Cardiovascular Pathology 6

Question 1

_______ is the most common systemic disorder associated with pericarditis

Answer 1

uremia

Question 2

secondary pericarditis causes

Answer 2

MI, cardiac surgery, autoimmune causes such and Dressler’s Syndrome, SLE, radiation, rheumatic fever, uremia, malignancies

Question 3

fibrinous pericarditis is seen in what causes of pericarditis?

Answer 3

• RHD
• uremia
• post MI
• post viral

bread and butter appearance

Question 4

what are the 4 types of exudate seen in pericarditis?

Answer 4

• fibrinous
• fibrinous and hemorrhagic
• fibrinopurulent
• caseous

Question 5

clinical features of pericarditis

Answer 5

• high pitched friction rub

- chest pain not related to exertion and is relieved by leaning forward

Question 6

acute pericarditis, especially following _______ and _____ pericarditis can lead to _________

Answer 6

caseous and suppurative; constrictive pericarditis (diastolic dysfunction causing ↑ JVP and ↓ BP) which is similar to restrictive cardiomyopathy

Question 7

what are the 3 types of arteriosclerosis

Answer 7

• arteriolosclerosis: hyperplastic and hyaline; full thickness
• Monckeberg medial sclerosis: calcification in the media so no luminal thickening so no clinical features and is age related
• atherosclerosis

Question 8

atherosclerosis is a disorder of the _____ in the large arteries due to the formation of fibro fatty plaques called atheromas

Answer 8

intima;

Question 9

what vitamin deficiency is associated with atherosclerosis

Answer 9

• B12 and folate → homocystinuria (high homocysteine levels)

Question 10

risk factors of atherosclerosis

Answer 10

• plasma homocystine
• lipoprotein A
• stress
• type A personality
• obesity

Question 11

endothelial activation due to endothelial injury results in :

Answer 11

• ↑ permeability
• ↑ expression of adhesion molecules
• ↑ adhesion of leukocytes

Question 12

what are two major causes of endothelial injury

Answer 12

• hemodynamic factors (↑ frequency of lesions at branch points, otsia of vessels_
• hypercholesterolemia

Question 13

when lipids get phagocytized by macrophages, they release ____ that damages the EC

Answer 13

free radicals

Question 14

with hyperlipidemia, lipoproteins accumulate in the _____ which generated ____ lipids

Answer 14

intima; oxidized

Question 15

what are the atherogenic properties of the oxidized lipids in the intima?

Answer 15

• create foam cells when they are ingested by macrophages
• stimulate release of cytokines
• inhibits motility of macrophages in the lesion

Question 16

the cytokines released by the macrophages will cause the recruitment of _______

Answer 16

smooth muscles cells from the tunica media into the tunica intima → formation of plaque

Question 17

smooth muscle proliferation is required for the conversion of _______

Answer 17

fatty streak → fibrofatty atheroma

Question 18

macrophages release what cytokines in atherosclerosis

Answer 18

IL-1 and TNF

growth factors for SMC proliferation

Question 19

the thin fibrous cap in _____ atheromas is due to

Answer 19

unstable; MMP’s (matrix metalloproteinases) that are released by inflammatory cells eats on the fibrous cap

Question 20

lots of lipids in the plaque is a feature of stable or unstable?

Answer 20

unstable

Question 21

features of an unstable cap

Answer 21

• thin fibrous cap
• ↑ lipid
• ↑ T cells and macrophages
• ↓ smooth muscle cells
• slender fragile neovascularization

Question 22

lots of lipids in the plaque is a feature of stable or unstable?

Answer 22

unstable

Question 23

what are some complications of atherosclerosis

Answer 23

• calcification
• focal rupture or ulceration or both leading to thrombus or emboli
• hemorrhage
• aneurysmal dilation due to the atrophy of the the media

Question 24

highest frequency of sites susceptible to atherosclerosis

Answer 24

abdominal aorta > proximal contrary arteries > thoracic aorta, femoral and popliteal arteries > internal carotid arteries > cerebral, basilar and middle cerebral arteries