Clinical Pathophysiology of the Endothelium

Question 1

Endothelium Properties

Answer 1

anti-inflammatory
anti-thrombotic
vasodilatory

Question 2

Endothelium Definition

Answer 2

a tissue consisting of a single layer of cells that lines the blood and lymph vessels, heart, and some other cavities

Question 3

Intima Definition

Answer 3

endothelium + thin layer connective tissue

Question 4

Media Definition

Answer 4

vascular smooth muscle and connective tissue

Question 5

Adventitia Definition

Answer 5

Loose connective tissue

Question 6

Large Arteries vs Smaller Arteries vs Arterioles

Answer 6

more elastin vs more collagen vs more smooth muscle

Question 7

Nitric Oxide Function

Answer 7

Diffuses to smooth muscle in media and causes cGMP-mediated vasodilation

Question 8

Decreased NO causes what?

Answer 8

Oxidative stress

Question 9

Inflammatory Molecules?

Answer 9

Selectins
Cell Adhesion Molecules (CAM)
Cytokines

Question 10

Atherosclerotic Plaque Cycle

Answer 10

1) Macrophages take up oxidized LDL and become Foam Cells
2) Leads to SM cell activation to intima (produce ECM)
3) Apoptosis, fibrosis, ongoing inflammation

Question 11

Stable vs Vulnerable Plaque

Answer 11

Stable Plaque
-Rich in fibrous tissue
-Calcified
-Less lipid content
-Less inflammation
-Less apoptosis	
(Opposite in vulnerable)

Question 12

Stroke Common Mechanism

Answer 12

Atheroembolization from carotid bifurcation lesion.
Source lesion does not need to be obstructive
Usually occurs in the opthalmic artery

Question 13

MI Description

Answer 13

Ruptured plaque, in-situ thrombosis, not necessarily obstructive prior to rupture

Question 14

Angina Description

Answer 14

Stable, obstructive (>70% reduction) lesion

Question 15

Occlusive vs Non-occlusive

Answer 15

1) Occlusive is a medical emergency and must be recanalized immediately.
2) Non-occlusive can generally be treated well pharmacologically

Question 16

Unstable Angina vs NSTEMI

Answer 16

NSTEMI presents with serum biomarkers!

Question 17

PAD Types

Answer 17

1) Claudication- obstructive, stable plaque

2) Acute Limb Ischemia- obstructs blood flow w/o prior collateral development

Question 18

In-situ thrombosis

Answer 18

Development of an thrombus at the site of plaque rupture (as opposed to a down stream occlusion)

Question 19

Venous Thromboembolic Disease

Answer 19

1) deep venous thrombosis

2) pulmonary embolism

Question 20

Three causes of occlusion

Answer 20

1) Inflammation
2) Thrombosis
3) Spasm

Question 21

Do the Clinical Pathophys Endothelium Questions!!!!

Answer 21

NOW!