Cardiovascular

Question 1

What is mitral stenosis? Which patients are more commonly affected?

Answer 1

Stiffening of mitral valve

More common among women (2/3)

Question 2

What is mitral regurgitation? What are the consequences for the rest of the heart?

Answer 2

Value doesn’t close strongly enough to prevent back flow.

Causes dilation and hypertrophy of left atrium, pulmonary htn, edema

Question 3

What is the relationship between arteriosclerosis and atherosclerosis?

Answer 3

Arterio-
Is a general description of arterial stiffening

Athero-
Is a particular type of hardening, that also involves narrowing, due to the formation of plaques

Question 4

Do men and women have equal risk for atherosclerosis?

Answer 4

Women have a lower risk until menopause. Then the risk evens out.

Question 5

What is the fundamental lesion of atherosclerosis? What is it made of?

Answer 5

Atheroma:
- foam cells (cells with accumulated lipids) —> endothelial cells, macrophages, or leukocytes

• collagen, proteoglycans
• lipids and cholesterol
• fibrous cap
• necrotic center

Question 6

What are the stages of progression of atheroma?

Answer 6

• fatty streak
• fibrous plaques
• complicated lesions

Question 7

What are fatty streaks, and when do they appear?

Answer 7

Fatty streaks are deposits of foam cells (mostly macrophages) in the tunica intima

First appear in infants and usually go away

First appear pathologically as early as age 10

Question 8

Swishing sounds are called what?

Different names in the heart and the periphery

Answer 8

• murmur (heart)

- bruit (periphery)

Question 9

2 theories for atherosclerosis:

Answer 9

• injury reaction and repair: chronic inflammatory response leads to endothelial dysfunction resulting in monocyte adhesion, etc.
• monoclonal: proliferation of smooth muscle cells accumulating in tunica intima and collecting lipids

Question 10

What is Monckeberg’s sclerosis?

Answer 10

Sclerosis of the tunica media —> calcification/ossification of tunica media leads to reduced vasotone control (less ability to constrict or dilate)

Question 11

Who is most commonly affected by Monckeberg’s sclerosis?

Answer 11

People with A-G-E

Question 12

What is primary vs secondary HTN?

Which is usually higher?

Answer 12

Primary is idiopathic - usually lifestyle related

Secondary is a sequela of some other known condition like kidney disease.

*secondary is usually higher (yikes!)

Question 13

What is arterioloscerlosis?

Most common types / causes?

Answer 13

Stiffening of the arterioles

most common
Hyaline = accumulation of proteins in arteriole wall eventually narrowing lumen

Hyperplastic = concentric proliferation of intimal tissues, leading to an “onion skin arteriole”

Question 14

What is arteritis?

What 3 things are increased in this condition?

Answer 14

Inflammatory disease of the arteries

Increased:

• thrombosis
• aneurysms
• obliterating scars

Question 15

What are 3 major subtypes of arteritis?

What is special about each?

Answer 15

• giant cell / temporal
• thromboangiitis obliterans, aka Buerger’s disease
• polyarteritis nodosa

Question 16

Where is giant cell or temporal arteritis located?

Answer 16

The head region, most commonly the superficial temporal a.

Question 17

What is polyarteritis nodosa?

Answer 17

vasculitis of small and medium arteries… an attack of the immune system on the vessels that results in nodular necrotic lesions

Question 19

What is thromoangiitis (aka Buerger’s disease)?

Answer 19

Arteritis affecting dominantly the digital arteries of young male smokers - in extreme cases the tissue dies grossly and is resorbed

Question 22

Most common location for atherosclerotic aneurysm?

Answer 22

Abdominal aorta
Common iliac aa.

*may cause LBP, especially that radiates into the abdomen

Question 23

Most common location for syphilitic aneurysm?

Answer 23

Ascending aorta
Aortic arch

*tree bark grooves in intima!

Question 24

Most common location for dissecting aneurysm?

Answer 24

Ascending aorta

Aortic arch

Question 25

Most common location for berry aneurysm?

Answer 25

Base of brain - circle of willis and cerebral arteries

Question 26

Why does tertiary syphilis cause aneurysms?

Answer 26

It damages or occludes the vaso vasorum.

Question 27

Increase risk for dissecting aneurysm?

• 1 condition
• 1 congenital condition

Answer 27

HTN

Marfan’s syndrome - connective tissue failure due to defect in genes regulating fibrillin

Question 28

What is a dissecting aneurysm?

Answer 28

Blood passes through a defect in the intima and separates the layers of the wall

Question 29

What is the difference between phlebothrombosis and thrombophlebitis?

Answer 29

Phlebothrombosis = NON inflammatory

Phlebothrombitis = inflammatory

Both associated with thrombosis of veins, and there is not a clear distinction between them

Question 30

What is the most common location for thrombi?

Answer 30

Deep veins of the leg and pelvis —> DVT!!

Question 31

What is superior vena cava syndrome?

What are the common symptoms?

Answer 31

Restriction of blood flow in the vessel due to:

• thrombosis
• Congestive heart failure
• thorax cancer causing compression

Sympt:

• dusky skin discoloration of upper body and head
• headaches

Question 32

What is inferior vena cava syndrome?

Answer 32

Restriction of blood flow in the vessel due to cancerous mass in the para-aortic lymph

Sympt:
Dusky skin discoloration in the lower body regions —> due to blood pooling and unusual collateral circulation

Question 33

What are varicose veins? What causes them?

Answer 33

Distention of veins allowing for blood pooling

Most common where there is little external support from musculature or where there are failing valves allowing retrograde flow

Question 34

What are the most common locations for varicose veins?

Answer 34

• superficial veins of lower extremities
• hemorrhoidal veins
• esophageal veins
• pampiniform plexus (vasculature around the spermatic cord)

Question 35

What is the most common risk factor for varicose esophageal veins?

How do you know if you have them?

Answer 35

Cirrhosis of the liver = risk

If esophageal varicose veins rupture —> hematemesis (bloody vomit or spit up)

*this rupture is fatal 50% of the time.