Chapter 7, Section 1 Cardiovascular Pathology :

Question 1

What are the three functional layers of blood vessels ?

Answer 1

intima, media, adventitia

Question 2

Intima

Answer 2

single layer of endothelial cells supported by a basement membrane.

Question 3

What separates intima and media ?

Answer 3

Internal Elastic Lamina

Question 4

What is the Internal Elastic Lamina ?

Answer 4

made up of an organized band of elastin fibers

Question 5

Where are internal elastic lamina prominently visual ?

Answer 5

Muscular Arteries

Question 6

What is the media compound of ?

Answer 6

Smooth Muscle Cells with circular orientation

Question 7

Where is this layer best developed ?

Answer 7

Muscular Arteries

Question 8

Which system demonstrates greatest variation ?

Answer 8

Media

Question 9

Elastic fibers are prominent in ?

Answer 9

Media

Question 10

What is the importance of elastic fibers ?

Answer 10

provide a cushioning effect that smoothes blood pressure during the cardiac cycle

Question 11

What is adventitia composed of ?

Answer 11

Loose connective tissue with small blood vessels called vasa vasorum

Question 12

Role of Vasa Vasorum ?

Answer 12

• Penetrate the larger arteries to provide nutrition to the media.

Question 13

What is the function of the venous system ?

Answer 13

functions as a low- pressure collecting system of the return of blood from capillary networks to the heart.

Question 14

What type of flow happens in the veins ?

Answer 14

Laminar

Question 15

What are the three layers of the heart ?

Answer 15

Endocardium, Muscular Wall, and Epicardium

Question 16

What is endocardium ?

Answer 16

intima of blood vessels

Question 17

What is the muscular wall made of ?

Answer 17

cardiac myocytes

Question 18

What is epicardium ?

Answer 18

consisting of adipose tissue covered by mesothelium containing coronary arteries and veins.

Question 19

What are cardiac valves composed of ?

Answer 19

Fibrous annulus to which are attached to valve leaflets

Question 20

What are the valve leaflets made up of ?

Answer 20

Core collagen covered by endothelium

Question 21

Where do the valves get their nutrition ?

Answer 21

luminal blood

Question 22

What does arteriosclerosis mean?

Answer 22

hardening of the arteries and corresponds to three separate pathologic entities.

Question 23

What are the three separate pathologic entities arteriosclerosis ?

Answer 23

Atherosclerosis, Monckeberg’s medical calcific sclerosis, and arteriolosclerosis

Question 24

Arteriolosclerosis is markedly accelerated in individuals with ?

Answer 24

hypertension or diabetes mellitus

Question 25

What are the two forms of arteriosclerosis ?

Answer 25

Hyaline and Hyperplastic

Question 26

What is hyaline arteriolosclerosis ?

Answer 26

is typical of diabetes and consists of the thickening of arterial walls by amorphous protein deposits

Question 27

What does the hyaline arteriolosclerosis result from ?

Answer 27

leakage of plasma proteins into the blood vessel wall

Question 28

Hyperplastic Arteriolosclerosis

Answer 28

characterized by hypertrophy/hyperplasia of smooth muscle cells in the media of small arteries

Question 29

What does hyperplastic arteriosclerosis result in ?

Answer 29

concentric muscle layers with an "Onionskin" appearance

Question 30

The process of hyperplastic arteriosclerosis is observed in ?

Answer 30

Kidneys in the setting of severe (malignant) hypertension

Question 31

Where is Atherosclerosis almost universally present in ?

Answer 31

- larger arteries of Western population.

Question 32

How are atherosclerosis characterized ?

Answer 32

progressive accumulation of lipid, inflammatory cells, smooth muscle cells, and connective tissue within intima of large and medium arteries.

Question 33

What are the results of the accumulation of materials in atherosclerosis ?

Answer 33

Progressive luminal narrowing and predisposition to thrombosis, - end-organ ischemia and infarction

Question 34

What is the essential lesion of atherosclerosis ?

Answer 34

atheroma (atherosclerotic plaque)

Question 35

What does the atheroma (atherosclerotic plaque) develops as?

Answer 35

As an eccentric thickening of the arterial intima.

Question 36

Atheromas are composed of

Answer 36

cellular, lipid, and extracellular matrix components

Question 37

Reaction to Injury Hypothesis

Answer 37

the interaction of multiple types with each other and with chemical and inflammatory mediators drives the incremental growth of atherosclerotic plaques

Question 38

What are form cells ?

Answer 38

the accumulation of macrophages with lipid droplets in their cytoplasm

Question 39

What is the first step in atherogenesis ?

Answer 39

Foam cells

Question 40

What are the fatty streaks ?

Answer 40

Whiteish yellow, non-raised longitudinal streaks on the endothelial surface of arteries

Question 41

Fatty streaks appear to be precursors of ?

Answer 41

Atheromatous plaques

Question 42

Endothelial Cells are key players in

Answer 42

events in atherosclerosis and - produce many mediators that direct plaque formation - attract or recruit key inflammatory cells and platelets from the blood

Question 43

Endothelium

Answer 43

active tissue that maintains hemostasis, regulates vascular tone, and modulates leukocyte and platelet adhesion.

Question 44

What does endothelial injury can result from ?

Answer 44

- mechanical shear stress - hyperlipidemia - Free radicals - Hyperhomocysteinemia

Question 45

What cell are involved in the development of plaque?

Answer 45

monocytes/macrophages as well as T and B lymphocytes which are activated by cytokines.

Question 46

What type of feedback drives plaque formation forward ?

Answer 46

- Positive feedback

Question 47

How does HDL reduce plaque formation?

Answer 47

they carry cholesterol away to the liver for removal from the body

Question 48

Nationally recommended levels for total blood cholesterol should not exceed

Answer 48

200 grams/dL

Question 49

What do oxidized LDL and other chemotactic factors eventually stimulate ?

Answer 49

the migration of smooth muscle cells from the arterial media across the internal elastic lamina into the intima

Question 50

When foam cells are stimulated from PDGF, FGF, and TGF-alpha they produce ?

Answer 50

produce collagen, elastin, and proteoglycans to form a "fibrous cap" over the lipid core of the mature atheroma

Question 51

What causes the release of proangiogenic factors ?

Answer 51

Artheromas increase in size, hypoxia at their center

Question 52

What causes neovascularization ?

Answer 52

release of proangiogenic factors

Question 53

Episodes of hemorrhage contribute to ?

Answer 53

hemosiderin to the plaque core as well as additional lipid material and cholesterol, derived from erythrocyte, membranes

Question 54

Enlargement of the plaque eventually results in ?

Answer 54

- significant obstruction to vascular flow with resultant end organ ischemia.

Question 55

What are the major complications of atherosclerosis ?

Answer 55

- ischemic heart disease, myocardial infarction, stroke, and gangrene

Question 56

What can initiate occlusive thrombosis or release of microthrombi ?

Answer 56

- formation of small platelet and fibrin thrombi on the surface of atheromas

Question 57

What happens when the plaque ruptures ?

Answer 57

exposes highly thrombogenic components of the lipid core - stimulates the production of an occlusive thrombosis - release of atheroemboli (cholesterol crystals) into the coronary circulation.