Cardiovascular 1

Question 1

vascular disease

Answer 1

responsible for more morbidity and mortality than any other cetegory of disease
two principal mechanisms:
narrowing or obstruction of vascular lamina
weakening of vascular walls, leading to dilation and/or rupture

Question 2

arteriosclerosis

Answer 2

hardening of the arteries

Question 3

artherosclerosis

Answer 3

affects larger arteries
characterized by atheroma, involves large and medium arteries
associated with formation of intimal lesions called atheromas plaques
atheromas protrude into the lumen of the vessel
atheromas can enlarge and obstruct blood flow
may weaken underlying media of the artery
plaques can rupture- resulting in catastrophic vessel thrombosis

Question 4

atherosclerosis epidemiology

Answer 4

high prevalence- united states, western europe
low prevalence- africa, far east
peak death rate from myocardial infarction- 54% in late 1960s
current death rate- 50% for all atherosclerosis- related complications (25% due to MI)

Question 5

monckeberg’s medial calcific sclerosis

Answer 5

medial calcification without luminal narrowing or intimal disruption

Question 6

arteriolosclerosis

Answer 6

affects arterioles
hyaline- thickening of basement membrane- hypertension and diabetes mellitus
hyperplastic (proliferative)-fibrocellular intimal thickening- malignant hypertension and scleroderma

Question 7

non modifiable risk factors of atherosclerosis

Answer 7

age- risk of acute myocardial infaction increases 5x in men between 40 and 60 years
gender- men>premenopausal women
genetics- most important factor- family history of MI

Question 8

potentially modifiable risk factors of atherosclerosis

Answer 8

cigarette smoking- 1 pack per day increases death rate by 200%. after cessation- risk gradually decreases
diabetes mellitus
hypertension- no specific level identifies increased risk
hypercholesterolemia- the higher the level of cholesterol and LDL, the greater the risk (Especially above 160 mg/dl)
HDL is inversely associated with atherosclerosis

Question 9

additional risk factors of atherosclerosis

Answer 9

inflammation (CRP- inflmmatory marker)
hyperhomocysteinemia
lipoprotein a levels
metabolic syndrome (obesity)
type a personality (stress) 
lack of exercise

Question 10

common sites of atheroma formation

Answer 10

major arterial branch points
abdominal aorta
coronary arteries
popliteal arteries
carotid arteries
cerebral arteries

Question 11

morphologic features of atheroma

Answer 11

plaques contain collagen, lipid, myofibroblasts, macrophages, neovascularization
fibrous cap- composed of smooth muscle cells (myofibroblasts) and collagen, develops over a central core of lipid/cellular debris with cholesterol
progressive changes in plaques include ulceration, fissure formation, thrombosis, embolization (thrombus or debris from the central core), calcification, hemorrhage into plaque from neovascularization , medial weakening

Question 12

response to injury hypothesis

Answer 12

endothelial injury- endothelial dysfunction
accumulation of lipoproteins- LDL and cholesterol in the vessel wall
monocyte adhesion- migration into intima with differentiation into macrophages and foam cells
lipid accumulation in the macrophages, with release of inflammatory cytokines
smooth muscle cell recruitment due to factors released from activated platelets, macrophages and vascular wall cells
smooth muscle cell proliferation and ECM (mostly collagen) production
fully developed plaque with collagen (fibrous cap) and central lipid core

Question 13

fatty streak

Answer 13

occurs in infants and children in atherosclerotic and nonatherosclerotic prone geographic areas
they can regress, some may progress to atheromas
characterized by lipid laden cells in the intima

Question 14

complications of atherosclerosis

Answer 14

ischemic heart disease
cerebral vascular accident (stroke)
gangrene
nephrosclerosis
aneurysm formation due to pressure atrophy of the media with altered balance of collagen synthesis/degradation

Question 15

prevalence of hypertension

Answer 15

25% of adults- increases with increasing age

Question 16

guidelines of hypertension

Answer 16

normal bp160/106

Question 17

symptoms of hypertension

Answer 17

none (early) at low and moderate hypertension
headache
fatigue
dizziness
palpitations

Question 18

secondary hypertension

Answer 18

primary renal disease renal artery narrowing or adrenal disorders- diseases that produce hypertension
hypertension is controlled when underlying disease is treated

Question 19

essential hypertension

Answer 19

accounts for 90% or more of all hypertension
contributing factors include genetics, stress, obesity, increased salt intake, inactivity, cigarette smoking
untreated hypertension tends to get higher and shortens life expectancy

Question 20

symptoms and complications of essential hypertension

Answer 20

most patients have no symptoms until organ damage has occurred
high bp causes headaches, fatigues, dizziness, palpitations

Question 21

pathogenesis of hypertension

Answer 21

hereditary factors
reduced renal sodium excretion-salt and water retention increased plasma volume- increased cardiac output
increased peripheral vascular resistance (vasoconstriction)
environmental factor- stress

Question 22

complications of hypertension

Answer 22

concentric left ventricular hypertrophy: compensated
LVH and ventricular dilation: decompensated (leads to CHF)
atherosclerosis and arteriolosclerosis
retinal injury
nephrosclerosis
dissecting hematoma of the aorta

Question 23

compensated hypertensive heart disease

Answer 23

left ventricular concentric hypertrophy provides normal cardiac output

Question 24

decompensated hypertensive heart disease

Answer 24

hypertrophy no longer adequate to provide normal cardiac output due to decreased myocardial contractility resulting in left ventricular dilation and gradual onset of CHF

Question 25

concentric hypertrophy

Answer 25

thickening of the left ventricular wall at the expense of the left ventricular chamber with little or no increase in the outside cardiac dimensions

Question 26

pathology of hypertension

Answer 26

concentric left venticular hypertrophy (compensated)
left ventricular hypertrophy plus dilation and congestive heart failure (decompensated)
atherosclerosis leads to ischemic heart disease, stroke, ischemic injury in other organs
arteriolosclerosis leads to retinal injury (visual disturbances_ and nephrosclerosis (renal failure)
dissecting hematoma of the aorta- longitudinal tear in the media

Question 27

malignant hypertension

Answer 27

relatively rapid onset of very high blood pressure- often superimposed on previous hypertension- very high systolic and diastolic pressures
medical emergency requiring prompt but cautious blood pressure lowering

Question 28

complications of malignant hypertension

Answer 28

cerebral edema with papilledema, retinal hemorrhage, severe headchae, vomiting, convulsions, transient blindness, encephalopathy, renal failure, heart failure, cerebral hemorrhage