Blood Vessels and CVS Flashcards
1
Q
What are the Three patterns of arteriosclerosis?
A
- Atherosclerosis
- Medial Calcific Sclerosis
- Arteriolosclerosis
2
Q
• Atheromatous plaques project
into and obstruct the lumen
and weaken the media
A
Atherosclerosis
3
Q
• Chronic inflammatory response of the arterial wall initiated by injury to the endothelium • Atheromatous plaques located in intima obstruct vessel lumen and weaken vascular wall
A
Atherosclerosis
4
Q
- Calcification of media
* Does not encroach on vessel lumen
A
MEdial calcific sclerosis
5
Q
• Affects arterioles • Thickened walls reduce lumen diameter causing ischemic injury • Hyaline arteriolosclerosis – Benign hypertension – Diabetes mellitus • Hyperplastic arteriolosclerosis – Malignant hypertension (200/120 mm Hg) • Ischemia: reduced blood flow • Hypoxia: deficiency of oxygen • Infarct: complete loss of blood supply causes localized area of necrosis
A
Arteriosclerosis
6
Q
What are the 3 Stages in the Progression of Atherosclerosis in order?
A
- Fatty streak
- Atheroma (plaque): covered by fibrous
cap - Complicated plaque: ulcerated
7
Q
Lipid-filled foam cells (macrophages) within
the intima
A
Fatty streak
8
Q
Plaque-like lesion that begins
in the intima and impinges on
the vessel lumen
A
Atheroma
9
Q
Complications of \_\_\_\_\_\_: 1. Ischemic injury: Compromised blood flow to distal organs 2. Disruption: Exposes thrombogenic substances 3. Thrombosis: Clotting on surface of ulcerated plaque causes further narrowing 4. Embolization: Thrombus or plaque material may embolize (thromboembolus) 5. Hemorrhage: A hematoma may expand or rupture plaque 6. Aneurysm: Weak wall may dilate and rupture
A
Atheromas
10
Q
Major Clinical Consequences of \_\_\_\_\_\_\_ • Myocardial infarct: Heart attack • Cerebral infarct: Stroke • Aortic aneurysm: Rupture • Peripheral vascular disease: Gangrene of legs
A
Atherosclerosis
11
Q
Risk Factors for _______
Constitutional (non-modifiable) risk factors
– Age– Gender– Family history– Genetic abnormalities
Major (modifiable) risk factors
– Hyperlipidemia– Hypertension– Cigarette smoking– Diabetes mellitus
- Multiple risk factors
multiplies risk
Additional risk factors
– Obesity– Physical activity– Personality type– Alcohol– Trans fatty acids– Lipoprotein A – Hyperhomocystinemia– Systemic inflammatory state (C-reactive protein CRP)
A
Atherosclerosis
12
Q
• Total Cholesterol < 200 mg/dl • Low Density Lipoprotein < 100 mg/dl – “Bad cholesterol” – Delivers cholesterol to peripheral tissues • High Density Lipoprotein > 40 mg/dl – “Good cholesterol” – Mobilizes cholesterol from atheromas and transports it to the liver for excretion
A
Hyperlipidemia
13
Q
- Syphilitic aortitis of ascending aorta may occur in tertiary syphilis
- Obliterative endarteritis of the vasa vasorum
A
Syphilitic Aneurysm
14
Q
• An intimal tear allows dissection of blood into media: may rupture leading to massive
hemorrhage
• Risk factors: hypertension, connective tissue abnormality (Marfan Syndrome)
A
Arteria dissection
15
Q
• Cirrhosis of liver causes portal
hypertension
• Rupture producing massive upper
GI bleed
A
Esophageal Varices
16
Q
• Prolonged increased intraluminal pressure and loss of vessel wall support produces dilated, tortuous veins
valvular incompetence
• Venous stasis - congestion, edema, pain,
A
Varicose veins
17
Q
- Lymphatic spread of bacterial infection
* Painful red streaks and regional lymphadenopathy
A
Lymphangitis
18
Q
• Compression of superior vena cava by neoplasm obstructing venous return
A
Superior vena cava syndrome
19
Q
• Inflammation of the blood vessel wall
• Etiology unknown: most cases are not infectious
• Clinical features
– Systemic : non-specific symptoms of inflammation
• Fever, fatigue, weight loss, myalgias
– Local : symptoms of organ ischemia due to luminal narrowing or thrombosis
A
Vasculitis
20
Q
• Most common form of vasculitis in older adults: Females over 50y • Granulomatous vasculitis • Flu-like symptoms with muscle and joint pain. ESR elevated • Branches of carotid artery – Headache – Visual disturbances 50% – Jaw claudication • Treatment: Anti-inflammatory – Corticosteroids
A
Large Vessel Vasculitis: Temporal (Giant Cell) Arteritis
21
Q
• Necrotizing arteritis involving multiple organs: lungs spared • Association with Hepatitis B • Classical presentation : young adults – Hypertension: Renal artery involvement – Abdominal pain with GI bleeding: • mesenteric artery involvement – Neurologic disturbances – Skin lesions
A
Medium Vessel Vasculitis: Polyarteritis Nodosa
22
Q
• Necrotizing granulomatous vasculitis • Target organs: Nasopharynx, lungs, kidneys – Nasopharyngeal ulceration, sinusitis – Hemoptysis: Lung involvement – Hematuria: Renal involvement • Glomerulonephritis – ^ Middle-aged males • “Strawberry” gingiva • Antiproteinase-3 (PR3) • c-ANCA 95%
A
Small Vessel Vasculitis: Wegener Granulomatosis
23
Q
• Optimal blood pressure:
A
<120 and <80
24
Q
• Normal blood pressure
A
<130 and <85
25
• Stage I Hypertension
140-159 or 90-99
26
```
• The final common pathway
of many forms of heart
disease
• Inability of the heart to
pump a sufficient amount
of blood through the body
• Onset preceded by
compensatory mechanisms
(cardiac hypertrophy)
```
CHF
27
Left-sided heart failure: _____ edema
pulmonary
| edema
28
Right-sided heart failure: _____ edema
peripheral
| edema
29
______ dysfunction: Deterioration of
contractile function
– Ischemic heart disease
– Hypertension
Systolic
30
______ dysfunction: Inability to
relax, expand and fill
– Left ventricular hypertrophy
Diastolic
31
______ hypertrophy
• Concentrically increased wall thickness
• Seen in hypertension, aortic stenosis
Normal LV < 1.5 cm
Pressure-Overloaded Hypertrophy
32
_____ hypertrophy
• Dilation of chambers
• Valvular incompetence
Volume-Overloaded Hypertrophy
33
```
• Caused by:
– Ischemic heart disease
– Hypertension
– Valvular disease: aortic and
mitral valves
• Clinical effects result from
– Decreased peripheral blood
pressure and flow
– Backup of blood in pulmonary
circulation
• Pulmonary congestion
• Pulmonary edema
```
Left sided heart failure
34
• Dyspnea : Shortness of breath
• Orthopnea: Difficulty breathing when lying flat
• Paroxysmal nocturnal dyspnea: Awakened by severe shortness
of breath and relieved by sitting up
Left sided heart failure
35
* Pure right-sided heart failure
* Right ventricular hypertrophy and dilation
* Pulmonary hypertension
Cor pulmonale
36
```
• Congestion in systemic and portal
venous circulations
• Congestive hepatomegaly:
– Chronic passive congestion
– “Nutmeg” liver
• Congestive splenomegaly
• Pleural effusion
• Peripheral edema: pitting edema
• Most common cause of right-sided
heart failure is left-sided heart
failure
```
Right sided heart failure
37
```
• Result of coronary artery
atherosclerosis
• Imbalance between myocardial
oxygen supply and demand
Angina pectoris
Myocardial infarction
```
Ischemic heart diesease
38
Does primary or secondary hypertension have an identifiable etiology?
Secondary
39
• Compensatory mechanism to
– Pressure overload
– Volume overload
Cardiac hypertrophy
40
```
• Transient myocardial ischemia
• Paroxysmal, recurrent pericardial
chest discomfort, constricting,
squeezing, choking, knife-like
• May radiate to arm, mandible
• Does not produce myocardial
necrosis (infarction)
```
Angina pectoris
41
```
• Due to a fixed stenosis: an
atherosclerotic plaque reduces coronary
perfusion to critical level
• Increased demand produces ischemia
• Pain that is predictably reproducible &
consistent over time
• Precipitated by physical effort such as
walking or climbing stairs but may also
occur with eating or stress.
• Pain is relieved by cessation of the
precipitating activity, by rest, or by the
use of nitroglycerin
```
Stable angina
42
```
• Due to a complicated plaque: a
variable stenosis
• New onset of pain
• Pain that is increasing in frequency,
more intense than before
– Key feature is the changing
character or pattern of the pain.
• Pain that is precipitated by less effort
than before, or pain that occurs at
rest
• Not readily relieved by nitroglycerin
• Medical emergency: May evolve into
MI
```
Unstable angina
43
```
• Coronary arterial spasm secondary to
vascular hyper-reactivity
• Occurs at rest
• May be unassociated with
atherosclerosis and coronary artery
disease
• Cocaine users -> vasospasm
```
Variant Angina (Prinzmetal Angina)
44
```
Pathogenesis of ___________
• Coronary atherosclerosis
• Complicated plaque
• Platelet adhesion and activation
• Thrombus formation
• Vessel occlusion
• Myocardial infarction (cellular
necrosis)
```
Transmural Acute Myocardial Infarction
45
What are the 3 serum cardiac markers?
* Myoglobin
* Cardiac-specific Troponin (T or I)
* Creatine kinase (MB fraction): CK-MB
46
* Aneurysm
* Wall rupture
* Mural thrombus
* Papillary muscle rupture
Post MI complications
47
```
________ diseases
• Stenosis: Doesn’t open completely
– Impedes forward flow
• Insufficiency/incompetence: Doesn’t close completely
– Allows reverse flow
Abnormalities of flow produce murmurs
```
Valvular heart diseases
48
```
• Aortic stenosis
• Aortic insufficiency
• Mitral stenosis –
rheumatic heart disease
• Mitral insufficiency -
myxomatous degeneration
(mitral valve prolapse)
```
Major valvular lesions
49
• Acute rheumatic fever is a complication of
Group A streptococcal pharyngitis
• Antibodies to Strep cross react with
cardiac antigens
• Inflammation leads to fibrotic valvular
disease
Type II Hypersensitivity Reaction
Acute rheumatic fever
50
The following molecules are associated with _______:
• Anitchkow cells (macrophages)
• Aschoff body
Acute Rheumatic fever
51
```
• Pericardium: fibrinous pericarditis
• Myocardium - myocarditis
• Valves
– Mitral vegetations
– Thickened leaflets
– Fused commissures
• ARF is the most frequent cause of
mitral stenosis
```
Rheumatic heart disease
52
```
• Most frequently bacterial
– Strep viridans (50-60%)
– Staph aureus: IV drug abusers
• Virulence of organism determines
course
• Thrombus formation on damaged
endothelium (vegetations)
• Bacteremia results in microbial
colonization of vegetations
• Septic emboli
```
Infective endocarditis
53
• Left side of heart affected most
commonly (aortic valve)
• Right side: for IV drug abusers
• Mortality due to heart failure
Infective endocarditis
54
Prevention of ________:
• Antibiotic prophylaxis for procedures causing
bacteremia: dental, gastrointestinal,
genitourinary, upper respiratory tract
• Dental procedures that involve manipulation of
gingival tissue, manipulation of the periapical
region of teeth, or perforation of the oral
mucosa
Infective endocarditis
55
```
• Abnormalities of the heart and great vessels that
are present at birth
• = 20-30% of all birth defects
• Faulty embryogenesis: weeks 3 to 8
• Most cases:
– Atrioventricular, ventricular or atrial septal defect
– Pulmonary stenosis
– Patent ductus arteriosus
– Tetralogy of Fallot
– Coarctation of aorta
– Aortic stenosis
– Transposition of great arteries
• 90% have no identifiable cause
```
Susceptibility to infective endocarditis: antimicrobial prophylaxis
Congenital Heart Disease
56
```
Etiology of ______"
• Most have no identifiable cause:
multifactorial environmental,
genetic and maternal factors
• Genetic
– Trisomy 21
– Turner syndrome
• Environmental
– Infectious
• fetal rubella or
cytomegalovirus
infection
– Drugs
• accutane, lithium, anti-
seizure medications,
cocaine, alcohol
```
Congenital heart disease
57
• Malformations causing
Right-to-Left Shunts:
_________
Cyanosis
58
• Malformations causing
Left-to-Right Shunts:
________
– Most common
59
```
_______ shunts:
• Pulmonary blood flow is
decreased
poorly-oxygenated blood
enters the systemic
circulation
• Cyanotic Congenital Heart
Disease
• May be associated with
paradoxical embolism
– Septal defect allows venous
emboli to bypass the lungs
and enter systemic arterial
circulation
• Begin with “T”
– Tetralogy of Fallot
– Transposition of the Great
Vessels
```
Right to left shunts
60
```
• Most common form of cyanotic congenital
heart disease
• Right-to-Left Shunt
1. Ventricular septal defect (VSD) : most
common form of congenital Heart Disease
2. Sub-pulmonary stenosis
3. Right ventricular hypertrophy
4. Aorta overides VSD
```
Tetralogy of fallot
61
```
________ Shunts
• Most common
• Pulmonary blood flow increased
– Pulmonary hypertension
– Shunt reversal -> cyanosis (Eisenmenger syndrome)
All contain a “D”
• Ventricular Septal Defect
• Atrial Septal Defect
• Atrial-Ventricular Septal Defect
• Patent Ductus Arteriosus
```
Left-to-Right Shunts
62
```
• Normal fetal blood vessel that allows
blood to bypass the lungs
• Left-to-right shunt from the aorta to
the pulmonary artery
• When pulmonary hypertension
develops, shunt reverses and cyanosis
develops
– (Eisenmenger syndrome)
```
Patent Ductus Arteriosus: Connects Pulmonary Artery and Aorta
63
```
• Obstructive defect located in the
area of the ductus that may be
asymptomatic until adulthood
• Rib notching due to collateral
circulation
• Males 2:1
```
Coarctation of the Aorta
64
Is there hypo or hypertension proximal to coarction?
Hypertension
65
Is there hypo or hypertension distal to coarction?
Hypotension
