Cardiac Path 2 (Atherosclerosis) Flashcards
Etiology of ____=
The endothelial cell injury, which may be a consequence of metabolic derangement’s (diabetes) or physical force (hypertension), is accompanied by the deposition of platelets and serum lipoproteins (LDL’s) under the endothelium which stimulates macrophages
Atherosclerosis
•The role of ______ in Atherogenesis:
- Growth factors released from _______ stimulate the proliferation of smooth muscle cells in the wall of the artery–> promotes the accumulation of cholesterol/other lipids in their cytoplasm.
- The trapped LDL’s inside the macrophages are transformed into foam cells.
- Some of the lipid-laden smooth muscle cells die, releasing lipid into the interstitial spaces that is degraded and deposited in the form of cholesterol crystals.
Platelets
Role of _________ in athrogenesis:
- These lesions attract ______ which take up the released lipids and cell remnants from dying or injured smooth muscle cells.
- _______ secrete cytokines, TNF, and other biologically active substances –> cause even more damage by stimulating collagen production, along with the damaged smooth muscle cells
- The repair of the initial arterial lesion involves scarring due to collagen deposition, leading to hardening or sclerosis.
Macrophages
Atherosclerosis-etiology:
What is the name for the bulge in the vessel wall caused by the repair of the initial lesion involving scarring due to collagen deposition, ultimately leading to hardening/sclerosis?
an Atheroma–> is the prototype lesion that bulges into the lumen of the artery.
Atherosclerosis- etiology:
What are the integral parts of an Atheroma?
- The central part: soft and consists of lipids and cellular debris.
- This soft core is covered on the surface by fibrous tissue that forms a fibrous or surface cap.
The major complication of the ________is hardening of the vessel, a consequence of calcification, precipitated by local tissue degeneration.
Atheroma
Atherosclerosis: The Atheroma-
The lipids released from dead cells and abnormal cellular matrix attract calcium salts, seen on_____ as radiodense material.
X-rays
What is considered a multifactorial disease (genetic+environmental) with the following risk factors:
- Old Age
- Sex (M>, but sex differences less after menopause)
- Heredity
- Lipid metabolism
- HTN
- Obesity
- Diabetes
- Cigarette smoking
- Stress
Which hormones have a protective effect against atherosclerosis?
Female sex hormones
-Women who take replacement estrogen therapy after menopause reduce the progression of atherosclerosis
____________ is a genetic defect of LDL receptors, which does not allow lipoproteins into the liver
–> causes atherosclerosis at an early age and is the best known cause for familial atherosclerosis.
Familial hypercholesterolemia
A hereditary risk factor for atherosclerosis
_______accumulates in Atheromas and is one of the major pathogenic factors in the formation of atherosclerosis.
Lipid
Atherosclerosis- Risk factors:
Elevated serum levels of _________directly correlate with the extent and severity, and with the early onset of clinical symptoms of Atherosclerosis
lipids-cholesterol, lipoproteins, and triglycerides
Atherosclerosis- risk factors:
___________ has a direct correlation with the acceleration of atherosclerosis if not properly controlled
- the exact role in the development in not fully understood
HTN
Possible reason for why _______ is a risk factor for Atherosclerosis:
- the elevated pressure of the blood compresses the intimal cells, making them ischemic or stimulating them to release some sort of cytokine that promotes proliferation of smooth muscle cells.
- ________may cause changes in the clotting system by damaging platelets, causing their aggregation and the release of biogenic substances from their cytoplas
HTN
Risk factor of atherosclerosis:
- __________ causes a secondary hyperlipidemia due to increased total body fat.
- These pts develop atherosclerosis at an earlier age with more pronounced lesions
Obesity
Risk factor of atherosclerosis:
_________ predisposes individuals to atherosclerosis.
- Hyperglycemia alters the metabolism of basement membranes and damages small blood vessels (diabetic microangiopathy) of the glomerular capillaries and larger renal arterioles.
- also accelerates atherosclerosis in larger arteries (coronaries, cerebral, and aortic).
Diabetes
Risk factor of atherosclerosis:
Constant _____ may accelerate or aggravate atherosclerosis as compared to ppl w/ relaxed lifestyles, eat well and exercise
Stress
Characteristics of ______:
- common in older men and almost everyone >50y/o have some degree of atherosclerosis
- Lesions vary from mild to severe
- Lesions may be focal to diffuse
- The mildest forms are found in young or middle-aged persons and such patients have fatty streaks (slightly raised fibrotic plaques)
Aortic atherosclerosis
Do fatty streaks progress to atheromas?
Yes
T/F:
Atheromas may rupture, become calcified and fibrosed, which may INCREASE the elasticity of the vessel.
FALSE
this REDUCES the elasticity of the vessel which causes weakness
Which condition?
In the final stages, the aorta is transformed into a rigid, calcified tube that has a rough, jagged, ulcerated internal surface covered focally with thrombi.
Atherosclerosis of the aorta
Atherosclerosis of the aorta:
Is the blood pressure affected by atherosclerosis?
Yes.
- The atherosclerotic aorta can’t adapt to the changes of blood pressure that occur during the normal cardiac contraction cycle.
- b/c the calcified aorta can’t expand during systole, HTN develops as the same amount of blood now passes through a narrower blood vessel.
- This pressure from inside causes dilation of the inelastic aorta–> aneurysm
Atherosclerosis of the aorta:
The pressure from inside causes dilatation of the inelastic aorta, which leads to the formation of ________.
Aneurysms
•Where do aneurysms of the aorta most commonly occur?
Atherosclerotic anerysms most often occur in the abdominal aorta
____________ occur most often in the abdominal aorta, are usually clinically silent, and many are discovered accidentally during a medical examination.
Atherosclerotic aneurysms
Small saccular aneurysms at the base of the brain involving the circle of Willis are called ________
Berry aneurysms
Most often ________ are fusiform, saccular or spindle-shaped.
aneurysms
What is the most feared complication of aneurysms?
rupture and death by exsanguination
What is the most feared complication of an aortic aneurysm?
A Dissecting Aneurysm:
When the jet of blood also dissects through the wall of the aorta and form a periarterial second lumen
-This may also be from the roof of the aorta
_______ can be resected surgically and replaced by an artificial vessel made of Dacron or Gortex material.
Aneurysms
T/F: The rupture of aneurysms is associated with a LOW mortality.
FALSE
The rupture of aneurysms is associated with a HIGH mortality.
What are the top 2 reasons that aortic root dissection occurs?
(verbally stated by Dr. Fischione in class)
85% due to high blood pressure
15% from Marfan’s syndrome
Most common location of an aortic dissection?
(Verbally stated by Dr. Fischione in class)
Aortic root dissection
