Ch 11 Flashcards
What is arteriosclerosis defined as?
Hardening of arteries - arterial wall thickening and loss of elasticity
What are the types of arteriosclerosis? 4
- ArterioLOsclerosis
- Monckberg medial sclerosis
- Fibromuscular intimal hyperplasia
- Atherosclerosis
What is arterioLOsclerosis? Causes?
Hardening of small arteries, generally causes downstream ischemic injury.
HTN
What is Monckberg medial sclerosis?
Calcification of medial wall of muscular arteries and internal elastic membrane, DO NOt affect lumen. Usually older adults over 50. Not clinically significant.
What is fibromuscular hyperplasia? Causes?
Hardening of muscular arteries secondary to inflammation - trauma (balloon angio), healed arteritis
Stroke, coronary and peripheral vascular disease are cause by (type of vessel narrowing)
Atherosclerosis
What are the clinical signs of malignant hypertension?
SBP >200
Renal failure
Retinal haemorrhages and exudates-/+papilledema
What is the formula for cardiac output (CO)?
CO=HR x SV
When is renin released (trigger)?
Low pressure in glomerular AFFERENT arteriole
What does renin do?
Cleaves angiotensinogen (liver) to Ang I
What does Angiotensin II do?
Raises BP by:
1. Stimulate aldosterone(adrenal gland) to absorb Na and water in kidney (distal convoluted tubule)
2. Peripheral vasoconstriction
How does atrial natriuretic peptide affect BP?
Reduced BP by:
1. Vasodilation
2. Kidney excretion of Na and water
Causes of hypertension? 4
- Idiopathic (90%)
- Renovascular: eg renal artery stenosis, low flow leading to increased renin secretion
3.single gene disorders: eg aldosterone synthase leading to increased aldosterone - Protein mutations: Liddle syndrome, mutation in epithelial Na channel leads to increased reabsorption of Na
Onion skinning seen in blood vessel is which type of arteriosclerosis?
Hyperplastic
What are non modifiable causes of atherosclerosis? 4
- Family history
- Age
- Male gender
- Genetic abnormalities
What are the modifiable risk factors of atherosclerosis? 5
- Hyperlipidemia
- Hypertension
- Cigarette smoking
- Diabetes
- Inflammation
How do statins reduce cholesterol?
Inhibit HMG Coa reductase (limits liver synthesizing cholesterol)
How does diabetes cause atherosclerosis?
Induction of hypercholesterolemia
_____ (blood disease) is associated with premature vascular disease.
Hyperhomocysteinemia
____ (type of lipoprotein) is associated with coronary disease independent of cholesterol/LDL levels.
Lipoprotein A
What are atheromatous plaques made of? 2
Cholesterol and cholesterol esters
What are fatty streaks?
Lipid filled macrophages
Aneurysms cause by Ehler Danlos is due to defective (collagen type)
Type III
What proteins are responsible in degrading collagen?
Metalliproteinases (MMP)
What are the causes of aneurysms?
- Intrinsic quality of connective tissue is poor (Ehler Danlos)
- Excess TGFB (Marfan)
- Inflammation altering balance of collagen synthesis (aortitis increasing MMPs)
4.loss of SM (ischemia to artery secondary to tertiary syphilis)
____ (risk factor) is greater in AAA
Atherosclerosis
___(risk factor) is most common etiology in ascending aortic aneurysm
Hypertension
Clinical signs of thoracic artery aneurysm? 5
- Chest pain
- Myocardial ischemia (compression of coronary artery)
- Difficulty swallowing
- Hoarseness (laryngeal nerve irritation)
5.resp irritation
Young patient with backpain with high inflammatory markers could be —
Inflammatory AAA
What are the 2 types of aortic aneurysm?
- type A: involves ascending aorta, proximal.
- Type B: does not involve ascending aorta, distal.
What are the 2 types of vasculitis based on mechanism?
- Immune mediated nflammatory (non infective)
- Infective
What are the main immunologic mechanisms in non infective vasculitis? 4
- Anti-neutrophil cytoplasmic ab (ANCA)
- Anti-EC ab
- Immune complex deposition
- Autoreactive T cells