CV lecture 1- Arteriosclerosis and Hypertension

Question 1

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

Answer 1

vascular disease

Question 2

name the 2 principal mechanisms of vascular disease

Answer 2

1) Narrowing or obstruction of vascular lumina

2) Weakening of vascular walls, leading to dilation and/or rupture

Question 3

atherosclerosis is characterized by _________, which are A fatty deposit in the inner lining (intima) of an artery

Answer 3

atheromas

Question 4

ahterosclerosis effects the _________ and _________ arteriolies

Answer 4

medium and large

Question 5

what condition is classified by: medial calcification without luminal narrowing or intimal disruption

Answer 5

Mönckeberg’s medial calcific sclerosis

Question 6

what are the 2 types of atherosclerosis? (describe both types)

Answer 6

1) hyaline type: thickening of basement membrane

2) hyperplastic (proliferative) type: fibrocellular intimal thickening

Question 7

malignant hypertension and scleroderma both cause what type of atherosclerotic formation?

Answer 7

hyperplastic

Question 8

hyaline type athrosclorosis is caused by _________ and ________

Answer 8

hypertension and diabetes mellitus

Question 9

Atheromas protrude into the ______ of the vessel

Answer 9

lumen

Question 10

how can atheromas cause injury to the body?

Answer 10

1) can enlarge and obstruct blood flow
2) May weaken the underlying media of the artery (aneurysm)
3) Plaques can rupture, resulting in catastrophic vessel thrombosis

Question 11

what regions of the world have a high prevalence for atherosclerosis? which regions have a low prevalence?

Answer 11

High Prevelance – United States, Western Europe

Low Prevelance – Africa, Far East

Question 12

name the Non-modifiable (“constitutional”) modifiers for risk of atherosclerosis

Answer 12

Genetics (family history) – most important in this group

Increasing age

Male gender

Question 13

what are the major modifiable risk factors for atherosclerosis?

Answer 13

Hypercholesterolemia – high LDL, low HDL

Diabetes Mellitus

Hypertension

Cigarette smoking

Question 14

what modifiable risk factor will increase your risk for Atherosclerosis by 200%?

Answer 14

smoking one pack of cigarettes a day

Question 15

what are the steps involved in the “Response-to-injury” hypothesis for atherosclerosis?

Answer 15

1) endothelial cell injury
2) accumulation of lipoproteins
3) monocyte adhesion

Question 16

what are the common sites for atheroma formations?

Answer 16

1. Major arterial branch points
2. Abdominal aorta
3. Coronary arteries
4. Popliteal arteries
5. Carotid arteries
6. Cerebral arteries

Question 17

atheroma plaques contain what substances?

Answer 17

plaques contain collagen, lipid, myofibroblasts, macrophages, neovascularization.

Question 18

during atheroma formation, a fibrous cap, composed of __________ and ________, develops over a central core of lipid/cellular debris with cholesterol

Answer 18

smooth muscle cells (myofibroblasts) and collagen

Question 19

Progressive changes in atheroma plaques include:

hint: theres 6 of them

Answer 19

1) ulceration
2) fissure formation
3) thrombosis
4) embolization (thrombus or debris from the central core)
5) calcification
6) hemorrhage into the plaque from neovascularization

Question 20

Fatty streaks appear in atherosclerosis involving __________, and is independent of geography, gender, race and environment

Answer 20

children

Question 21

T/F: Fatty streaks will form in almost any location, regardless of if that location is prone to atheroma formation

Answer 21

True

Question 22

T/F: fatty streaks signal the start of atheromas formation

Answer 22

False

not all atheroma formations will start as fatty streaks
- its a possible step in formation, but not always present

Question 23

what complications are associated with atherosclerosis?

theres 5

Answer 23

Ischemic heart disease (MI)
Cerebral infarct (stroke)
Gangrene
Renal artery stenosis (narrowing)
Aortic aneurysm (dilation/bulge)

Question 24

what is mild hypertension?

what is mild to severe hypertension?

Answer 24

Mild: BP between 140/90 - 159/104 mmHg

Moderate – severe: BP greater than 160/106 mmHg

Question 25

Hypertension affects approximately _____% of the US population

Answer 25

25%

Question 26

the "peak death rate" for Myocardial infarctions (heart attacks) was ______% in the 1960s

Answer 26

54%

Question 27

what is the current death rate for all atherosclerosis-related complications ?

Answer 27

50%

Question 28

___________ hypertension Accounts for 90% or more of all hypertension

Answer 28

essential hypertension

Question 29

Contributing factors for hypertension include:

Answer 29

``` genetics stress obesity increased salt intake inactivity cigarette smoking ```

Question 30

what are the symptoms of low, and moderate, hypertension?

Answer 30

NO SYMPTOMS

Question 31

name the symptoms of severe hypertension:

Answer 31

Headache Fatigue Dizziness Palpitations

Question 32

what is "essential hypertension"

Answer 32

hypertension that has no identifiable cause

Question 33

what are the FOUR factors involved in the pathogenesis of ESSENTIAL hypertension?

Answer 33

a) Peripheral vascular resistance (vasoconstriction) b) hereditary factors c) Reduced sodium excretion → salt and water retention→ increased plasma volume and cardiac output d) environmental factors

Question 34

what are the COMPLICATIONS of hypertension? | theres 6 of them

Answer 34

1) Concentric left ventricular hypertrophy (LVH) 2) LVH + ventricular dilation 3) Atherosclerosis and arteriolosclerosis 4) Retinal injury 5) Nephrosclerosis 6) Dissecting hematoma of the aorta

Question 35

which complication of hypertension, if "decompensated", can lead to coronary heart failure (CHF)?

Answer 35

LVH + ventricular dilation | LVH = left ventricular hypertrophy

Question 36

what occurs during decompensated hypertensive heart disease?

Answer 36

- hypertrophy no longer adequate to provide normal cardiac output due to decreased myocardial contractility - results in left ventricle dilation and gradual onset of CHF

Question 37

what are the characteristics of "Concentric Hypertrophy"?

Answer 37

- Thickening of the left ventricular wall at the expense of the left ventricular chamber - little or no increase in the outside cardiac dimensions. (heart increases muscle mass at the expense of chamber volume)

Question 38

name the characteristics of Accelerated (Malignant) Hypertension:

Answer 38

- Relatively rapid onset - Often superimposed on previous hypertension - Very high systolic and diastolic pressures

Question 39

the complications of accelerated (malignant) hypertension include:

Answer 39

``` cerebral edema papilledema encephalopathy renal failure cerebral hemorrhage ```

Question 40

the thickness of what structure will determine if it is a vulnerable plaque or a stable plaque?

Answer 40

the fibrous cap - it surrounds the lipid core of the plaque thick cap = stable thin cap = vulnerable

Question 41

what are the PRE-clinical phases of plaque formation?

Answer 41

1) normal artery 2) fatty streak (may not be part of progression) 3) Fibrofatty plaque 4) Advanced/vulnerable plaque

Question 42

what differentiates a foam cell from a macrophage?

Answer 42

foam cells are macrophages that have become engorged with lipoproteins (cholesterol)

Question 43

during atherosclerosis progression, what happens once monocytes adhere to the lipoprotein deposits?

Answer 43

- migration into intima | - differentiation into macrophages and “foam cells” (macrophages that have ingested lipid)

Question 44

what are the lipoproteins that adhere to the vessel walls following endothelial injury?

Answer 44

LDL and cholesterol