Cardiac Path 2 (Atherosclerosis)

Question 1

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

Answer 1

Atherosclerosis

Question 2

•The role of ______ in Atherogenesis:

1. 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.
2. The trapped LDL’s inside the macrophages are transformed into foam cells.
3. 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.

Answer 2

Platelets

Question 3

Role of _________ in athrogenesis:

1. These lesions attract ______ which take up the released lipids and cell remnants from dying or injured smooth muscle cells.
2. _______ secrete cytokines, TNF, and other biologically active substances –> cause even more damage by stimulating collagen production, along with the damaged smooth muscle cells
3. The repair of the initial arterial lesion involves scarring due to collagen deposition, leading to hardening or sclerosis.

Answer 3

Macrophages

Question 4

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?

Answer 4

an Atheroma–> is the prototype lesion that bulges into the lumen of the artery.

Question 5

Atherosclerosis- etiology:

What are the integral parts of an Atheroma?

Answer 5

• 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.

Question 6

The major complication of the ________is hardening of the vessel, a consequence of calcification, precipitated by local tissue degeneration.

Answer 6

Atheroma

Question 7

Atherosclerosis: The Atheroma-

The lipids released from dead cells and abnormal cellular matrix attract calcium salts, seen on_____ as radiodense material.

Answer 7

X-rays

Question 8

What is considered a multifactorial disease (genetic+environmental) with the following risk factors:

1. Old Age
2. Sex (M>, but sex differences less after menopause)
3. Heredity
4. Lipid metabolism
5. HTN
6. Obesity
7. Diabetes
8. Cigarette smoking
9. Stress

Question 9

Which hormones have a protective effect against atherosclerosis?

Answer 9

Female sex hormones

-Women who take replacement estrogen therapy after menopause reduce the progression of atherosclerosis

Question 10

____________ 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.

Answer 10

Familial hypercholesterolemia

A hereditary risk factor for atherosclerosis

Question 11

_______accumulates in Atheromas and is one of the major pathogenic factors in the formation of atherosclerosis.

Answer 11

Lipid

Question 12

Atherosclerosis- Risk factors:

Elevated serum levels of _________directly correlate with the extent and severity, and with the early onset of clinical symptoms of Atherosclerosis

Answer 12

lipids-cholesterol, lipoproteins, and triglycerides

Question 13

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

Answer 13

HTN

Question 14

Possible reason for why _______ is a risk factor for Atherosclerosis:

1. 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.
2. ________may cause changes in the clotting system by damaging platelets, causing their aggregation and the release of biogenic substances from their cytoplas

Answer 14

HTN

Question 15

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

Answer 15

Obesity

Question 16

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).

Answer 16

Diabetes

Question 17

Risk factor of atherosclerosis:

Constant _____ may accelerate or aggravate atherosclerosis as compared to ppl w/ relaxed lifestyles, eat well and exercise

Answer 17

Stress

Question 18

Characteristics of ______:

1. common in older men and almost everyone >50y/o have some degree of atherosclerosis
2. Lesions vary from mild to severe
3. Lesions may be focal to diffuse
4. The mildest forms are found in young or middle-aged persons and such patients have fatty streaks (slightly raised fibrotic plaques)

Answer 18

Aortic atherosclerosis

Question 19

Do fatty streaks progress to atheromas?

Answer 19

Yes

Question 20

T/F:

Atheromas may rupture, become calcified and fibrosed, which may INCREASE the elasticity of the vessel.

Answer 20

FALSE

this REDUCES the elasticity of the vessel which causes weakness

Question 21

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.

Answer 21

Atherosclerosis of the aorta

Question 22

Atherosclerosis of the aorta:

Is the blood pressure affected by atherosclerosis?

Answer 22

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

Question 23

Atherosclerosis of the aorta:

The pressure from inside causes dilatation of the inelastic aorta, which leads to the formation of ________.

Answer 23

Aneurysms

Question 24

•Where do aneurysms of the aorta most commonly occur?

Answer 24

Atherosclerotic anerysms most often occur in the abdominal aorta

Question 25

____________ occur most often in the abdominal aorta, are usually clinically silent, and many are discovered accidentally during a medical examination.

Answer 25

Atherosclerotic aneurysms

Question 26

Small saccular aneurysms at the base of the brain involving the circle of Willis are called ________

Answer 26

Berry aneurysms

Question 27

Most often ________ are fusiform, saccular or spindle-shaped.

Answer 27

aneurysms

Question 28

What is the most feared complication of aneurysms?

Answer 28

rupture and death by exsanguination

Question 29

What is the most feared complication of an aortic aneurysm?

Answer 29

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

Question 30

_______ can be resected surgically and replaced by an artificial vessel made of Dacron or Gortex material.

Answer 30

Aneurysms

Question 31

T/F: The rupture of aneurysms is associated with a LOW mortality.

Answer 31

FALSE

The rupture of aneurysms is associated with a HIGH mortality.

Question 32

What are the top 2 reasons that aortic root dissection occurs?

(verbally stated by Dr. Fischione in class)

Answer 32

85% due to high blood pressure

15% from Marfan’s syndrome

Question 33

Most common location of an aortic dissection?

(Verbally stated by Dr. Fischione in class)

Answer 33

Aortic root dissection