Cardiac Pathology Flashcards
Which layer of the Artery Wall is Endothelium in?
Tunica Interna
Which layer of the artery wall is Tunica Media in?
Smooth Muscle
What are the Key functions of Vascular Endothelial Cells?
- Semi-permeable Barrier
- Produce Nitric Oxide as local level BP control
- Prevent Platelets sticking to vessel walls
- Reduce inflammation
- Production of new blood vessels (Angiogensis)
What is the importance of L-arginine
- can be converted to Nitric Oxide by enzymes
- Smooth muscle cells causing relaxation
What cause endothelial cell dysfunction and what does it lead to?
- Atherosclerotic Risk Factors such as Diabetes, HTN, HLD, Cigarettes
- Reduced NO production
- Decreased Flexibility / reactivity of the vessel
- Atherogenesis (fatty streaks)
What is the first visible sign of Atherosclerosis
- Atherogenesis: Formation of abnormal fatty or lipid masses in arterial walls (fatty streaks)
What are Non-Modifiable Risk Factors?
- Gender
- Age
- Family History
What is Atherosclerosis and what can it lead to?
- Atherosclerosis is the hardening and narrowing of arteries due to plague buildup
- occurs because of the inflammation of the endothelium
- can lead to heart attack, stroke, or death
What is Plague made up of?
- Fat
- Cholesterol
- Calcium
- Other substances found in blood
What are fatty streaks and how do they develop?
- Lighter areas in arteries caused by lipid deposition
- Can eventually develop into plagues
- Initial visible lesion
- Presence of Foam cells
How does Endothelium damage lead to Foam cells?
- Endothelium damaged
- LDL comes in from the blood
- Endothelium sends marker
- Monocyte comes in and turn into Macrophages to eat the LDL
- Macrophages eat themselves to death and become Foam cells
What is Fibrous Cap?
- Composed of smooth muscle cells and collagen covering the plaque over luminal aspect
Vulnerable Plaque
- Thin fibrous cap, inflammatory cells, Large lipid core
- Ruptures, Thrombus, can lead to an Acute Coronary Syndrome
Stable Plaque
- Thick, smooth muscle cells, small lipid core
- Reduced Coronary Flow Reserve (CFR)
- Demand Ischema +/- Angina
What are the two main types of myocardial infarction?
- Full thickness (Transmural)
- Partial Thickness ( Sub-endocardial)
What are the characteristics of Myocardiac Ischemia?
- Compromised blood flow (caused by a blockage)
- Insufficient for Metabolic needs
- Demand greater than Supply
- Silent myocardial is ischemia
What is Angina Pectoris? and what are the typical presentations?
- Symptom of chest pain
- Squeezing, pressure, heaviness, tightness or pain
- Decreased blood flow with increased O2 demands
How can Angina symptoms be different in Women?
- Nausea, shortness of breath, abdominal pain or extreme fatigue
- can happen without chest pain
- discomfort in the neck, jaw or back
- can experience stabbing pain
How can you differentiate between stable and unstable angina?
Stable angina has a predictable threshold (occurs with exertion), while unstable angina is unpredictable, lasts over 15 minutes, and can lead to a myocardial infarction
What is Demand Ischemia?
Stable Angina
What is Supply Ischemia?
Unstable Angina
Which Angina is Chronic narrowing (atherosclerosis)?
- Stable Angina
Which Angina is Non-occlusive thrombosis / ruptured plaque?
- Unstable Angina
How to relieve symptoms of Stable Angina?
- rest
- reduce stress
- nitroglycerin
