Blood Vessels III Flashcards by Matt Stanton

obesity

accumulation of adipose tissue sufficient to impair health

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BMI

weight in kg / height in m-2

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BMI increases risk for

DM, HTN, hypertriglyceridemia and low HDL

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metabolic syndrome**

obesity
dyslipidemia
HTN
insulin resistance (pre-diabetic)

predisposition to CV disease and DM type II

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vasoconstriction

can occur at sites of plaques

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2/3 cholesterol metabolism

LDL receptor pathway
-apo B100 and E

75% LDL receptors on hepatocytes

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cholesterol released from LDL

1 suppresses cholesterol synthesis
-inhibits HMG CoA reductase (like statins)

2 activates ACAT - ester and storage of cholesterol

3 down regulates synthesis of LDL receptors

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statins

inhibit HMG CoA reductase

promote synthesis of LDL receptors

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1/3 cholesterol metabolism

oxidized LDL - to scavenger receptor pathway

to macrophages - foam cells

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lipoprotein lipase

lipolysis of VLDL - in capillaries

-release triglycerides - stored in fat cells or used as energy in skeletal m.

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IDL

after capillary lipolysis of VLDL

-to liver OR converted to LDL

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cholesterol acyltransferase

storage of cholesterol esters

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highest risk factor for atherosclerosis

LDL-C > 190

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decreased risk for atherosclerosis

increased HDL

increases with exercise and alcohol
decreases with obesity and smoking

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estrogen

does not decrease risk for heart attacks in post-menopausal women***

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omega 3

beneficial

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trans-unsaturated fats

margarine

-BAD

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increased risk of CAD with oral contraceptives

women > 35 yo who also smoke

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familial hypercholesterolemia

autosomal dominant

mutations in LDL receptor
elevated LDL cholesterol in plasma

leads to oxidized LDL - scavenger receptor pathway
-cytotoxic

monocytes, macrophages, smooth m, endo cells - receptors for oxidized LDL

atherosclerosis, xanthomas, and cytotoxicity occur

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class 2 familial hypercholesterolemia

disrupted transport to golgi

most prevalent
abnormal protein folding
cannot transport from ER to golgi

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familial hypercholesterolemia mutation classes

1 - synthesis
2** - transport to golgi
3 - binding apoprotein ligands
4 - clustering in coated pits
5 - recycling in endosomes

heterozygote familial hypercholesterolemia

2-3x increase in plasma cholesterol

no xanthomas

homozygote familial hypercholesterolemia

5x increase in plasma cholesterol
-severe atherosclerosis, corneal arcus, xanthomas, mitral valve stenosis

die from complications as child or young adult

arcus

ring around outside of iris

strong predictor for major atherosclerotic event

elevated plasminogen activator inhibitor 1

lipoprotein a

higher risk of coronary and cerebrovascular disease

premature vascular disease

elevated homocystine -low folate or vit B - homocystinuria therapeutic homocystine elevation - no atherosclerosis

C-reactive protein

acute phase reactant - from liver | -strong and independent predictor for risk of MI, stroke, PAD, and sudden cardiac death

to reduce CRP

smoking cessation weight loss statins exercise

best marker for degree of atherosclerosis

C-reactive protein**

pathogenesis of endo injury

accumulation of lipoproteins (LDL) - oxidized adhesion of monocytes and migration into intima adhesion/activation of platelets migration of smooth m cells - become neointimal proliferate and deposit ECM/collagen foam cell accumulation over time lay down collagen - fibrous cap

infections and atherosclerosis

chlamydia pneumoniae herpesvirus cytomegalovirus

cholesterol efflux from plaques**

HDL helps clear cholesterol from accumulations

celecoxib

COX2 inhibitor - no prostacyclin formation - prothrombotic state

aspirin

COX1 inhibitor - no thromboxane formation - anti-thrombotic state

prostacyclin

formed during COX2 pathway | -inhibited vy celecoxib

thromboxane

formed during COX1 pathway | -inhibited by asprin

aneurysm

localized dilation of blood vessel or wall of heart

abdominal aortic aneurysm

atherosclerosis

thoracic aortic aneurysm

HTN - medial cystic degeneration vaso vasorum arteriolosclerosis - not enough nutrients to media - degeneration of wall occurs

mycotic aneurysms

with infection - embolization of septic embolus - extension of adjacent suppurative process - circulating organisms

marfan syndreom

inadequate fibrillin -aberrant TGF-beta activation - loss of elastic tissue matrix likely to aneurysm

loeys-dietz

TGF-beta receptor mutations - elastic tissue loss likely to aneurysm

ehlers-danlos syndrome

defective collagen III synthesis likely to aneurysm

scurvy

Vit C deficiency -defective collagen cross-linking likely to aneurysm

increased MMP activity

by inflammatory cells - cause net loss of medial ECM - aneurysm

true aneurysm

bound by aterial wall component or myocardium

saccular aneurysm

rounded - localized one area out-pouching

fusiform aneurysm

entire vessel wall circumferentially

false aneurysm

hematoma secondary to transmural rupture aka pseudoaneurysm

X-ray of abdomen

see aneurysms - cannot tell if false vs. true