BV and heart Flashcards
1
Q
4 types of arteries
A
- elastic: aorta & beginnings of branches
- muscular: thick smooth muscle tunica media
- small: autonomic blood flow regulation
- arterioles: fewer than 5 layers of muscle
2
Q
Lipoproteins are…
formed in…
A
- any complex of lipids with proteins
2. usually formed in liver or intestine
3
Q
Atherosclerosis
pathology
process
nomenclature
A
Atheroschlerosis is the #1 killer in US.
- It is a response to injury featuring the accumulation of cholesterol-rich fat in the intima of the large and medium-sized arteries
- Plaques occlude arteries (slowly over time or suddenly by rupture of plaques) causing ischemic heart disease, myocardial infarction, stroke and gangrene of the extremities.
- This term derives from Greek word meaning “hardening” or “induration”.
4
Q
4 types of arteriosclerotic lesion
A
- atherosclerosis
- arteriolosclerosis
- hypertensive arteriosclerosis
- medial calcific sclerosis (produces calcification in the media of large arteries in elderly people)
5
Q
6 risk factors for atherosclerosis are:
and causes
A
- high LDL level - heredity, diet, exercise
- cigarette smoking - smoke oxidizes LDL
- high blood pressure - intima damage
- lack of exercise - change in lipoprotein receptor count
- heredity - familial hypercholesterolemia
- low HDL levels - HDL keep LDL from binding to plaques
6
Q
The risk factors for atherosclerosis can be divided into three groups:
A
- factors that we cannot do anything about: heredity, male sex, and advancing age
- “deadly quartet”: hypertension, hyperlipidemia (cholesterol and LDL), cigarette smoking, and diabetes mellitus
- “soft” factors of uncertain importance: obesity, inactivity and personality characteristics
7
Q
Examination of the ocular fundus is an important test for :
A
monitoring of any patient who is liable to develop any form of arteriosclerosis.
8
Q
Vascular smooth muscle is an important factor in atherosclerosis because (2)
A
- it has receptors for LDL
2. it can get into intima through holes in the internal elastic membrane.
9
Q
Atherosclerosis development has different stages, it starts with:
A
an early lesion of the endothelial surface of large arteries.
10
Q
response-to-injury hypothesis (4)
A
- the development of areas of chronic endothelial injury (fatty streaks) -begins in all children
- fibrosis in smooth muscle cells in the intima
- insudation of lipoproteins (oxidized LDL and VLDL) producing cell injury
- accumulation of macrophages & platelets and formation of fibrous cap & atheroma
- at this stage its no longer reversible
11
Q
3 possible types of plaques(3)
A
- calcified producing the “eggshell aorta”
- ulcerated- important complication that may lead to embolization of plaque debris, and also provides a naked non-endothelialized surface which is a site for thrombosis and possible thromboembolism
- bleed- haemorrhage into plaques
12
Q
Hypertension pressures
A
SBP > 160 mmHg and /or
DBP > 90 mmHg
13
Q
With expansion of plaques, what happens to the intima? (2)
most common location
If it is not surgically repaired what is the most important complication of aneurysm?
A
- internal layer of the intima may become broken up and the lesion may induce pressure changes on the tunica media. => (2) formation of atherosclerotic aneurysm (fusiform or saccular shaped)
- Most common location of this aneurysm is in the aorta below the a. renalis, and often going down into the iliac arteries.
- If it is not surgically repaired the most important complication of aneurysm is rupture followed by severe haemorrhage into the peritoneal cavity.
14
Q
Hypertension is result from an imbalance in the interactions between: (4)
A
- cardiac output: systemic pressure, venous return
- renal function: renin-angiotensin-aldosteron
- peripheral resistance: arteriosclerosis
- sodium homeostasis: diet, pheochromocytoma
15
Q
Aneurysms
def
why they develop
most common in…
A
- Abnormal dilatations of arteries or veins
- They develop as a result of marked weakening of the wall of a vessel (t. media).
- most frequent in aorta
16
Q
Vasculitis def 3 types
A
- inflammation and necrosis of blood vessels (aortitis).
3 types:
a) Raynaud phenomenon (vasculitis)
b) polyarteritis nodosa
c) thromboangiitis obliterans - Buerger disease
17
Q
3 things (disorders) that cause aneurysms
A
- congenital (atherosclerosis)
- infections (syphilis)
- trauma
18
Q
Dissecting aneurysm is:
what it is
what it leads to
associated with … (2)
A
- a lesion which occurs when blood is forced through an intimal defect into the wall of an artery, under arterial pressure
- This may lead to extension of a column of blood that may travel for a considerable distance along the arterial tunica media, and separate the wall into two planes - “dissection.”
- associated with hypertension, or is the result of the arterial wall degeneration seen in cystic medial necrosis or Marfan’s syndrome.
19
Q
classification of dissecting aneurysm (2)
A
type A - if it involves the ascending part
type B - if it involves the descending part
20
Q
what does cor pulmonole do?
A
causes PE block BF and die
21
Q
Varicose veins
A
abnormally dilated, tortuous veins caused by increased vessel intraluminal pressure.
22
Q
What is affected–varicose veins?
A
Any vein in the body may be affected, but superficial veins of the leg are by far the most frequently involved (beside legs hemorrhoidal plexus of veins at the anorectal junction, and esophagus are also common locations).
23
Q
Berry aneurysms
what are they?
where do they develop
why do we care?
A
- They are saccular outpouchings of the arterial wall which may fill with thrombus and which may bleed to produce subarachnoid bleeding.
- characteristically develop at branch points of arteries in the basal cerebral circulation
- It is important cause of intracranial bleeding in young patients.
24
Q
5 Risk factors for varicose veins are
A
- sex
- age
- heredity
- posture
- obesity
25
Hemangioma
1. benign tumor of blood vessel usually located in the skin, but can be found in internal organs
26
Deep venous thrombosis
what 2 words are used to describe thrombus formation? What is associated with the condition?
why do we care about it?
1. Thrombophlebitis and phlebothrombosis = thrombus formation in deep veins (usually legs) in presence and absence of infection or inflammation
2. associated with prolonged bed rest and
3. can be threat to life because of embolization to the lung.
27
Hemangiosarcoma
rare, highly malignant tumor that usually begin as small, painless red nodule located in skin, liver.
28
Congenital heart disease Statistics
1. Congenital anomalies are the leading cause of death in children under one year old, with (CHD) as the most prevalent
29
Congenital heart disease:
def
single or combination?
genetic chromosomal syndromes its associated with
1. broad term which can describe a number of different abnormalities affecting the heart, present at birth
2. may be a single lesions or in combinations (majority are isolated defect)
3. genetic chromosomal syndromes: Down’s or Turner (XO) syndrome, trisomy 13, Marfan syndrome etc. Drugs, chemicals, alcohol and infections (rubella) may also produce CHD.
30
Shunt: Right-to-left
divert blood containing reduced hemoglobin away from the pulmonary circuit into the systemic circulation, reducing O2 saturation of the arterial blood that results in cyanosis.
31
how the embryo receives its nutrition (2)
| what happens after birrth
1. During embryogenesis oxygenated blood (for nutrition) is being supplied via the umbilical veins and communication between right and left heart atriums is done thru right-to-left shunt
2. After birth, these shunts should be closed in order to establish the normal adult blood flow, if not => shunts disorders
32
Left-to-right shunt
divert blood from the systemic into the pulmonary circulation depriving tissues of O2. which may result in cyanosisAdditional blood volume demands on the right side and the pulmonary circulation results in hypertrophy of the pulmonary arterioles walls and increased pulmonary resistance that cause right ventricle hypertrophy leading to shunt “reversal”.
33
CHD divisions of shunts
cynaosis (3)
w/o cynaosis (4)
```
cyanosis
1. tetralogy of Fallot
2. transposition of great vessels
3. patent ductus arteriosus
without cyanosis:
1. atrial septal defect (ASD)
2. ventricular septal defect (VSD)
3. coarctation of aorta
4. pulmonic stenosis
```
34
Tetralogy of Fallot
type of shunt
4 anatomical defects
1. right-to-left shunt
4 anatomical defects:
1. pulmonary stenosis
2. ventricular septal defect- (missing part of wall)
3. dextroposition of aorta (allows blood from right and left ventricle to be pumped into the aorta)
4. right ventricular hypertrophy
35
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Ductus arteriosus
what is it
disease associated with defect
what happens in this disease process
leads to
```
1. it is the embryonic blood vessel that connects the pulmonary artery to the aorta
2. PDA= ductus arteriosus persistant - is defect when this is not closed at birth which leads to (3) oxygen blood leaving left side of heart flows from the aorta -> pulmonary artery -> back into lungs
4. leads to increased pulmonary pressure and CHF
36
Transposition of the great vessels (TGA)
description
associated with- results in...
1. two main arteries, aorta and pulmonary artery are transposed (aorta arises from the right ventricle, and the pulmonary artery from the left ventricle.)
2. usually associated with an atrial or ventricular septal defect (VSD) or patient ductus arteriosus which keeps the child alive because: (3) this combo allows mixing of blood from both sides of the heart, so enough oxygen is supplied to the different organs to permit adequate function
37
```
Ventricular and atrial septal defect (VSD and ASD)
def
type of shunt
large VSD and ASD can cause
```
1. opening in the wall between the ventricles or atria. This opening may be small, medium or large and may be single or multiple.
2. Due to the left-to-right shunt, so more blood than normal flows into the lungs causing breathing difficulty in children
3. Large VSD and ASD defects may cause heart failure (right ventricle cannot pump increased blood volume) that is associated with rapid shallow breathing, sweating, inability to feed, constant crying and failure to grow normally.
38
Coarctation of the aorta
what/ where
clinical signs for upper and lower extremities
1. local constriction of aorta (more frequent in males) immediately below the origin of the subclavian artery
2. Clinically- upper extremities exhibit increased blood pressure (and left ventricular hypertrophy), but lower extremities show decreased blood pressure, diminished peripheral pulses, pallor and coldness predisposing to intermittent claudications [cramp and pain in calf because diminished blood supply for energy and oxygen] in calf muscles.
39
Heart failure (4)
1. insufficient to pump blood at the rate required by the tissues
2. associated with defective myocardial function.
3. The failing heart usually shows dilatation of one or more chambers.
4. Longer standing heart failure is often accompanied by ventricular hypertrophy
40
Left heart failure
associated with (2)
CHF
1. is usually associated with pulmonary congestion and (2) respiratory symptoms like dyspnea and orthopnea [cannot breath lying down] progressing to pulmonary edema.
3. Congestive heart failure usually implies significant infarction of the left ventricle (30-40% of the ventricular mass).
41
```
Right heart failure
usually causes
associated with...
what happens to liver and gut?
classic symptom
```
1. usually causes chronic passive congestion of the liver, spleen and gut
2. is associated with peripheral edema and ascites.
3. Severe cases of liver venous congestion may produce necrosis and result in destruction of the normal liver tissue.
4. Edema of the gut may lead to “cardiac cachexia”
5. *pitting edema classic sign*
42
cor pulmonale
associated with...
acute
chronic
1. secondary disease- associated with right ventricular enlargement and associated heart failure
2. Acute type is seen in acute pulmonary embolism.
3. Chronic type is seen in chronic obstructive pulmonary disease
43
Plasma proteins are classified on the basis of density (lipid content) as: (3)
1. High - HDL - 50%lipids / 50%proteins
2. Low - LDL- large amount of cholesterol
3. very low - VLDL - 25% cholesterol
44
right to left shunt
def
results in...
1. diverts blood containing reduced Hb away from pulmonary circuit to systemic circulation => less O2 saturation in arterial blood
2. *result is cyanosis* (blue baby syndrome)
45
```
left to right shunt
what it does
results in (2)
```
1. diverts blood from systemic circulation to pulmonary system
2. this deprives the tissues of O2 and overloads the lungs with too much blood
3. => hypertrophy of pulmonary arterioles and resistance => right ventricle hypertrophy => shunt reversal (un-fixable)
46
4 types of ischemic heart disease
1. angina pectoris
2. myocardial infarction
3. chronic ischemic heart disease
4. sudden death
47
underlying lesion of IHD is usually due to... (2)
1. atherosclerosis
| 2. occlusion of coronary arteries
48
ischemic heart disease a.k.a.
coronary heart disease
49
angina pectoris
def
signs
triggered by (and why)
1. chest pain resulting from MI
2. sudden onset of intense compression feeling, burning, tightness, or pain radiating to jaw or left arm
3. generally trigger by physical activity because it is caused by imbalance of myocardial O2 supply and demand
50
3 major forms of angina
1. stable angina
2. variant angina
3. unstable angina
51
stable angina
superlative
primary characteristic
how is it treated
1. most common form of IHD
2. primary characteristic is its brought on by physical activity because of imbalance of myocardial O2 supply and demand
3. beta blockers and organic nitrates are used to treat
52
variant angina
def
what triggers it
how is it treated
1. coranary artery vasospasm (vasoconstriction) => decreased myocardium O2
2. may be triggered by emotional or environmental stimuli
3. Ca channel blockers are used to treat
53
unstable angina
waste basket term for
def
what triggers is
1. used to identify life threatening forms of MI associated with thrombosis in coronary arteries
2. combo of stable and variant form => vasoconstriction overlapping with increased O2 needs
3. may begin with minimal physical activity or spontaneously
54
MI
def
where it occurs
rare cases
1. necrosis of portion of heart muscles because of thrombosis in coronary artery
2. thrombus is usually formed at site of ulcerated and ruptured atheromatous plaque
3. in rare cases can be from multiple ischemia produced by prolonged arterial spasm (arteritis)
55
2 types of MI
1. transmural infarcts
| 2. subendocardial infarct
56
```
transmural infarct
def
stats
3 most common sites (in order)
ECG
```
1. necrotic area is extended thru full thickness of myocardium
2. 90% of these pts have history of thrombosis
3. most common sites for thrombosis are:
left ant descending
right coronary
left circumflex
3:2:1 ration
4. ECG shows progressively deeper and wider Q-wave
57
subendocardial infarct (2)
1. necrotic area is partial thickness
| 2. a.k.a. non-Q wave
58
lots and lots of heart failure clinical features (5)
1. *Pitting edema or cardiac edema*- signs of right sided heart failure
2. Dyspnea: feeling of breathlessness (due to vascular congestion which reduces pulmonary oxygenation and due to reduced cardiac output to the periphery)
3. Orthopnea- dyspnea that occurs in the recumbent position and it is often gauged by the number of pillows the patient sleeps on.
4. Paroxysmal nocturnal dyspnea: is the occurrence of sudden dyspnea that awakens the patient.
5. Nocturia
59
lots of physical signs of heart failure (5)
1. Tachycardia: is a compensatory mechanism for maintaining cardiac output.
2. Pulmonary rales: increased hydrostatic pressure produces transudation into the alveoli. As air circulates through the alveoli pulmonary rales are produced.
4. Abnormal heart sounds: atrial and ventricular gallop also called fourth and third heart sound.
5. Neck vein distention: is a sign of increased central venous pressure due to the right-side heart failure.
60
heart infarction- how the pt presents (5)
1. severe chest pain or pressure that persists for more than 30 min and is unrelieved by nitroglycerin
2. usually associated with nausea, vomiting and shortness of breath.
3. occurs when patient is at rest or involved in minimal activity.
4. Vigorous activities usually cause sudden death without infarction. If the infarction is extensive on physical examination hypotension and tachycardia may be present.
5. Patient is apprehensive and appears ill.
61
```
Heart infarction – complications
arrhythmia
pump failure
mitral regurgitation
left ventricular aneurysm
```
1. Arrhythmia: patient having an acute myocardial infarction is subject to acute lethal ventricular arrhythmia, particularly within first 24 hours after infarction.
2. Pump failure: When 30% of the myocardium muscle is infarcted from one or more infarctions, congestive heart failure is likely to ensure.
3. Mitral regurgitation: Dysfunction or infarction of the papillary muscles may lead to systolic prolapsing of the mitral valve into the left atrium causing blood regurgitation.
4. Left ventricular aneurysm.
62
rheumatic heart disease
caused by
3 symptoms
1. acute rheumatic fever= immunologically mediated disease caused by anti-streptococcus antibodies
symptoms develop after 2 weeks
a. migratory arthritis
b. carditis of all 3 heart layers (myocardium, pericardium and endocardium)
c. erythema
63
valvular heart disease
4 examples
2 types
egs:
1. calcified aortic stenosis
2. mitral valve prolapse
3. bacterial or nonbacterial endocarditis
4. systemic lupus erythematous
types
1. stenosis- failure of valve to open properly => obstruction to forward blood flow
2. insufficiency- inability of valve to close properly => allows backward flow of blood
64
myocardial heart disease
| 2 generic nomenclatures
1. myocarditis- any inflammatory condition
| 2. cardiomyopathy- any non inflammatory disorder
65
3 categories of cardiomyopathy
1. dilated (congestive)- idiopathic disease characterized by dilation and hypertrophy of heart chambers and CHF
2. hypertrophic (obstructive) - inherited condition with hypertrophied myocardium and mitral insufficiency
3. restrictive cardiomyopathy- rare condition with restriction of ventricular filling
66
pericardial heart disease (2)
1. pericardial effusion- space btwn epicardium and pericardium fills with excess fluid
2. pericarditis - inflammation of visceral or parietal pericardium (classified according to exudate)
67
serous acute pericarditis
due to bacterial, viral or immunologically mediated inflamation
68
fibrinous acute pericarditis (3)
1. most common
2. seen after MI or trauma
3. produces pericardial friction rub with adhesions
69
purulent acute pericarditis
1. associated with infectious agents (bacteria and fungi)
70
hemorrhagic acute pericarditis (2)
1. due to TB or (2) neoplasia
71
cardiac neoplasm
benign
malignant
primary tumors are rare
1. benign- myxomas that arise in left atrium
2. malignant- angiosarcoma
