Cardiovascular Flashcards
What is mitral stenosis? Which patients are more commonly affected?
Stiffening of mitral valve
More common among women (2/3)
What is mitral regurgitation? What are the consequences for the rest of the heart?
Value doesn’t close strongly enough to prevent back flow.
Causes dilation and hypertrophy of left atrium, pulmonary htn, edema
What is the relationship between arteriosclerosis and atherosclerosis?
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
Do men and women have equal risk for atherosclerosis?
Women have a lower risk until menopause. Then the risk evens out.
What is the fundamental lesion of atherosclerosis? What is it made of?
Atheroma:
- foam cells (cells with accumulated lipids) —> endothelial cells, macrophages, or leukocytes
- collagen, proteoglycans
- lipids and cholesterol
- fibrous cap
- necrotic center
What are the stages of progression of atheroma?
- fatty streak
- fibrous plaques
- complicated lesions
What are fatty streaks, and when do they appear?
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
Swishing sounds are called what?
Different names in the heart and the periphery
- murmur (heart)
- bruit (periphery)
2 theories for atherosclerosis:
- 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
What is Monckeberg’s sclerosis?
Sclerosis of the tunica media —> calcification/ossification of tunica media leads to reduced vasotone control (less ability to constrict or dilate)
Who is most commonly affected by Monckeberg’s sclerosis?
People with A-G-E
What is primary vs secondary HTN?
Which is usually higher?
Primary is idiopathic - usually lifestyle related
Secondary is a sequela of some other known condition like kidney disease.
*secondary is usually higher (yikes!)
What is arterioloscerlosis?
Most common types / causes?
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”
What is arteritis?
What 3 things are increased in this condition?
Inflammatory disease of the arteries
Increased:
- thrombosis
- aneurysms
- obliterating scars
What are 3 major subtypes of arteritis?
What is special about each?
- giant cell / temporal
- thromboangiitis obliterans, aka Buerger’s disease
- polyarteritis nodosa
Where is giant cell or temporal arteritis located?
The head region, most commonly the superficial temporal a.
What is polyarteritis nodosa?
vasculitis of small and medium arteries… an attack of the immune system on the vessels that results in nodular necrotic lesions
What is thromoangiitis (aka Buerger’s disease)?
Arteritis affecting dominantly the digital arteries of young male smokers - in extreme cases the tissue dies grossly and is resorbed
Most common location for atherosclerotic aneurysm?
Abdominal aorta
Common iliac aa.
*may cause LBP, especially that radiates into the abdomen
Most common location for syphilitic aneurysm?
Ascending aorta
Aortic arch
*tree bark grooves in intima!
Most common location for dissecting aneurysm?
Ascending aorta
Aortic arch
Most common location for berry aneurysm?
Base of brain - circle of willis and cerebral arteries
Why does tertiary syphilis cause aneurysms?
It damages or occludes the vaso vasorum.
Increase risk for dissecting aneurysm?
- 1 condition
- 1 congenital condition
HTN
Marfan’s syndrome - connective tissue failure due to defect in genes regulating fibrillin
What is a dissecting aneurysm?
Blood passes through a defect in the intima and separates the layers of the wall
What is the difference between phlebothrombosis and thrombophlebitis?
Phlebothrombosis = NON inflammatory
Phlebothrombitis = inflammatory
Both associated with thrombosis of veins, and there is not a clear distinction between them
What is the most common location for thrombi?
Deep veins of the leg and pelvis —> DVT!!
What is superior vena cava syndrome?
What are the common symptoms?
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
What is inferior vena cava syndrome?
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
What are varicose veins? What causes them?
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
What are the most common locations for varicose veins?
- superficial veins of lower extremities
- hemorrhoidal veins
- esophageal veins
- pampiniform plexus (vasculature around the spermatic cord)
What is the most common risk factor for varicose esophageal veins?
How do you know if you have them?
Cirrhosis of the liver = risk
If esophageal varicose veins rupture —> hematemesis (bloody vomit or spit up)
*this rupture is fatal 50% of the time.
