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Pathology I > Blood Vessels and Cardiovascular System > Flashcards

Blood Vessels and Cardiovascular System Flashcards

1
Q

describe blood vessel composition

A
  • vessels composed of smooth muscle cells and ECM
  • inner lumen: endothelial cells
  • proportion varies throughout vasculature
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1
Q

describe arterial walls and the layers

A
  • thicker layers to accomodate pulsatile flow and BP
  • tunica intima, tunica media, adventitia
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2
Q

describe veins and the layers

A

thin walled due to reduced pressure
- tunica intima, media, adventitia

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3
Q

describe capillaries and the layers

A
  • smallest vessel for exchange of material between blood and tissue
  • basement membrane, tunica intima
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4
Q

what is the blood flow of heart

A

IVC -> RA -> RV -> pulmonary artery -> lungs -> pulmonary vein -> LA -> LV -> aorta

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5
Q

describe hypertensive vascular disease

A
  • often asymptomatic for years
  • over 25% of individuals in general population are hypertensive
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6
Q

what qualifies as stage 1 hypertension

A

greater than or equal to 130/80 mmHg

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7
Q

what qualifies as stage 2 hypertension

A

greater than or equal to 140/90mmHg

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8
Q

what is primary hypertension

A
  • idiopathic
  • 95% of cases
  • favorable prognosis unless complication such as MI or stroke
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9
Q

what is secondary hypertension

A
  • related to an underlying condition
  • prognosis dependent on tx of underlying disease
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10
Q

what is the most common cause of secondary HTN

A

renal disease

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11
Q

what are the other causes of secondary HTN

A
  • renal
  • endocrine
  • cardiovascular
  • neurologic
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12
Q

what is the mechanism of essential HTN

A
  • reduced renal/sodium excretion results fluid volume increase
  • vasoconstriction or structural changes in vessel wall
  • genetic factors
  • environmental factors - stress, smoking, obesity, diet
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13
Q

describe atherosclerosis

A
  • chronic arterial disease, consists of cholesterol plaques that lead to hardening and narrowing
  • in the US, diseases linked to atherosclerosis are the #1 leading cause of death
  • risk factors include nonmodifiable and modifiable factors
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14
Q

what are the nonmodifiable factors of atherosclerosis

A
  • genetic abnormalities
  • family history
  • increasing age
  • male gender
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15
Q

what are the modifable risk factors for atherosclerosis

A
  • hyperlipidemia
  • hypertension
  • cigarette smoking
  • diabetes
  • inflammation
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16
Q

what is atherosclerosis characterized by

A

atheromas that impinge on vascular lumen
- can rupture and cause occlusion

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17
Q

what is atherosclerosis composed of

A

soft, friable lipid cores (cholesterol) , necrotic debris and a fibrous cap

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18
Q

what do atherosclerotic plaques do

A
  • obstruct vascular lumen leading to stenosis
  • prone to rupture -> thrombosis -> occlusion
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19
Q

what is in the fibrous cap

A

smooth muscle cells
- macrophages
- foam cells
- lymphocytes
- collagen
- elastin
- proteoglycans
- neovascularization

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20
Q

what is in the necrotic center

A
  • cell debris
  • cholesterol crystals
  • foam cells
  • calcium
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21
Q

what is the pathogenesis of atherosclerosis

A
  • chronic inflammatory response of the arterial wall to endothelial injury
  • endothelial injury -> accumulation of lipoproteins -> platelet adhesion -> macrophage migration -> lipid accumulation within macrophages -> smooth muscle cell recruitment and proliferation
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22
Q

what type of arteries are most commonly involved in athersclerosis

A
  • large elastic arteries: aorta, carotid, iliac artery
  • medium sized arteries: coronary, renal, popliteal
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23
Q

ischemia to what areas are most common in atherosclerosis

A
  • heart
  • brain
  • kidney
  • lower extremities
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24
what are major clinical consequences of atherosclerosis
- myocardial infarction - stroke - aortic aneurysm - peripheral vascular disease- gangrene of extremities
25
what is ischemic heart disease
- broad category caused by myocardial ischemia - 90% of cases are a result of reduced coronary blood flow secondary to atherosclerosis - remaining cases may be a result of increased demand, diminished blood volume, diminished oxygenation or diminished oxygen carrying capacity
26
ischemic heart disease is a direct consequence of:
insufficient blood supply to the heart
27
what is the clinical presentation of ischemic heart disease
- angina pectoris- intermittent chest pain caused by reversible myocardial ischemia - myocardial infarction - chronic IHD with congestive heart failure - sudden cardiac death
28
what is a myocardial infarction
- necrosis of the heart muscle due to ischemia - major underlying cause is atherosclerosis - more common in males
29
what is MI pathogenesis
- most are caused by acute thrombosis within coronary arteries: form from preexisting atherosclerotic plaque and results in infarction of the myocardium - 10% of cases MI occurs in absence of occlusive atherosclerotic vascular disease: coronary artery vasospasm, mural thrombi emboli, valve vegetations
30
what happens in MI within seconds of vascular obstruction ( reversible and irreversible changes)
- aerobic metabolism ceases - reversible changes: drop in ATP, accumulation of noxious metabolites, glycogen depletion, cellular swelling -> rapid loss in contractility - irreversible: prolonged ischemia lasting 20-40 minutes -> coagulative necrosis of myocytes
31
what are the clinical features of MI
- severe, crushing chest pain- may radiate to neck, jaw, epigastrium or left arm - 10-15% patients present with atypical symptoms - some are asymptomatic - electrocardiographic abnormalities - elevated serum biomarkers
32
what are the elevated serum biomarkers in MI
- myoglobin - troponin - creatine kinase
33
what are the complications after MI
- contractile dysfunction - arrythmias - myocardial rupture - mural thrombus - heart failure
34
describe congestive heart failure
- the heart cannot generate sufficient output to meet metabolic demands of tissue - usually develops gradually due to cumulative effects of chronic work overload or progressive loss of myocardium
35
CHF may result from:
systolic or diastolic dysfunction
36
what is systolic dysfunction in CHF
- inadequate myocardial contractile function - ischemic heart disease, HTN
37
what is diastolic dysfunction in CHF
- inabiltiy of herat to adequately relax and fill - left ventricular hypertrophy
38
describe left sided heart failure
- most common causes: ischemic heart disease, systemic hypertension - systolic: LV pumps blood with reduved ejection volume - diastolic: LV does not relax and fill
39
what are the clinical features of left sided heart failure
- dyspnea- earliest and most significant symptom - cough - tachycardia - cardiomegaly
40
describe right sided heart failure
- inefficient pumpling of blood to the lungs - usually a consequence of left sided heart failure - same etiology as left sided
41
what is cor pulmonale
isolated right heart failure
42
what is cor pulmonale caused by and what is it
- respiratory disease - myocardial hypertrophy and dilation
43
what are the clinical features of right sided heart failure
- systemic and portal venous congestion - hepatic and splenic enlargement - peripheral edema - pleural effusion - ascites
44
describe congenital heart disease
- abnormalities of the heart or major vessels that are present at birth - accounts for 20-30% of all birth defects - most commonly arises from faulty embryogenesis - etiology unkown in 90% of cases - environmental factors - genetic factors
45
what are the environmental factors involved in congenital heart disease
- rubella infection - teratogens - maternal diabetes
46
what are the 3 categories of congenital heart disease
- left to right shunt malformations - right to left shunt malformations - malformations causing obstruction
47
what is a shunt
abnormal communication between blood vessels
48
describe right to left shunt malformations
- pulmonary circulation is bypassed - clinical sign: cyanosis
49
describe right to left shunt malformations
- tetralogy of Fallot: 4 heart abnormalities - ventricular septal defect: shunt between ventricles - overriding of VSD by the aorta - stenosis - narrowing of R ventricular outflow tract - right ventricular hypertrophy
50
describe left to right shunt malformations
- increase blood flow into pulmonary circulation - right ventricular hypertrophy - may lead to right side failure
51
what are malformations causing obstriction
- narrowing of chambers, blood vessels, and valves - aortic coarctation - atresia
52
what is atresia
complete obstruction
53
what is aortic coarctation
narrowing of the aorta
54
describe aortic coarctation
- more common in males - clinically associated with systolic murmurs and palpable thrills
55
describe valvular heart disease
- group of diseases that affect the heart valves: tricuspid, pulmonary, mitral and aortic - may result in stenosis, insufficiency or both
56
what is insufficiency
- failure of valve to close completely, allowing backflow of blood -regurgitation or incompetence
57
what is stenosis
failure of valve to open completely, obstructing forward flow
58
what is rheumatic heart disease/ fever
- acute, immunologic mediated, multi system inflammatory disease after group A Beta- hemolytic streptococcal infection
59
what does rheumatic heart disease involve
valve inflammation and scarring - results in mitral valve stenosis
60
what is rheumatic heart disease pathogenesis
- hypersensitivity type II-antibodies directed against streptococcal antigen cross reacts with a myocardial antigen - binds to proteins in the myocardium and cardiac valves - fibrotic lesions are a consequence of healing and scarring associated with resolution of acute inflammation
61
what histological charactersitic is characteristic of rheumatic disease
aschoff bodies
62

Pathology I (24 decks)

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