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Disease Mechanisms > Ch 11: Blood Vessels > Flashcards

Ch 11: Blood Vessels Flashcards

1
Q

what are the main cellular components of blood vessels

A

endothelial cells (EC)
smooth muscle cells (SMC)
extracellular matrix (ECM)

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2
Q

what three things make up the extracellular matrix of blood vessels

A

elastin
collagen
glycosaminoglycans

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3
Q

what are the 4 main roles of the blood vessels

A

transport blood to tissues
regulate blood flow to tissues
control blood pressure
secrete chemicals

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4
Q

what are the three layers of arteries and veins

A

intima
media
adventitia

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5
Q

the aorta is which type of vessel

A

elastic

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6
Q

middle sized arteries are what type of vessels

A

muscular

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7
Q

the smallest arteries are called what

A

arterioles

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8
Q

what is blood pressure

A

outward force that blood exerts on walls of blood vessels
unit it mmHg

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9
Q

where is blood pressure the highest and lowest

A

highest: systemic arteries
lowest: systemic veins

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10
Q

what are the two factors that determine arterial blood pressure

A

cardiac output and peripheral resistance

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11
Q

what is the relationship of cardiac output and peripheral resistance to blood pressure

A

as they both go up, blood pressure goes up
as they both go down, blood pressure goes down

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12
Q

what three parts of the nervous system affect vessel regulation

A

sympathetic and parasympathetic effects
baroreceptor reflex
chemoreceptor reflex

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13
Q

what three endocrine hormones affect vessel regulation

A

vasopressin
epinephrine
atrial natriuretic peptide

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14
Q

what is vasopressin and what does it do

A

endocrine hormone whose release is stimulated by anti-diuretic hormone (ADH)
increases blood pressure by causing the reabsorption of water by the kidney

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15
Q

what is epinephrine and what does it do

A

endocrine hormone that raises blood pressure by increasing heart rate, cardiac contractility, and vascular tone

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16
Q

what is atrial natriuretic peptide (ANP) and what does it do

A

endocrine hormone that acts as a vasodilator to decrease blood pressure

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17
Q

what is hypertension

A

disorder caused by effects from multiple different genetic and environmental factors
mostly affects small muscular arteries and arterioles
can lead to degenerative changes in vessel walls

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18
Q

which hypertension reading requires intervention

A

anything over >130/80 mmHg (ACC)
anything over >140/90 mmHg (ESC)

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19
Q

what are the two types of hypertension

A

primary and secondary

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20
Q

what is primary hypertension and what are three things that it influences

A

essential or idiopathic (unknown origin)
makes up 95% of cases
usually caused by increase in CO/PR
influences sodium reabsorption, aldosterone pathways, and the RAAS

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21
Q

how do genetic factors play a role in hypertension

A

single gene disorders lead to rare forms of hypertension
60 genetic loci that are susceptible

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22
Q

what are four environmental factors that play a role in hypertension

A

stress
obesity
physical inactivity
heavy salt consumption

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23
Q

what drugs are used to treat hypertension

A

diuretics
beta blockers
ACE inhibitors
calcium channel blockers
alpha blockers

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24
Q

what is secondary hypertension

A

5-10% of cases
altered hemodynamic (blood flow) functions due to primary disease/condition
usually due to an underlying renal or adrenal disease or renal artery stenosis (RAS)

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25
Q

what is the mechanism of secondary hypertension

A

renovascular HTN: renal arterial sclerosis causes decrease in glomerular flow and pressure in afferent arteriole; increased renin secretions; increase blood volume and vascular tone

primary hyperaldosteronism: most common cause; idiopathic or aldosterone secreting adenomas

single gene defects: increase aldosterone and reabsorption of sodium

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26
Q

what are the four types of secondary hypertension

A

renal
endocrine
cardiovascular
neurologic

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27
Q

what is the mechanism of primary hypertension

A

insufficient renal sodium excretion leads to increased volume
increased volume leads to increased CO/PR which increases blood pressure

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28
Q

what are the three general patterns of thickening of the vessel walls

A

arteriolosclerosis
monckeberg medial sclerosis
atherosclerosis

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29
Q

what is arteriolosclerosis

A

affects small arteries and arterioles
leads to luminal narrowing and ischemic injury
two types: hyaline and hyperplastic

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30
Q

what is monckeberg medial sclerosis

A

calcium deposits in the media of muscular arteries
common in those older than 50
doesn’t cause big issues because the diameter of the lumen stays the same

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31
Q

what is atherosclerosis

A

most common
affects elastic and muscular arteries; begins in the intima
accumulation of plaque (atheromas) which narrows lumen of vessel
can obstruct flow, rupture, or form aneurysms

32
Q

what are some acquired risk factors that can cause atherosclerosis

A

hypertension
cigarette smoking
hyperlipidemia (excess fat in blood)
diabetes
inflammation

33
Q

what is hyperlipidemia

A

excess amounts of fat in the blood due to a low amount of low density lipoprotein (LDL) removing it

34
Q

what are 2 inherited risk factors can cause atherosclerosis

A

family history
genetic abnormalities

35
Q

what are gender and age associated factors that can cause atherosclerosis

A

increasing age
male gender

36
Q

what are the two portions of an atherosclerotic plaque

A

fibrous cap and necrotic center

37
Q

what is the fibrous cap of an atherosclerotic plaque made of

A

smooth muscle cells, macrophages, foam cells, lymphocytes, collagen, elastin, proteoglycans, and new vasculature

38
Q

what are foam cells

A

macrophages that engulf lipids

39
Q

what is the necrotic center of an atherosclerotic plaque made of

A

cell debris, cholesterol crystals, foam cells, and calcium

40
Q

what are the five steps of atherosclerosis

A

1.) chronic endothelial injury
2.) endothelial dysfunction
3.) macrophage activation with smooth muscle recruitment
4.) macrophages and smooth muscle cells engulf lipids
5.) smooth muscle proliferation, collagen deposition, and extracellular lipids

41
Q

what is the overall pathophysiology of atherosclerosis

A

plaque lesion involves: lipoproteins, macrophages, and T cells interacting with endothelial and smooth muscle cells of arterial wall

42
Q

what are the four main complications of atherosclerosis

A

myocardial infarction (heart attack)
cerebral infarction (stroke)
aortic aneurysms
peripheral vascular disease (gangrene)

43
Q

what is a true aneurysm

A

all layers of vessel involved
blood confined within vessel
two types: saccular and fusiform
ex. ventricular aneurysm

44
Q

what is a saccular true aneurysm

A

one area of lumen is weakened and bulged

45
Q

what is a fusiform true aneurysm

A

entered area of vessel is weakened and bulged

46
Q

what is a fake aneurysm (pseudo aneurysm)

A

defect in vascular wall causes extravascular hematoma (out pouching of blood)
ex. ventricular rupture after MI

47
Q

what is an arterial dissection

A

defect in intima of vessel wall where blood tunnels through the medial and advential layers

48
Q

where is the most common area to get an intimal tear

A

ascending aorta

49
Q

can all aneurysms and dissections rupture?

A

yes

50
Q

what are the three things that directly cause structural weakness of arterial walls

A

aberrant TGF-beta signaling
loss of smooth muscle cells
changes in extracellular matrix

51
Q

what three things cause structural weakness in vessels

A

genetic defects, ischemia, or defective matrix remodeling

52
Q

what are some risk factors that lead to aneurysms

A

older age
smoking
trauma
vasculitis
congenital defects
infections

53
Q

what are the two most important causes of aortic aneurysms

A

atherosclerosis and hypertension

54
Q

what is an abdominal aortic aneurysms (AAA)

A

dilation of abdominal aorta
more common in men and smokers
can rupture, cause obstruction, embolism, or cause impingement
usually do to atherosclerosis

55
Q

what is a thoracic aortic aneurysm

A

dilation of thoracic aorta
presents with chest pain, ischemia, difficulty swallowing, hoarseness, and respiratory complications
usually do to hypertension

56
Q

what causes hoarseness in those with thoracic aortic aneurysms

A

recurrent laryngeal nerve

57
Q

what is an aortic dissection

A

blood separates from vessel wall and forms a blood filled channel within aortic wall
caused by hypertension
affects older men or those with diseases affecting aorta
can be iatrogenic (caused by a procedure) or from pregnancy
two types: A and B

58
Q

what is a DeBakey 1 type A aortic dissection

A

more common and devastating
affects ascending and descending aorta

59
Q

what is a DeBakey 2 type A aortic dissection

A

more common and devestating
only affects ascending aorta

60
Q

what is a DeBakey 3 type B aortic dissection

A

begins distal to subclavian artery
only in descending aorta

61
Q

what is vasculitis

A

inflammation of vessel wall

62
Q

what are some systemic manifestations of vasculitis

A

fever, malaise (unhappiness), myalgias (muscle pain), and arthralgias (joint pain)

63
Q

what are the two main causes of vasculitis

A

immune mediated inflamamtion
invasion of pathogens into vascular walls

64
Q

what is large cell vasculitis

A

usually caused by granulomatous disease
ex. giant cell arteritis

65
Q

what is giant cell arteritis

A

affects aorta and medium sized vessels
granule builds up in head vessels like superficial temporal artery
affects older than 40 or those with poly myalgia rheumatica
cells: lymphocytes and macrophages
presents with: facial pain or headache
treated with: steroids

66
Q

what is medium vessel vasculitis

A

can be caused by anti-endothelial cell antibodies
ex. Kawasaki disease

67
Q

what is Kawasaki disease

A

inflammation of medium and small sized vessels
presents with: fever, enlarged lymph nodes, rash, swelling of hands and feet, coronary artery aneurysms, mucositis, and bilateral conjunctivitis
treated with: aspirin

68
Q

what is small vessel vasculitis

A

eosinophilia, asthma, and granulomas (seen in infection/hypersensitivities)
ex. churg-strauss syndrome

69
Q

what is churg-strauss syndrome

A

immune complex mediated disease that affects medium and small sized vessels
cells: lymphocytes, macrophages, neutrophils, and lots of eosinophils
presents with: renal problems, GI bleeding, and skin involvement
seen in those with asthma and atopy (tendency to develop allergies)

70
Q

what’s another name for buerger disease

A

thromboangiitis obliterates

71
Q

what is thromboangitis obliterates (buerger disease)

A

affects medium and smaller sized arteries (tibial and radial arteries) as well as veins
cells: lymphocytes, macrophages, neutrophils, and eosinophils
causes thrombosis, fibrosis, scar tissue, and nerve involvement
common in young, male smokers
presents with: pain, claudication (muscle pain), and venous inflammation

72
Q

what are three complications of buerger’s disease

A

ulceration, gangrene, and amputation

73
Q

what are some characteristics of primary Raynaud phenomenon

A

affects 3-5% of population
usually young women symmetrically
triggered by hyperactivity of smooth muscle cells

74
Q

what are some characteristics of secondary Raynaud phenomenon

A

secondary to systemic diseases like SLE, scleroderma, buerger disease, and atherosclerosis
asymmetric involvement that worsens over time

75
Q

what are varicose veins

A

abnormally dilated and tortuous veins caused by increase intraluminal pressure by loss of support of vessel wall
usually involve superficial veins of leg
caused by prolonged standing, pregnancy, obesity, or a genetic predisposition
presents with: aching, swelling, eczema, and ulcerations
treated with: stockings or surgery

76
Q

what are the two most common sites for varicose veins

A

esophageal varies and hemorrhoids

Disease Mechanisms (19 decks)

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