CVD Flashcards
For embolic strokes, the most
important risk factors are structural cardiac disease and
arrhythmias, mostly atrial fibrillation, which increases
the incidence of stroke about _____, and by 18-fold if, as
was common in the past, there is also ______
6-fold
rheumatic valvular
disease
____ hastens the atherosclerotic process in both
large and small arteries
Diabetes
As in the case of coronary artery disease, the level
of ________cholesterol has the most
impact on the incidence of stroke but elevated triglycerides may also confer risk.
low-density lipoprotein (LDL)
Subsidiary factors, such as low
______________,
are associated with an increased stroke rate in several
studies, including one in which we participated, but the
mechanism of this effect is obscure
potassium intake and reduced serum levels of potassium
Chromosomal abn associated with stroke and has putative connections with vascular dse
Chromosome 12
Atheromatous plaques preferentially form at branching
points and curves of the cerebral arteries.
The most frequent sites are
(1) in the ________at its origin from the common carotid; (2) in the ___________ and at their junction to form the basilar artery;
(3) in the stem or at the main bifurcation of the ______
(4) in the ____________ as they wind around the midbrain; and
(5) in the proximal anterior cerebral arteries as they pass anteriorly and curve over the corpus callosum
internal carotid arteries
cervical part of the vertebral arteries
middle cerebral arteries;
proximal posterior cerebral arteries
an atherothrombotic lesion in a proximal vessel may
serve as the nidus for the formation of an embolus that
manifests itself as a stroke in one of the territories of that
vessel-called__________ embolism
“artery-to-artery”
it is the high degree of stenosis, usually above ______ percent of the original lumen compromised, or a residual lumen of less than approximately ______mm, of the carotid artery that
is most likely to be associated with strokes in the distal
territory of the vessel.
90
2
________infarction nearly always
indicates embolism (although venous occlusion can do
the same)
hemorrhagic
In CE stroke, Any region of the brain may be affected, the
territories of the middle cerebral artery, particularly the
________ division, being most frequently involved
superior
According to the Framingham Heart Study, patients
with chronic atrial fibrillation are approximately_______ times more liable to stroke than an age-matched population with normal cardiac rhythm
six
the risk for stroke conferred by the presence
of atrial fibrillation varies with age, being 1 percent per
year in persons younger than age 65 years, and as high
as_______ percent per year in those older than age 75 years
with additional risk factors
8
Cardiac catheterization or surgery,
especially _________, may disseminate fragments
from a thrombus or a calcified valve
valvuloplasty
as many as 38 percent of a group of
patients with no discernible cause for embolic stroke had
echogenic atherosclerotic plaques in the ____________________ a size found to be
associated on a statistical basis with strokes.
aortic arch that
were greater than 4 mm in thickness,
This ___________ syndrome is most evident in cases of posterior cerebral artery occlusion, either from a cardiagenic source or from a thrombus in the proximal vertebral artery
migrating or traveling embolus
_______ occurs when an abnormal communication
exists between the right and left sides of
the heart (particularly a patent foramen ovale [PFO])
or the alternative route of connection via a pulmonary
arteriovenous fistula
Paradoxical embolism
_______ (often from previous pulmonary embolism) favors the occurrence of paradoxic embolism, but these strokes occur even in the absence of pulmonary
hypertension.
Pulmonary hypertension
the risk of second stroke was 2 percent in those with
a PFO alone and 15 percent among those with both a
PFO and an _________
atrial septal aneurysm
T or F
about one-third of patients in all age
groups will be found to have a PFO, and anticoagulation
or repair of these lesions in older patients with embolic
stroke has not been shown to be beneficial
T
Usually, when valvular prolapse is associated
with stroke, it is usually ___________and a propensity to accumulate clot behind the
valve.
severe with ballooning of the
valve
The ________ are a potential, if infrequent, source
of cerebral emboli, as reflected by the occurrence of cerebral abscesses in association with pulmonary infectious
disease
pulmonary veins
In _________, pulmonary shunts serve as a conduit for
emboli
Osler-Weber Rendu disease
A rare type of embolism follows thyroidectomy,
where thrombosis in the stump of the ___________ extends proximally until a section of the clot, protruding into the lumen of the carotid artery; is carried into the cerebral circulation
superior thyroid
artery
tumor embolism with stroke is known from_______ and _______, and occasionally with other tumors, even systemic ones
cardiac myxoma and fibroelastoma
______________
is a rare complication of abortion, scuba diving, or
cranial, cervical, or thoracic operations involving large
venous structures or venous catheter insertion;
Cerebral air embolism
brief, reversible episodes of focal ischemic brain disturbance without evidence of cerebral infarction
TIA
Approximately _________percent of infarcts that
follow TIAs occur within a month after the first attack,
and approximately 50 percent within a year
20
the occurrence of
carotid TIAs is a predictor not only of cerebral infarction
but also of ________
myocardial infarction.
visual episodes evolve
swiftly; over 5 to 30 s, and are described as a horizontal
shade falling (or rising) smoothly over the visual field
until the eye is completely but painlessly blind.
transient monocular
blindness (also called amaurosis fugax or TMB)
escalating episodes
of weakness in the face, arm, and leg and culminating
in a capsular lacunar stroke.
“capsular warning syndrome
Embolization of _______ from atherosclerotic sites indeed may be the cause of attacks in some cases, but it is difficult to understand how attacks of identical pattern could
be caused by successive emboli from a distance that
enter the same arterial branch each time.
fibrin-platelet material
Restated, a single transitory episode, especially
if it lasts longer than 1 h, and m ultiple episodes of diff erent pattern, suggest ___________ and must be distinguished from brief (2- to 1 0-min) recurrent attacks of the same clinical pattern, which s uggest TIAs from ________
embolism
atherosclerosis and thrombosis in a large vessel.
exercise and postural TIAs, when they do occur, are particularly suggestive of stenosis of
aortic branches, as occurs in _______
Takayasu disease
hemodynamic changes in the retinal or cerebral circulation make their appearance when the lumen of the internal carotid artery is reduced to \_\_\_\_\_\_\_\_\_\_ mm or less (normal diameter, 7.0 mm; range, 5 to 10 mm, lower part of this range in women).
2.0
___________have been recorded
in 10 to 15 percent of patients with vertebrobasilar
insufficiency
drop attacks
Cerebral infarction basically comprises two pathophysiologic processes:
one, a loss of the supply of _____________, and the
other, an array of changes in cellular metabolism consequent to the collapse of energy-producing processes, ultimately with disintegration of cell structures and their membranes, a process subsumed under the term _______
oxygen
and glucose secondary to vascular occlusion
necrosis.
Implicit in discussions of ischemic stroke and its treatment
is the existence of a ________zone that is marginally
perfused and contains at-risk but viable neurons
“penumbra”
Over a range of mean
blood pressures of approximately _________, the
small pial vessels are able to dilate and to constrict in
order to maintain cerebral blood flow (CBF) in a relatively
narrow range.
50 to 150 mm Hg
critical level for infarction for CBF
critical level was 23 mL/ 100 g/ min (normal is 55);
Reduction of CBF below 10 to 12 mL / 100 g/min causes infarction, almost regardless of its duration.
In the region of marginal perfusion, the _______ level increases (as a result of efflux from injured depolarized cells) and _________ and ________ are depleted
K
adenosine triphosphate (ATP) and creatine phosphate
A CBF of 6 to 8 mL/ 100 g/min causes marked
1.
2.
3.
invariably leading to histologic signs of necrosis
ATP depletion, increase in extracellular K, increase in intracellular Ca, and cellular acidosis,
After _______min of anoxia,
there was irreversible damage, reflected by an inability
of the tissue to utilize glucose and to synthesize protein
30
A reduction of even ________ (3.6 to 5.4°F) reduces the metabolic requirements of neurons and increases their tolerance to hypoxia by 25 to 30 percent.
2 to 3°C
These neurotransmitters,
released by ischemic cells, excite neurons and produce
an intracellular influx of Na and Ca
Glutamate and aspartate
Involved in the process of thrombosis are changes in a
number of natural anticoagulant factors such as
1.
2.
3.
4.
heparin cofactor 2, antithrombin III, protein C, and protein S.
________ is a vitamin K-dependent
protease that, in combination with its cofactors protein S
and antithrombin III, inhibits coagulation
Protein C
_______depicts the “time of flight” of blood through vessels
and is not as accurate as CT angiography in measuring
the degree and morphology of changes within a
cerebral or intracranial vessel
MRA
___________which demonstrate atheromatous plaques and stenoses of large vessels, particularly of the carotid but also of the vertebrobasilar arteries
CDS
a bruit at the angle of the jaw is caused by stenosis at
the origin of the____________ or is a radiated
murmur from the aortic valve and can then be misleading
external carotid artery
