Block I - CVS, Wound Healing, Vasculitis, etc. Flashcards
What is the most important mediator in the healing process?
FGF. Earliest growth factor in healing; stimulates macrophages and MMPs
What does TGF-beta do?
Causes fibrosis and some angiogenesis
What synthesizes the extracellular matrix?
Fibronectin; responsible for cross-linking
What secretes PDGF?
Activated platelets and macrophages.
What does PDGF do?
Induces vascular remodeling, smooth muscle cell migration, sand stimulates fibroblast growth for collagen synthesis
What is responsible for attachment of epithelium to extracellular matrix?
Integrin
What is the maximum wound strength possibility?
85%; at around 4 months
What is responsible for would contraction in burns?
Myofibroblasts
What is the first step in healing?
Clot formation
What would you expect to see 0-4 hours in healing?
Waviness of fibers
What would you expect to see 12-23 hours in healing?
Contraction band necrosis
What would you expect to see 2-3 days in healing?
Neutrophils peaking; causing increased vessel permeability and migration into tissue
What would you expect to see 3-7 days into healing?
Macrophages predominating; clear debris via mediators and MMP to eat collagen
What would you expect to see 7-21 days into healing?
Granulation tissue & Type III Collagen; angiogenesis, and wound contraction via myofibroblasts
What would you expect to see 6-7 weeks into healing?
Scar formation; when repair cannot be done by cell generation alone.
What does collagenase require in order to break down Type III collagen?
Zinc
What is Keloid?
Abnormal scar formation due to proliferation of Type I and Type III collagen; grows outside of border of normal wound.
How does diabetes cause problems in wound healing?
Enzymatic Glycosylation
What is a Desmoid Tumor?
Abnormal growth from connective tissues that provide strength and flexibility; seen in bones, ligaments, muscles. Break sutures, fibroid tissue into infiltrate.
What phase must a cell be in for regeneration?
G1
How does an atheroma develop?
Injury to endothelial cell
Differentiate between an atheroma and fatty streak:
Atheroma has a necrotic core and cholesterol clefts while fatty streak does not.
What presents with a “beading appearance?”
Fibromuscular Dysplasia
In renal artery stenosis, in which kidney is the renin level increased?
Increased renin in the affected kidney; causes unilateral atrophy
What is the main cause of an abdominal aortic aneurysm?
Atherosclerosis
What are two complications of an abdominal aortic aneurysm?
- Formation of mural thrombus leading to impotence and gangrene.
- Rupture if greater than 5cm in diameter.
What is the most common cause of sudden adult death, and how does it occur?
Ventricular aneurysm caused by ischemia.
A vasculitis involving small vessels, causing a necrotizing granuloma; presence of C-ANCA is what?
Wegeners; commonly in middle-aged male, will have nosebleeds, sinusitis, hemoptysis with bilateral lung infiltrates.
The most common form of arteritis in adults greater than 50; commonly found in the carotid artery is what, and what is a complication?
Giant (Temporal) Cell Arteritis; can lead to blindness. Will have ESR levels very high usually above 100.
What vasculitis is a granulomatous vasculitis, commonly seen in young, Asian females?
Takayasu; presents with weak or absent pulse in upper extremities.
What is the main cause of aortic dissection and what is it due to?
Cause: HTN
Due: Endothelial tear.
What has a sharp, severe chest pain that radiates to the back, and can cause pericardial tamponade leading to death?
Aortic Dissection
What are the components of Tetralogy of Fallot?
- VSD
- Overriding Aorta
- Pulmonary HTN
- RVH
What is the main cause of Eisenmerger?
Pulmonary HTN
What is commonly seen in Marfan’s, and describe the murmur.
Mitral Valve Prolapse; mid-systolic click followed by a late systolic murmur best heard at the base of the apex
What happens to the Mitral Valve Prolapse murmur on standing or valsalva?
Increases; earlier systolic click, and longer murmur (note this is opposite in aortic stenosis)
Describe the Mitral Regurgitation murmur:
Seen in Rheumatic Fever and chordae tendinae rupture; is a holosystolic, blowing, high-pitched murmur that radiates to the left axilla.
Describe the Mitral Stenosis murmur:
Apical, mid-diastolic rumble; seen in RHD and Pulmonary HTN
Describe the Aortic Regurgitation murmur:
Decrescendo, diastolic murmur present with head-bobbing, Waterhammer pulse, and pulsation of retinal arteries; also seen in Marfan’s and syphilis.
Describe the Aortic Stenosis murmur:
Harsh, systolic, crescendo-decrescendo with radiation to the carotids.
What amyloid is seen in age-related amyloidosis of the heart?
Transthyretin
What amyloid is seen in Multiple Myeloma?
Light-chain
Describe a Ventricular Rhabdomoma:
Tuberosclerosis, hypopigmentation of the skin, ash-leaf spot, and kidney tumor; seen in children commonly at left ventricle.
What causes endocarditis of healthy adults and IV drug users?
Staph Aureus
What causes endocarditis of previously damaged heart valves?
Strep Viridans; alpha-hemolytic
What are Roth spots and Osler’s nodes due to?
Immune Complex Deposition
What are Janeway lesions due to?
Thromboembolism
What are the tumors of VHL?
Hemangioblastoma, angioma of the retina, and bilateral renal carcinoma.
In a capillary hemangioma where the parents are worried about appearance of the child, what should you suggest?
Do nothing; will go away on it’s own while surgical intervention can leave a scar
What are two late complications of MI?
Free wall rupture (3-5 days) due to LAD occlusion, presenting with cardiac tamponade and Dressler Syndrome (5 weeks) which is pericarditis due to immune response with chest pain and fever.
Pulmonary edema is caused by what?
Increased hydrostatic pressure
What causes HOCM?
Obstruction of aortic outflow due to septum being too thick, and the anterior and posterior leaflets coming together to completely block outflow
What does HOCM sound like on auscultation; and what effect does valsalva/standing have?
Aortic Stenosis; will increase this murmur on standing/valsalva (aortic stenosis would decrease)
What genetic effect causes HOCM, and what does HOCM lead to?
Beta-myosin mutation; creates cardiac tissue with several branches, thicker, tighter muscle. Leads to death during exercise; Autosomal Dominant.
Describe concentric hypertrophy:
Pressure overload (narrowing the lumen); seen in aortic stenosis or HTN
Describe essentric hypertrophy:
Volume overload; seen in aortic regurgitation
What is nutmeg liver?
Due to passive venous congestion; typically seen in Congestive Heard Disease, presents with fatty change around portal triad. Never caused by alcohol or hypoxia.
