Cardiovascular Disease

Question 1

What is Hyperlipidemia?

Answer 1

Increased cholesterol, phospholipids, and triglyceride levels in blood

Question 2

How are lipids transported in the blood?

Answer 2

Apoproteins

Question 3

What is a lipoprotein?

Answer 3

Apoprotein-lipid complex

Question 4

What are the different lipid densities?

Answer 4

LDL
VLDL
HDL

Question 5

Which lipids don’t you want in your blood?

Answer 5

LDL

VLDL

Question 6

Which lipids are good lipids?

Answer 6

HDL

Question 7

How are lipids transported into the blood through the intestinal tract?

Answer 7

Cholymicrons

Question 8

What is atherosclerosis?

Answer 8

Atheroma that forms in the intima of a larger blood vessel wall

Question 9

What is an atheroma?

Answer 9

Fibrofatty tissue

Question 10

What does atherosclerosis result in?

Answer 10

Hypoperfusion (ischemia) of tissues

Question 11

What is an infarction and what is it a result from?

Answer 11

Cell death due to ischemia

Question 12

What are the three stages of a lesion in atherosclerosis?

Answer 12

Fatty streak
Fibrous atheromatous plaque
Complicated lesion

Question 13

What is the “fatty streak” stage of a lesion?

Answer 13

Cells and lipids are deposited in the vessel wall resulting in discolouration. Change only occurs in blood vessel wall. There is still 90% patency of BV

Question 14

Describe the “fibrous atheromatous plaque” stage

Answer 14

Further deposition of cells (macrophage and platelets) lipids, fibres and smooth muscle cells. Change still only occurs in the vessel wall. 40%-50% compromise

Question 15

Describe “complicated lesion” stage

Answer 15

This stage triggers an MI, stroke. Change occurs in the lumen of the BV. The thrombus can be dislodged and travel elsewhere in the body and cause a blockage.

Question 16

Describe the pathogenesis of atherosclerosis

Answer 16

Monocytes and other inflammatory cells bind to endothelium, once monocytes enter endothelium they become macrophages. Macrophage release free radicals (causing more injury) and engulf lipids, foam cells release growth factor causing muscle cell proliferation in BV forming an atheroma, blood then hemorrhage a into plaque/atheroma resulting in a thrombus

Question 17

What is a macrophage that has engulfed a lipid called?

Answer 17

Foam cell

Question 18

Where are the most common sites for atherosclerosis?

Answer 18

Abdominal aorta and iliac arteries
Proximal coronary arteries
Thoracic aorta, femoral and popliteal arteries
Vertebral, basilar, and middle cerebral arteries

Question 19

What is hypertension?

Answer 19

Persistently increased blood pressure that cannot be brought back to normal

Question 20

Why is a normal blood pressure needed?

Answer 20

To properly perfuse tissues

Question 21

What are four major control systems of BP?

Answer 21

Arterial baroreceptors
Renin-angiotensin system
Vascular auto regulation
Regulation of fluid volume

Question 22

Where are arterial baroreceptors located?

Answer 22

Carotid artery and aorta

Question 23

How does the RAAS system regulate BP?

Answer 23

Enzyme renin is released by kidney which coverts angiotensin I to angiotensin II which increases BP by vasoconstriction, increases Na+ reabsorption in kidney

Question 24

How does the vascular auto regulation system regulate BP?

Answer 24

Vessels constricting or dilating on their own

Question 25

How does the regulation of fluid volume occur to regular BP?

Answer 25

ADH and aldosterone act on kidney to increase water and sodium reabsorption

Question 26

If someone has a BP that overlaps in two categories, how do we categorize their HTN?

Answer 26

Err on side of caution and categorize their HTN in the higher category

Question 27

What are risk factors of CVD?

Answer 27

``` Smoking HTN Hyperlipidemia High cholesterol Diabetes Obesity Physical inactivity ```

Question 28

What is malignant HTN?

Answer 28

When the diastolic BP is >120, very serious

Question 29

What are the manifestations of HTN

Answer 29

Increased BP

Question 30

What are late complications of HTN

Answer 30

Palpitations, AM headache, blurred vision, dizziness, organ damage

Question 31

What is the first type of treatment for HTN?

Answer 31

Lifestyle modifications (diet, exercise, weight loss)

Question 32

What is the first line drug therapy used for HTN?

Answer 32

Diuretic

Question 33

How does a diuretic decrease BP?

Answer 33

Kidneys excrete more water which decrease blood volume and decreases BP

Question 34

What do calcium channel blockers do to decrease BP?

Answer 34

They block the channel calcium takes to cross the cell membrane and is necessary for creating an action potential. The less calcium that crosses means the hearty decrease number or strength of beats

Question 35

What does an angiotensin II reception blocker do to decrease BP?

Answer 35

It blocks receptors that angiotensin II binds to and prevents vasoconstriction

Question 36

What do ACE I medications do to decrease BP?

Answer 36

They inhibit the enzyme (ACE) that conveys angiotensin I to angiotensin II