Cardio - Mechanisms of Disease - Valvular Heart Disease; Arteriosclerosis; Hypertension Flashcards
1
Q
What are the layers of any heart valve underneath the endothelium?
A
Fibrosa (collagen);
spongiosa (central core)
2
Q
Any/all valve diseases predispose to __________ _______itis.
A
Any/all valve diseases predispose to infective endocarditis.
3
Q
Cardiac valvular _________ is almost always chronic, while valvular _________ can be either acute or chronic.
A
Cardiac valvular stenosis is almost always chronic, while valvular regurgitation can be either acute or chronic.
4
Q
The mitral valve has a(n) _________ leaflet and a(n) _________ leaflet.
A
The mitral valve has an anterior leaflet and a posterior leaflet.
5
Q
Aortic stenosis can lead to what sort of effects in the left ventricle?
A
Hypertrophy;
ischemia;
dilation
6
Q
Stenosis of the cardiac valves most commonly leads to _________ ventricular hypertrophy.
A
Stenosis of the cardiac valves most commonly leads to concentric ventricular hypertrophy.
7
Q
Valvular insufficiency of the cardiac valves most commonly leads to _________ ventricular hypertrophy.
A
Valvular insufficiency of the cardiac valves most commonly leads to eccentric ventricular hypertrophy.
8
Q
Syncope is loss of consciousness due to what?
A
Poor brain perfusion
9
Q
What is the main etiology of mitral stenosis?
A
Rheumatic fever
10
Q
Mitral stenosis has what effect on the left atrium?
How does this present on EKG?
A
Left atrial overload/dilation;
‘notched’ P wave
11
Q
True/False.
Rheumatic fever can lead to mitral stenosis, myocarditis, and fibrinous pericarditis.
A
True.
12
Q
What type of histological change is apparent in cases of myocarditis resulting from rheumatic fever?
A
Aschoff bodies
(granulomas made of Anitschkow cells surrounding areas of fibrinoid necrosis)
13
Q
Describe the Aschoff bodies seen in cases of myocarditis resulting from rheumatic fever.
A
Granulomas made of Anitschkow cells surrounding areas of fibrinoid necrosis
14
Q
Rheumatic fever most commonly causes what two valvular lesions?
A
- Mitral stenosis
- Aortic stenosis
15
Q
The mitral stenosis associated with rheumatic fever is often referred to as having a ‘______-mouth’ deformity.
A
The mitral stenosis associated with rheumatic fever is often referred to as having a ‘fish-mouth’ deformity.
16
Q
Name the described valvular disorder:
degenerative calcium deposits in the mitral valve near the base of the leaflets
A
Mitral annular calcification
17
Q
Mitral annular calcification is most common in what patient population?
A
Females over 60
18
Q
How severely does mitral annular calcification typically affect valvular function?
A
It typically does not.
19
Q
Although typically asymptomatic, what are some of the major complications associated with mitral annular calcification?
A
Mitral regurgitation or stenosis;
AV conduction defects (and associated arrhythmias);
thrombosis, endocarditis
20
Q
True/False.
Cardiac valvular regurgitation almost always results due to defects in the valve leaflets.
A
False.
Cardiac valvular regurgitation can occur due to defects in the valve leaflets, valve annulus, and/or papillary muscles.
21
Q
True/False.
Both mitral stenosis and mitral regurgitation can lead to left atrial dilatation.
A
True.
22
Q
About 50% of cases of mitral regurgitation results from what?
A
Floppy valve
(often acute)
23
Q
Most cases of mitral valve prolapse are ___________ (cause).
A
Most cases of mitral valve prolapse are idiopathic.
24
Q
Mitral prolapse is most often a result of ___________ degeneration that leads to a floppy valve.
A
Mitral prolapse is most often a result of myxomatous degeneration that leads to a floppy valve.
25
Mitral valve prolapse can be found in \_\_\_\_% of the population, most commonly in **females** between ages ____ and \_\_\_\_.
Mitral valve prolapse can be found in **_5_**% of the population, most commonly in **females** between ages **_20_** and **_40_**.
26
What are the three major forms of arteriosclerosis?
1. Atherosclerosis
2. Arteriolosclerosis
3. Mönckeberg medial calcific sclerosis
27
Atherosclerosis is a thickening of the tunica ________ in medium or large arteries.
Arteriolosclerosis is a thickening of the tunica ________ in arterioles (i.e. small arteries).
Mönckeberg medial sclerosis is a thickening of the tunica ________ in medium or large arteries.
Atherosclerosis is a thickening of the tunica **_intima_** in medium or large arteries.
Arteriolosclerosis is a thickening of the tunica **_intima_** in arterioles (i.e. small arteries).
Mönckeberg medial sclerosis is a thickening of the tunica **_media_** in medium or large arteries.
28
Atherosclerosis is a thickening of the tunica intima in ________ (size) arteries.
Arteriolosclerosis is a thickening of the tunica intima in ________ (vessel).
Mönckeberg medial sclerosis is a thickening of the tunica media in ________ (size) arteries.
Atherosclerosis is a thickening of the tunica intima in **_medium or large_** arteries.
Arteriolosclerosis is a thickening of the tunica intima in **_arterioles_** (i.e. small arteries).
Mönckeberg medial sclerosis is a thickening of the tunica media in **_medium or large_** arteries.
29
What are the two main forms of arteriolosclerosis?
Hyaline;
hyperplastic
30
Mönckeberg medical calcific sclerosis occurs in what blood vessel layer?
The **medial** layer (in the elastic lamina)
31
Atherosclerosis refers to what?
Lipid accumulation in vascular lesions
32
Atherosclerosis most commonly occurs in which vessels?
Elastic and muscular arteries
33
In descending order, name the four arteries most commonly affected by atherosclerosis.
1. **Abdominal** **aorta**
2. **Coronary** arteries
3. **Popliteral** arteries
4. **Internal carotid** arteries
34
Why is atherosclerosis often seen at vessel branch points?
Increased turbulence
35
What process converts a fatty streak into a true atheroma?
Smooth muscle proliferation
36
Atheromas are more likely to rupture if they have a _____ core and _____ fibrous cap.
Atheromas are more likely to rupture if they have a **_necrotic_** core and **_thin_** fibrous cap.
37
What is the initial step of atherosclerosis?
Endothelial damage
38
The steps of atherosclerosis:
## Footnote
1. ____________ cell damage
2. _________ oxidation/deposition beneath the endothelium
3. _________ enter the area and are converted to _______ cells
4. __________ response, \_\_\_\_\_\_\_\_, and smooth muscle \_\_\_\_\_\_\_\_\_
The steps of atherosclerosis:
## Footnote
1. **_Endothelial_** cell damage
2. **_Lipid_** oxidation/deposition beneath the endothelium
3. **_Monocytes_** enter the area and are converted to **_foam_** cells
4. **_Inflammatory_** response, **_fibrosis_**, and smooth muscle **_proliferation_**
39
Describe the appearance/structure of an atheroma in a coronary artery.
40
What does it mean if an atheroma is 'complicated?'
It could **rupture**, **bleed**, or **calcify**
41
The inflammatory process that converts fatty streaks to atheromas is driven by which cytokines?
**PDGF**, **FGF**, **TGF-a**
42
An atheromatous lesion shows a variety of small slits and spaces in the layer of plaque beneath endothelium. What are these called?
**Cholesterol clefts**
(places where now-phagocytosed lipids used to be)
43
**True/False**.
The thinner the fibrous cap and the fewer the number of foam/inflammatory cells, the more likely an atheroma is to rupture.
**False**.
The thinner the fibrous cap and the ***greater*** the number of foam/inflammatory cells, the more likely an atheroma is to rupture.
44
Although there is no good way to measure the number of inflammatory cells in an atheroma pre-mortem, ______ is an inflammatory marker that correlates with a higher risk of atheromatous rupture.
Although there is no good way to measure the number of inflammatory cells in an atheroma pre-mortem, **_CRP_** is an inflammatory marker that correlates with a higher risk of atheromatous rupture.
45
Do atheromas typically develop in the medial or lateral walls of arterial branch points?
**Lateral**
(where flow is slowest and eddies can form)
46
Myocardial infarction and stroke are most commonly due to what event?
Plaque rupture
47
Atherosclerotic **emboli** are distinguished by what characteristic histological appearance?
Cholesterol clefts
48
What form of arteriolosclerosis is shown here?
Hyaline arteriolosclerosis
49
Name the two most common causes of hyaline arteriolosclerosis.
1. **Benign hypertension**
2. **Diabetes mellitus** (non-enzymatic glycosylation leads to protein deposition)
50
Name the renal disease that hyaline arteriolosclerosis leads to in diabetics.
**Arteriolonephrosclerosis**
(glomerular scarring which then progresses to chronic renal failure)
51
\_\_\_\_\_\_\_\_ arteriolosclerosis is most commonly seen in either malignant hypertension or vasculitis.
**_Hyperplastic_** arteriolosclerosis is most commonly seen in either malignant hypertension or vasculitis.
52
What form of arteriolosclerosis is shown here?
Hyperplasic arteriolosclerosis
53
Name the most common cause of hyperplastic arteriolosclerosis.
Malignant hypertension
54
**Hyperplastic** arteriolosclerosis often occurs due to hypertension and is most often seen in the vessels of the \_\_\_\_\_\_\_\_. It is probably a result of increased cytokine release calling for increased _______ \_\_\_\_\_\_\_ proliferation.
**Hyperplastic** arteriolosclerosis often occurs due to hypertension and is most often seen in the vessels of the **_kidney_**. It is probably a result of increased cytokine release calling for increased **_smooth_** **_muscle_** proliferation..
55
Fibrinoid necrosis is an end-result of ___________ arteriolosclerosis.
Fibrinoid necrosis is an end-result of **_hyperplastic_** arteriolosclerosis.
56
What renal outcome is classically associated with hyperplastic arteriolosclerosis?
**Acute renal failure**
| (with 'flea-bitten' appearance)
57
Atherosclerosis is characterized by lipid deposits below the tunica \_\_\_\_\_\_, while Mönckeberg sclerosis is characterized by calcifications in the tunica \_\_\_\_\_\_\_\_.
Atherosclerosis is characterized by lipid deposits below the tunica **_intima_**, while Mönckeberg sclerosis is characterized by calcifications in the tunica **_media_**.
58
Atherosclerosis is characterized by _______ deposits below the tunica intima, while Mönckeberg sclerosis is characterized by _______ in the tunica media.
Atherosclerosis is characterized by **_lipid_** deposits below the tunica intima, while Mönckeberg sclerosis is characterized by **_calcifications_** in the tunica media.
59
Mönckeberg calcific sclerosis most commonly affects the _______ (location) arteries and is of _______ (little/severe) clinical significance.
Mönckeberg calcific sclerosis most commonly affects the **_radial_** arteries and is of **_little_** clinical significance.
60
While taking a blood pressure on a healthy 73-year-old man, you notice that his radial artery feels hard beneath your finger. Assuming this is an issue with the tunica media of his arteries, what is your next step in management?
**Nothing**.
Mönckeberg calcific sclerosis is not clinically significant.
61
How might Mönckeberg calcific sclerosis appear on X-ray?
Opaque, twisted vessels
(highly visible due to calcium deposits)
62
Why does Mönckeberg calcific sclerosis not carry much clinical significance?
## Footnote
*(Even when arteries in the upper and lower extremities are highly calcified and visible on X-ray)*
The calcifications are in the tunica media and do not affect the lumen
63
What is a true aneurysm?
One involving all wall layers
64
What is a false aneurysm?
An aneurysm that does not involve all the wall layers
65
A dissection is a form of ______ aneurysm.
A dissection is a form of **_false_** aneurysm.
66
Name the three main causes of aortic aneurysm formation.
***ASC***
1. **Atherosclerosis**
2. **Syphilis**
3. **Cystic medial degeneration** (dissection)
67
What are the two pre-disposing factors that are necessary to the development of a dissection?
1. High pressure
2. Pre-existing medial weakness
68
Hypertension increases risk of aortic dissection by causing hyaline arteriolosclerosis of what vessels?
The vasa vasorum
69
The most common cause of aortic dissection is long-standing \_\_\_\_\_\_\_\_\_\_\_.
The most common cause of aortic dissection is long-standing **_hypertension_**
(***hyaline arteriolosclerosis of vasa vasorum + high intra-aortic pressures***).
70
Understand the difference between the following types of aneurysm:
## Footnote
**Saccular**
**Fusiform**
**Dissecting**
**Saccular** (balloon)
**Fusiform** (football)
**Dissecting** (false lumen)
71
Abdominal aortic aneurysms are ________ (shape) aneurysms and typically occur below the ________ arteries.
Abdominal aortic aneurysms are **_fusiform_** aneurysms and typically occur below the **_renal_** arteries.
72
Abdominal aortic aneurysms typically occur below the ________ arteries and above the ________ \_\_\_\_\_\_\_\_.
Abdominal aortic aneurysms typically occur below the **_renal_** arteries and above the **_aortic_** **_bifurcation_**.
73
Most aortic aneurysms occur in what two locations?
1. Thoracic
2. Abdominal
74
Where do syphilitic aortic aneurysms typically occur?
Just distal to the aortic valve
75
Syphilitic aneurysms are __________ (shape) aneurysms.
Syphilitic aneurysms are **_saccular_** aneurysms.
76
Aortic dissections typically begin within the first ____ cm of the aorta.
Aortic dissections typically begin within the first **_10_** cm of the aorta.
77
The cause of aortic dissection is often a loss of \_\_\_\_\_\_\_\_.
The cause of aortic dissection is often a loss of **_elastin_**.
78
Where do the majority of aortic dissections begin?
The first 10 cm of the aorta
| (highest pressures)
79
What is the most common cause of death in a patient with an aortic dissection?
Cardiac tamponade
80
**True/False**.
Aortic aneurysms increase the risk of thrombi/emboli formation.
**True**.
(The ballooned section develops low-pressure areas, leading to stagnant/turbulent flow.)
81
Aortic dissections typically occur in what two patient populations?
1. **Men aged 40-60 with hypertension**
2. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
1. Men aged 40-60 with hypertension
2. **_Individuals with connective tissue disorders (Ehlers-Danlo, Marfan)_**
82
Aortic dissections typically occur in what two patient populations?
1. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
2. **Individuals with connective tissue disorders (Ehlers-Danlo, Marfan)**
1. **_Men aged 40-60 with hypertension_**
2. Individuals with connective tissue disorders (Ehlers-Danlo, Marfan)
83
Type ____ aortic dissections involve the ascending aorta.
Type **_A_** aortic dissections involve the ascending aorta.
84
Type ____ aortic dissections involve the descending aorta.
Type **_B_** aortic dissections involve the descending aorta.
85
Type A aortic dissections involve the ___________ aorta.
Type B aortic dissections involve the ___________ aorta.
Type A aortic dissections involve the **_ascending_** aorta.
Type B aortic dissections involve the **_descending_** aorta.
86
What aortic pathology is associated with a tearing pain that radiates to the back?
Aortic dissection
87
What is the triad of signs/symptoms that presents in rupture of an aortic aneurysm?
1. Pulsatile abdominal mass
2. Hypotension
3. Flank pain
88
Abdominal aortic aneurysms are at an especially high risk of rupture when ≥ ____ cm.
Abdominal aortic aneurysms are at an especially high risk of rupture when ≥ **_5_** cm.
89
Cystic medial degeneration in the aorta is often characterized by a loss of what substance in the tunica media?
Elastin
90
What value is the normal cut-off for classifying a systemic blood pressure as hypertensive?
≥ 140 / 90 mmHg
91
**True/False**.
Although ≥90% of cases of hypertension are primary (essential) and idiopathic (poorly understood), we do know what the risk factors for primary hypertension are (e.g. race, age, obesity, stress, lack of physical activity, high-salt diet, smoking, etc.).
**True.**
92
Malignant hypertension occurs acutely (may be de novo or due to an exacerbated benign hypertension) as pressures increase to be ≥ \_\_\_\_\_/\_\_\_\_\_ mmHg.
Malignant hypertension occurs acutely (may be de novo or due to an exacerbated benign hypertension) as pressures increase to be ≥ **_200_**/**_120_** mmHg.
93
Name the most common cause of secondary hypertension.
Renal artery stenosis
94
Renal artery stenosis manifests as hypertension with a(n) ________ (increased/decreased) plasma renin and a(n) ________ (hypertrophic/atrophic) affected kidney.
Renal artery stenosis manifests as hypertension with an **_increased_** plasma renin and an **_atrophic_** affected kidney.
95
What is the most likely cause of renal artery stenosis in an older male?
Atherosclerosis
96
What is the most likely cause of renal artery stenosis in a young female?
**Fibromuscular dysplasia**
(developmental defect resulting in thickened medium-sized arteries)
97
What is benign hypertension?
A clinically silent, mild-to-moderate elevation in BP
98
On routine mammogram in an older patient, you note long calcified lesions that appear to follow blood vessels. This could be a sign of what benign form of arteriosclerosis?
Mönckeberg medial sclerosis
