Q

Elevated LDLs promote ___ that deposit ____ on ______

A

Atherosclerosis that deposits cholesterol on arterial walls

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37
Q

What is HDL?

A

Help clear cholesterol from arteries, transporting it to the liver for excretion.

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38
Q

What is considered a healthy HDL level? Unhealthy

A

60 mg/dL or more

Men: 40
Female: 50

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39
Q

What is the therapeutic goal of PAD? How do we achieve it?

A

Maximize HDL levels, minimize LDL levels

Genetic and lifestyle mods

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40
Q

_____ is an important risk factor for CVD?

41
Q

What is the function of TG and how is it processed?

A

Used for fat storage and energy use

Transported to adipose for storage by VLDL which is transformed to LDL

42
Q

What is Atheroma?

A

Region of plaque consisting of calcium, macrophages, lipids, and fibrous connective tissue.
Immune cells at the site of plaque formation create a chronic inflammatory response.

43
Q

What needs to happen for artherioscleosis to begin?

A

When endothelial cells are damaged → LDL reaching damage → WBC attack LDL → Plaque forms

44
Q

What are chronic inflammatory response associated with atheroma?

A
  1. Proliferation of smooth muscle
  2. Smooth muscle cells secrete extracellular matrix that stabilizes plaque
45
Q

Describe the mechanism of atherosclerosis formation?

46
Q

What is the function of EC?

A
  1. Line vessels
  2. Regulate blood flow by maintaining anticoagulants and procoagulant surface
  3. Maintain fibrinolytic mechanism → thrombus formation → promotion of blood flow
47
Q

What occurs during endothelial dysfunction?

A

Normal anti-inflammatory and antithrombotic state with appropriate vasoconstriction and vasodilation toward →
A proinflammatory, prothrombic state of reduced vasodilation

48
Q

What happens if endothelial dysfunction is prolonged?

A

Arteriosclerosis → arterial thrombosis → obstruction of blood flow

49
Q

What is thrombosis?

A

Process of formation of a clot that obstruct flow to organs

50
Q

What are the functions of VSMC?

A
  1. Contract and dilate
  2. Synthesize ECM
  3. Disrupt atheromatous plaque (fatty deposits)
51
Q

What is purpose for ECM?

A
  1. Structure and support
  2. Normal vascular hemostasis
52
Q

What are the dysfunction of VSMC?

A

Vasospasm: decrease vessel diameter → Decrease blood flow

53
Q

What happens when LDLs oxidize how does that lead to atherosclerosis?

A

Induce cytokines → increased expression of adhesion molecules → migration of leukocytes into the intima

54
Q

What is the physiology of atherosclerosis?

A

Accumulation of small particles of low-density lipoprotein (LDL) cholesterol in tunica intima due to a lesion (atheroma)

55
Q

What are foam cells?

A

MP that localize to fatty deposits on BV ingesting LDL → rich with lipid → foamy appearance

56
Q

What causes aneurysm?

A

Lesions may weaken the intima and form an aneurysm → bulge in BV

Bulging of weak arterial wall, of which plaque and hypertension make up the primary cause

57
Q

What happens if lesion ruptures?

A

Thrombosis → Decrease BF

58
Q

When O2 exchange is insufficient arteries ___ to ____ BF?

A

Dilate; increase

59
Q

How does atherosclerosis affect arterial passage?

A

Narrows arteries → decrease BF → plaque grows → person is asymptomatic before obstruction → ischemia

60
Q

What occurs when atherosclerotic plaque rupture? Where is it most likely to occur?

A
  1. Acute infarction and thrombosis
  2. Repetitive cycles of plaque rupture lead to fibrous tissue formation

Fibrous cap

61
Q

Why are fibrous caps more susceptible for rupturing?

A
  1. Thin fibrous caps are prone to rupture.
  2. May involve superficial erosion of the intima.
  3. Endothelial dysfunction
62
Q

How does the body react to plaque ruptures?

A

Plaque rupture exposes lipid-rich core and its thrombogenic material to the blood, activating the clotting cascade

63
Q

What are some features of the clotting cascade in response to plaque rupture?

A

Platelet adhesion → Platelet activation further activates and recruits more platelets → Activated platelets bind adhesive proteins and stimulate thrombin formation, leading to platelet aggregation ad coagulation → thrombin → occlusive thrombus → thrombosis or infarction

64
Q

What is thrombin?

A

Clotting enzyme that converts fibrinogen to fibrin, which helps form clots

65
Q

What is stable plaque?

A

Contains thick fibrous cap that protects atheroma from shearing forces within artery

66
Q

What is vulnerable plaque?

A

More inflammation and thinner fibrous cap; more susceptible for rupture with subsequent thrombi formation

67
Q

What small plaque ruptures dangerous?

68
Q

What are the types of ASCVD?

A
  1. Stroke
  2. Transient ischemic attack (TIA)
  3. Peripheral artery disease (PAD)
  4. Claudication
  5. Limb ischemia
  6. Angina pectoris
  7. Myocardial ischemia
  8. Myocardial infarction
69
Q

What are the 3 major consequences of PAD? Manifestations?

A
  1. Stroke
  2. PAD
  3. MI

Asymptomatic → ischemia

70
Q

What is AC stenosis?

A

Partial or complete blockage of artery due to atherosclerotic plaque.

71
Q

What is Carotid artery disease?

A

Plaque found in carotid arteries, which can lead to stroke

72
Q

What is Coronary artery disease (CAD)?

A

Plaque found in heart → myocardium ischemia

73
Q

Cramping muscle pain in region of narrowing when blood flow to skeletal muscle is insufficient

A

Claudation

74
Q

Concerns of aneurysm in brain?

A

headaches, dilated pupils, visual changes, left or right facial weakness or numbness

75
Q

What is an arterial dissection?

A

Caused by tear in tunica intima in which blood vessel splits and blood goes between inner and outer layers, spreading of dissecting walls of vessel

76
Q

Risk factors of arterial dissection?

A
  1. Trauma
  2. Heredity
  3. Cocaine use
  4. Pregnancy
  5. Hypertension
  6. Size of split
77
Q

Is arterial dissection an emergency?

A
  1. Arterial obstruction
  2. Emboli
78
Q

What is a stroke?

A

Interruption in blood supply to region of brain or bleeding of vessel resulting in brain tissue damage or infarction

79
Q

What are the types of stroke?

A
  1. Ischemic (Neurologic deficits)
  2. Hemorrhagic (elevates ICP)
80
Q

What are the causes of ischemic stroke?

A
  1. Vascular disorder (Cerebral ischemia)
  2. Atherosclerosis
81
Q

Is ischemic stroke only caused in brain?

A

No, can occur elsewhere and make its way to the cerebral vessels

Cardiac and hemotologic conditions: Decreases in EF

82
Q

What is an ischemic stroke?

A

Partial or complete occlusion of cerebral blood flow due to thrombus or embolus

83
Q

Compare the differences between stable and unstable plaque?

84
Q

What are the types of ischemic strokes?

A
  1. Thrombotic (vessel occlusion from plaque buildup) - most common
  2. Embolic (posting clot that forms else where) - most are cardia origin
  3. Lacunar (occlusion in deeper brain vessels)
85
Q

What is a hemorrhagic stroke?

A

Bleeding into brain from burst blood vessels

86
Q

What is a hemorrhagic stroke?

A
  1. Intracerebral
  2. Intraventricular
  3. Extracerebral
  4. Subarachnoid hemorrhage
87
Q

What are the structural causes of hemorrhagic stroke?

A
  1. Aneurysm
  2. Arteriovenous malformations
88
Q

What is a intraceerebral hemorrhage? Causes?

A
  1. Vessels bleed into brain
  2. Caused by chronic HTN
89
Q

What is intraventricular hemorrhage?

A

Vessel bleeds into ventricles

90
Q

What is extra cerebral hemorrhage?

A

Vessel bleeds into membranes surrounding brain

91
Q

What is subarachnoid hemorrhage?

A

Vessel bleeds under arachnoid membrane and above pia mater

92
Q

What is a cerebral aneurysm?

A

Abnormal bulge along vessel wall in brain that fills with blood; caused by a weak or thin area of vessel wall

93
Q

What is areteriovenous malformations?

A

Tangle of abnormal or poorly formed blood vessels, including arteries and veins

94
Q

What is the most important cause of morbidity and mortality in survivors of aneurysmal subarachnoid hemorrhage?

A

Delayed cerebral ischemia

95
Q

What is delayed cerebral ischemia?

A
  1. Occurs in ~30% of patients in first 2 weeks following hemorrhage.
  2. Brain injury in first 72 hours leads to spontaneous waves of cerebral tissue depolarization and profound hypoperfusion of cortex
  3. Coagulation cascade activation impairs fibrinolytic cascade → microthrombosis
96
Q

What is cerebral vasospasm? How is it treated?

A
  1. Complication of subarachnoid hemorrhage
  2. Treated with balloon angioplasty
97
Q

How doe you treat obstructive hydrocephalus

A

Vantriculostomy → draining CSF

98
Q

What are clinical manifestations of strokes?

A

Sudden onset of focal neurologic deficit

Drug Action I (32 decks)

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