blood vessel pathology Flashcards
origins of atherosclerosis
d
What is the most common form of arteriosclerosis
atherosclerosis
what is atherosclerosis
a narrowing and hardening of arteries due to intimal atheromas (atherosclerotic plaque)
What are the vessels most affected by atherosclerosis
abdominal aorta coronary arteries popliteal arteries carotid arteries vessels of the circle of willis
what are the contents of an artherosclerotic plaque
fibrous cap
lipid core
necrotic center (cell debris, cholesterol, foam cells, and calcium)
What are the steps of atherosclerosis development
- chronic endothelial injury
- endothelial dysfunction/monocyte adhesion and immigration
- macrophage activation/ smooth muscle recruitment
- leukocytes and smooth muscle engulf lipid
- smooth muscle proliferation/ collagen and extracellular lipid deposition
what can cause chronic endothelial injury
hypertension hyperlipidemia smoking toxins viruses immune reactions
what happens when high blood pressure damages the endothelium of blood vessels
it causes inflammation. mostly in areas of turbulent flow, this increases cholesterol invasion/plaque formation
What are the risk factors for atherosclerosis
age gender genetics lifestyle* smoking diabetes inflammation
What are the complications caused by atherosclerosis
stenosis
thrombus/embolism
aneurism
calcification
how does LDL increase atherosclerosis
OXIDIZED LDL causes adhesion and entry of monocytes, then the monocytes turn into macrophages, which consume the LDL and turn into a foam cell. foam cells release growth factors that encourage atherosclerosis
what are the two types of LDL
type A = large less dense
type B = small more dense
which is the worse type of LDL, type A or type B
type B. it is smaller so it can fit through the endothelium more easily, and it is more dense so it bounces along the endothelium more, causing it again to be more likely to penetrate the endothelium
what determines which type of LDL you have more of
genetics, oral contraceptives, and diet
what kind of diet increases type B LDL
low fat, high carb diets
is LDL type B commonly measured in a blood test? if not, what is a good substitute?
it can be measured but usually isn’t
TG:HDL is a good surrogate
what is a good TG:HDL level
less than 1.5 is good, less than 2 is recommended
what diet decreases both LDL type B and TG:HDL levels
a low carb, high fat diet
what must occur for cholesterol to be a problem in atherosclerosis
is must be oxidized.
how do we prevent our LDL from being oxidized and becoming problematic
antioxidant therapy
exercise
keto diet
what does the HMG CoA reducatase enzyme do
it causes cholesterol to be synthesized
what actiavates, and what deactivates HMG CoA reductase
insulin activates, glucagon inactivates
what drugs inhibit HMG CoA reductase
statins
What are the negative side effects of statins
increase risk of diabetes kidney failure liver failure muscle pain (myopathy ) reduces ubiquinone reduced important cholesterols
What are the potential problems caused by statins reducing ubiquinone (electron carrier in the ETC of the mitochondria)
muscle break down (rhabdomyelosis)
muscle weakness and pain
reduced mitochondrial function (oxidative stress)
cataracts
what is the most cost effective treatment of coronary heart disease
aspirin
what are the 5 cholesterol containing things that are important that can be reduced by statins
cell membrane cholesterols steroid synthesis ubiquinone bile salts vitamin D
what are the two types of hypertension
benign and malignant
what are the two types of benign hyper tension
essential or primary and secondary
what is essential or primary hypertension
idopathic hypertension that arises from a mix of genetic and environmental factors
what is seconday hypertension
hypertension resulting from
structural renal, or endocrine defects
what are the symptoms of malignant hypertension
>200/120 mm/hg lethal in 1-2 years if untreated renal failure retinal hemorrhages papilledema
what is the major pathogenic defect that initiates the hypertensive process
insulin resistance
what are the 5 ways insulin resistance affects hypertension
RAAS dysfunction (antidiuretic, increased bp)
enhanced growth factor (thicker vessel walls)
SNS activity increase (increased heart rate)
dyslipidemia (less HDL, more LDL type B)
decrease in Nitric oxide (NO is vasodilator)
what is an aneurism
local abnormal vessel dilation
what is an aneurism
local abnormal vessel dilation
what causes aneurisms
atherosclerosis wall degeneration trauma conginital defects (marfan) infection
what is aortic dissection
aneurism of the aorta
what are the types of aortic dissection
1 = both ascending and descending 2 = ascending only 3 = descending
what are the four types of vessel tumors
hemangioma - common and benign
glomus tumor - benign but painful
kaposi sarcoma - low malignant
angiosarcoma - highly malignant
