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AU17: Gen Pathology > Cariovascular Disease > Flashcards

Cariovascular Disease Flashcards

1
Q

What category of disease is responsible for more morbidity and mortality than any other?

A

Vascular disease

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2
Q

What are the two principal mechanisms for vascular disease?

A
  1. Narrowing or obstruction of the lumen

2. Weakening of vascular walls

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3
Q

Which level of artery controls blood pressure?

A

Arteriole

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4
Q

What type of vascular disease causes calcifications in the muscle walls and is clinically insignificant?

A

Monckeberg’s Disease

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5
Q

What are the two types of arteriolosclerosis (affects arterioles)?

A
  1. Hyaline: hypertension and diabetes

2. Hyperplastic: malignant hypertension

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6
Q

Which type of arteriosclerosis affects larger arteries?

A

Atherosclerosis

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7
Q

Which type of arteriosclerosis will have atheromas protruding into the lumen?

A

Atherosclerosis

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8
Q

What is the difference between hyaline and hyperplastic arteriolosclerosis?

A

Hyaline: thickening of basement membrane
Hyperplastic: Fibrocellular thickening

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9
Q

An enlargement of the vessel is protruding into the lumen of a large artery. The enlargement seems to have a necrotic center filled with cholesterol crystals. What vascular disease is this resulting from?

A

Atherosclerosis

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10
Q

What do people with atherosclerosis normally die from?

A

Myocardial Infarction (25%)

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11
Q

What are some non modifiable risk factors for atherosclerosis?

A
  1. Genetics: most important!
  2. Age: 40-60
  3. Gender: man
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12
Q

What are some modifiable risk factors for atherosclerosis?

A
  1. High LDL and low HDL cholesterol
  2. Diabetes
  3. Hypertension
  4. Smoking
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13
Q

What is the response-to-injury hypothesis in forming atheromas?

A
  1. Endothelial injury
  2. LDL and cholesterol accumulate in vessel wall
  3. Monocyte adhesion -> macrophages
  4. Inflammatory cytokines released -> smooth muscle cell recruitment
  5. Smooth muscle cells and macrophages engulf lipid
  6. Collagen released
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14
Q

Where are the most common sites of atheroma formation?

A

Major arteriole branches

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15
Q

What are some hallmark features of an atheromic plaque?

A

A fibrous cap (myofibroblasts and collagen) over a central core of lipid, cellular debris, and cholesterol

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16
Q

T/F: Fatty streaks are a sign of a progressing atheroma and must be treated.

A

FALSE

Seen in most children and they may regress, or progress into atheromas

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17
Q

T/F: Macrophages surrounding lipids are commonly seen in atherosclerotic plaques.

A

True

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18
Q

T/F: A plaque with a thick fibrous plaque is most vulnerable to complications.

A

FALSE

Thin fibrous cap is the most dangerous

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19
Q

What BP numbers correlate with moderate - severe hypertension?

A

160/106

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20
Q

T/F: Hypertension affects approximately 25% of the US.

A

True

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21
Q

What is the most common type of hypertension?

A

Essential hypertension

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22
Q

Left ventricular hypertrophy can be either compensated or decompensated. What is the difference?

A

Compensated: maintains normal cardiac output

Decompensated: loss of functions leads to ventricular dilation which can lead to congestive heart failure

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23
Q

Hypertension could eventually lead to ______________ which can cause ischemic heart disease, stroke, and ischemic injury to other organs.

A

Atherosclerosis

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24
Q

T/F: During concentric (compensated) hypertrophy the outside dimensions of the heart increase.

A

FALSE

Cardiac muscle fibers grow into the ventricle

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25
Q

Several different diseases may cause _________ hypertension.

A

Secondary

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26
Q

Cerebral edema and hemorrhage as well as encephalopathy are complications of which type of hypertension?

A

Malignant: rapid onset

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27
Q

Define congestive heart failure.

A

Failure of the heart to pump an adequate amount of blood to the organs

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28
Q

What are some mechanisms that can compensate for a failing heart?

A
  1. Neurohormonal systems: NE increases heart rate; renin-angiotensin system increases blood volume
  2. Frank-Starling: fibers contract more forcefully
  3. Myocardial hypertrophy: increased thickness into the lumen
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29
Q

What often causes compensatory mechanisms of CHF to fail?

A

Increased oxygen requirements

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30
Q

T/F: Left sided heart failure is much more common.

A

TRUE

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31
Q

What is the most common cause of right sided heart failure?

A

Left sided failure

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32
Q

What are the causes of left sided heart failure?

A
  1. Ischemic heart disease
  2. Hypertension
  3. Myocarditis
  4. Cardiomyopathy
  5. Valvular disease
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33
Q

A septal defect with a left-to-right shunt would cause CHF of which side?

A

Right

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34
Q

What is the most common clinical manifestation of left ventricular failure?

A

Pulmonary edema and congestion

35
Q

Cerebral hypoxia can be a result of CHF on which side?

A

Right and/or left

36
Q

Respiratory symptoms come from _____ sided failure, while edema in the periphery comes from ______ sided failure.

A

Left; right

37
Q

T/F: 90% of congenital heart disease has unknown causes.

A

True

38
Q

What is the difference between cyanotic and non-cyanotic heart disease?

A

Cyanotic: shunting of poorly oxygenated blood to systemic arteriole circulation bypassing the lungs

39
Q

What is the most common non-cyanotic heart disease?

A

Ventricular septal defect

40
Q

What is a patent ductus arteriousus? Cyanotic or non-cyanotic?

A

Connects aorta and pulmonary artery

Non-cyanotic

41
Q

What are the four anomalies that lead to the Tetralogy of Fallot?

A
  1. VSD
  2. Narrowed right ventricular outflow
  3. Overriding of the VSD by aorta
  4. Right ventricular hypertrophy
42
Q

What is a transposition of the great arteries?

A

A cyanotic heart defect where the ventricles empty into the wrong great artery

43
Q

What causes over 90% of ischemic heart disease?

A

Coronary artery atherosclerosis

44
Q

T/F: Ischemic heart disease is the leading cause of death in the U.S.

A

True

45
Q

A fissure in the fibrous cap of an atherosclerotic plaque in the coronary artery would lead to what?

A

Thrombosis in the coronary artery leading to ischemic heart disease

46
Q

Other than coronary artery issues, what are some other factors that can lead to IHD?

A
  1. Hypertension
  2. Shock/hypotension
  3. Pneumonia
  4. Anemia
47
Q

What are four clinical manifestations of IHD?

A
  1. Angina
  2. Myocardial infarction
  3. Chronic IHD with CHF
  4. Sudden cardiac death
48
Q

A patient comes in complaining of severe chest pain while exercising that gets better with rest. What is the diagnosis?

A

Stable angina

49
Q

The necrosis of cardiac muscle caused by ischemia is called __________.

A

Acute myocardial infarction

50
Q

How long does it take for an ischemic episode to cause irreversible myocyte injury and cell death?

A

20-40 minutes

51
Q

What is a secondary way that myocardial ischemia can lead to death?

A

Arythmia

52
Q

What molecules can be tested for as a potential warning for a heart attack?

A

CK-MB and troponin

53
Q

What is a possible complication in the treatment of myocardial infarction?

A

Reperfusion injury: muscle damage due to ROS

54
Q

In ________ cardiomyopathy the disease is confined to the heart muscle; in _________ cardiomyopathy there is a systemic disorder causing problems.

A

Primary; secondary

55
Q

What are the three types of cardiomyopathies?

A
  1. Dilated (most common)
  2. Hypertrophic
  3. Restrictive
56
Q

T/F: In dilated cardiomyopathy all four chambers are dilated.

A

True

57
Q

T/F: Genetics often plays a large role in dilated cardiomyopathy.

A

True

58
Q

T/F: Dilated cardiomyopathy involves poor atrial contractility.

A

FALSE

Ventricular

59
Q

Which type of cardiomyopathy prevents adequate filling of the ventricles (diastolic dysfunction)?

A

Hypertrophic cardiomyopathy (and restrictive)

60
Q

What virus is the most common cause for myocarditis in the U.S.?

A

Coxsackie A and B

61
Q

Recurrent bouts of acute rheumatic fever can lead to fibrosis and _________.

A

Mitral valve stenosis

62
Q

What is a stenosis?

A

Failure of valve to fully open

63
Q

Aschoff bodies are seen in which cardiac disorder?

A

Rheumatic carditis

64
Q

What is valve regurgitation?

A

Valve does not close completely

65
Q

What two cardiac disorders can cause mitral valve regurgitation?

A

IHD and endocarditis

66
Q

Myxomatous degeneration is a feature of _________.

A

Mitral valve regurgitation

67
Q

What are the common causes of aortic valve stenosis?

A

Fibrosis and calcification of valve from either:

  1. Chronic rheumatic valvular disease
  2. Advanced age
  3. Congenitive malformation
68
Q

What are the three mechanisms for aortic valve regurgitation?

A
  1. Valve cusp destruction (endocarditis)
  2. Myxomatous degeneration (weakened valve cusps)
  3. Dilation of aortic root
69
Q

What is the most common cause of infective endocarditis?

A

Bacterial infection in the heart valve

70
Q

What are the three important factors in the pathogenesis of infective endocarditis?

A
  1. Endocardial/endothelial injury due to abnormal blood flow
  2. Fibrin thrombi
  3. Organisms in the blood
71
Q

What is the difference between acute and subacute endocarditis?

A

Acute: short, prominent tissue destruction, previously normal valve

Subacute: long, less tissue destruction, previously abnormal valve

72
Q

What are some complications of infective endocarditis?

A
  1. Valvular regurgitation
  2. Rupture of chordate tendineae
  3. Spread of infection
  4. Thromboembolism
73
Q

What are the two forms of large vessel vasculitis?

A
  1. Giant cell (temporal) arteritis

2. Takayasu arteritis

74
Q

T/F: Both types of large cell vasculitis will have granulomatous inflammation.

A

True

75
Q

What type of vasculitis is typically referred to as the “pulseless disease”?

A

Takayasu arteritis

76
Q

A 30 year old comes in with granulomatous inflammation in the aortic arch. What is the diagnosis?

A

Takayasu arteritis

77
Q

Which type of vasculitis is often associated with renal failure?

A

Polyarteritis nodosa

78
Q

Which type of vasculitis often effects infants and young children?

A

Kawasaki disease

79
Q

________________ is associated with neutrophil-related endothelial damage mediated by PR3-ANCA.

A

Wegener granulomatosis

80
Q

Which type of vasculitis is specifically associated with cigarette smoke?

A

Thromoangiitis obliterans (Buerger Disease)

81
Q

Which forms of vasculitis are ANCA-positive?

A

Wegener’s granulomatosis and microscopic polyarteritis

Small vessel vasculitis

82
Q

What are the complications with a dissecting aortic hematoma?

A
  1. Hemorrhage

2. Branch obstruction

83
Q

What is a dissecting aortic hematoma?

A

A split between the mid and outer third of the tunica media

84
Q

Which type of aortic dissection causes the most complications?

A

Type A: involves ascending aorta

AU17: Gen Pathology (22 decks)

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