Cardiovascular

Question 1

layers of vessel wall

Answer 1

Tunica Intima-endothelium, basement membrane
* internal elastic memb
Tunica Media - SM, elastic fibers
Tunica advetentia - areolar connective tissue.

Question 2

Properties of vascular smooth muscle cells (VSMC)

Answer 2

Contractility
Secretory - ECM, GF, proteases
Plasticity - hypertrophy, prolif, angiogenesis (in response to ischemia, injury)

Question 3

Virchow triad describes the formation of ___

Answer 3

Thrombosis

Question 4

Virchow triad:

Answer 4

1) EC injury via HTN, shear stress, turbulent flow, bacterial infection.
2) disruption in laminar flow
3) Hypercoagulability -less frequent

Question 5

alterations in blood flow occurs in ____ .

Answer 5

• atherosclerotic plaques
• aneurysms
• MI
• mitral valve stenosis

Question 6

Edema is defined as ___

Answer 6

excess fluid in the interstitial spaces.

Question 7

What maintains fluid balance inflow/outflow?

Answer 7

• normally, fluid entering arterial end of microcirculation is balanced by inflow into venular end
• excess fluid is drained by lymphatics, which returns to bloodstream via thoracic duct.

Question 8

Increased Hydrostatic Pressure occurs in ___ (2)

Answer 8

impaired venous drainage, CHF

Question 9

Decreased Oncotic Pressure occurs due to ___, seen in ____ (3 conditions).

Answer 9

• reduced albumin

- nephrotic syndrome, cirrhosis, protein malnutrition (reduced production of plasma proteins).

Question 10

Factors that contribute to the development of an infarct:

Answer 10

1. presence of alternative blood supply (dual arterial supply–liver, lungs, hands VS. end arterial–renal, splenic)
2. rate of development of occlusion - slow growing are less likely to infarct due to dev of alternative flow (pre-existing collaterals),
3. vulnerability to hypoxia - neurons, myocardial cells, fibroblasts within myocardium,
4. O2 content of blood - anemia, cyanotic patient, C

Question 11

consequences of a systemic thromboembolism are dependent on ___ and ___.

Answer 11

the collateral supply and caliber (diameter) of the vessel occluded

Question 12

Infarction is defined as ___

Answer 12

an area of ischemic necrosis due to occlusion of arterial supply or venous drainage.

Question 13

Endothelium plays secretory and modulatory role for vascular SM tone and platelet function by producing….

Answer 13

vasodilators: NO, PGI2 (prostocyclins).
vasoconstrictors: Endothelin.
keeps platelets from aggregating
keeps vascular SM from doing mitosis

Question 14

Metabolic role of endothelium includes processing of vasoactive factors including ___ and __

Answer 14

• antiotensin converting enzyme production of Ang II (vasoconstrictor)
• breakdown of bradykinin (inflammation)

Question 15

Flow through a region is governed mainly by ____

Answer 15

resistance of the microcirculation

Question 16

Factors that affect blood pressure

Answer 16

P's law: deltaP= RQ = uLQ/r4
*r = radius of vessel is MOST important. 
R= resistance
Q= flow
L= length of vessel

Question 17

3 types of regulation involved with local blood flow

Answer 17

• Metabolic regulation – local metabolites cause vasodilation mostly
• Auto-regulation – transmural pressure (against the wall) causes vasoconstriction mostly
• Shear stress-induced vasodilation– caused by longitudinal pressure gradient

Question 18

Vascular tone means __, which is controlled by ___ and ___

Answer 18

• state of contractility
• myogenic tone (intrinsic factors)
• Neurologic and Humoral tone (extrinsic factors)-sym neurons

Question 19

areas of bifurcation are more liekly to have aneurysms due to ___ and ___ induced injury

Answer 19

sheer stress and turbulance

Question 20

If you increase radius by 2, flow …

Answer 20

r^4 is directly correlated with flow (Q). So if r doubles, flow is 16x higher!

Question 21

Pressure fluctuations in formation of edema:

Answer 21

• increased hydrostatic pressure or decreased plasma oncotic pressure (colloid onc P) leads to net acccumilation extravascular fluids. Causes edema when lymphatics cant drain this.

Question 22

4 changes tht can cause edema:

Answer 22

1) INC capillary permeability (burns, allergic inflammation–loss of plasma prot)
2) DEC capillary oncotic pressure (dec plasma prot production– cirrhosis, malnutrition)
3) INC capillary Hydrostatic P (venous obstruction, renal Na/water retention, heart failure)
4) lymph obstruction (cant drain)

Question 23

Edema points to ___ and ___, which impairs ___ and ____

Answer 23

• underlying disease, inflammation

- inflammation points to impaired wound healing and reduced ability to fight infection.

Question 24

4 things that can dec CO and lead to edema

Answer 24

• Heart failure
• malnutrition, neohrotic syndrome (dec. prot synth+ BV)
• ascites, other effusions
• primary renal failure

Question 25

Levels of Renin, AngII, ald, ADH are high in heart failure, why?

Answer 25

to compensate for low CO, by increasing salt and water retention => inc plasma volume.

Question 26

___ is often the cause of arterial thrombi.

Answer 26

Cardiac dysfunction

Question 27

Disseminated Intravascular Coagulation

Answer 27

- forming excess clots due of widespread activation of thrombin. Thrombin doesn’t stay localized (everywhere) - not a primary disease, a complication. - a “consumptive coagulopathy”-- consumes all the clotting factors, so none left to form a clot if there is hemorrhage. - manage it with anticoagulants and fresh frozen plasma (FFP). - Widespread ischemia, infarction, hypoperfusion - decreased fibrinolysis—not enough to keep up with clot formation.

Question 28

DIC is a major concern during pregnancy bc _____

Answer 28

risk of hemorrhage is high, but not enough clots can be formed in DIC (wasting clotting factors) = blood loss *Bleeding is a sign of the inability to form a clot

Question 29

Why do we test for D-dimers to rule out DIC?

Answer 29

3rd step of normal thrombus formation (dissolution, fibrinolytic activity) requires fibrin degradation products (FDP)—particularly D-dimers. But in DIC, there isn't enough D-diners to keep up with clot formation.

Question 30

A pulmonary thoromboemboli is most likely to originate from ___

Answer 30

a venous thrombi from a deep vein of the leg.

Question 31

PE in a (medium/small) vessel is more likely to cause an infarct.

Answer 31

small (mediums have collaterals).

Question 32

Complications of Pulmonary vs. systemic thromboembolism

Answer 32

PR: sudden death, CV collapse, cor polmonale | Systemic TE: complication in lower extrimities, brain, kidney, spleen (depends on size of vessel and collaterals).

Question 33

embolism

Answer 33

detached solid, liquid, or gaseous mass (usually a thrombus) travelling throuhgh vessels.

Question 34

infarct

Answer 34

zone of necrosis caused by blocked venous drainage OR arterial supply.

Question 35

initiating events for an infarct:

Answer 35

- primarily embolus/thrombus - local vasospasm - swelling of a atheroma (hemorrhage within a plaque) - compression of a vessel (tumor)

Question 36

concentric vs. eccentric hypertrophy of heart walls

Answer 36

``` concentric = muscular/buff eccentric = baggy heart ```

Question 37

Causes of cardiogenic shock

Answer 37

pump failure due to: - intrinsic myocardial damage - ventricular arrhythmias - outflow obstructions

Question 38

Causes of hypovolumic shock

Answer 38

- hemorrhage, burns, trauma

Question 39

Causes of septic shock

Answer 39

Gm Negative endotoxins (bacterial LPS released = inflammation) Lead to: systemic vasodilation, pump failure/CV collapse, even DIC (EC injury, activation of coagulatory factors)

Question 40

Causes of neurogenic shock

Answer 40

anesthesia or spinal cord injury causes imbalance bw sympathetic and parasympathetic NS --> massive vasodilation

Question 41

intimal thickening forms ____. Exaggerated healing response to vascular injury leads to intimal thickening and may result in ____

Answer 41

- neointima (ECM secreted by dedifferentiated SM cells) | - stenosis or occlusion.

Question 42

a progressive disease characterized by systolic dysfunction and simultaneous enlargement of ALL chambers of the heart

Answer 42

Dilated cardiomyopathy

Question 43

- ventricular hypertrophy - strong, hyperkinetic contractions - impaired diastolic filling. - This heart is also incapable of stretching, so cannot effectively adjust stroke volume

Answer 43

Hypertrophic cardiomyopathy | asymmetric septal hypertrophy

Question 44

renal damage and decreased urine output starts in which stage of shock?

Answer 44

progressive stage * non progressive=compensations maintain perfusion * irreversible = renal shutdown, acute tubular necrosis. Cannot be corrected by hemodynamics.

Question 45

individuals with abdominal aortic aneurisms are at risk for ___ and ___

Answer 45

ischemic heart disease and stroke (due to systemic nature of atherosclerosis

Question 46

most common cause is ____ due to medial destruction, second is ___. Primary type of aneurism ___

Answer 46

- atherosclerosis - plaque formation in the intima - abdominal aortic aneurism = most common.

Question 47

aneurism

Answer 47

- localized abnormal dilation of vessel or heart | - primarily due to weakened wall.

Question 48

false aneurism vs. dissection

Answer 48

``` FA = hematoma, extravasation of blood in extravascular connective tissue Dissection = tear in intima, extravasation of blood into the wall, but no dilation. ```

Question 49

forward failure vs. backward failure

Answer 49

``` forward = inadequate CO backward = venous backup ```

Question 50

Left side hrt failure can occur due to _____ vs. Rt side failure can occur due to ___

Answer 50

L=Systemic HTN, mitral/aortic valve disease, ischemic heart | R= Left Ventricular failure (with or without pulmonary congestion and disease)

Question 51

in CHF when sympathetics and myocyte hypertrophy is insufficient to compensate, ___ happens to inc PRELOAD, and achieve ___

Answer 51

dilation = chamber enlargement = inc preload. | Compensated heart failure.

Question 52

associated with CHF

Answer 52

- backward failure: pulmonary congestion, edema, venous congestion, systemic edema - dyspnea due to dec lung compliance (congested remember) - ortopnea due to increased venous return - may become cyanotic and acidotic.

Question 53

Amount of activated thrombin > antithrombins in ____

Answer 53

DIC