Effects of Systemic Disease on CVS Flashcards

1
Q

Identify some systemic diseases which affect the CVS.

A
– Diabetes mellitus
– Hypertension
– Chronic obstructive pulmonary disease 
– Amyloidosis
– Rheumatoid arthritis
– Vasculitides & SLE
– Thyroid disease
– Sarcoidosis
– Nutrition
– Drugs
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2
Q

Explain how diabetes mellitus affects the CVS.

A

“Hyperglycemia causes glycation of virtually all proteins, inducing collagen cross-linking with other extracellular matrix proteins in the arterial wall. Long-term exposure to elevated glucose levels alone can cause the endothelial cell dysfunction observed in diabetes (because instead of a carefully regulated protein sugar water gel, glucose molecules change the charge, changing the amount of water BM will allow) “

  • In the glomerulus, this means that the BM will not act as a good filter and will leak, so proteins will leak out (proteinuria)
  • If this happens in small vessels or eye, or brain, capillary thickens and becomes less efficient at letting the right things through and preventing the wrong things through
  • If microvessel damage occurs in the aorta, ichaemia to wall of aorta may occur, promoting ulceration and genesis of atheroma)
  • Similarly, if microvessel damage occur to the blood supply of a nerve, neuropathy may occur

-Besides the problem of glycation, it also seems that “elevated oxidative stress (associated with diabetes) can cause CV effects. Many diabetes-associated metabolic disorders are associated with this oxidative stress, including hyperglycemia, hypertriglyceridemia, hypercholesterolemia, hypoalphalipoproteinemia, and increased levels of advanced glycation end products, glycated and oxidized lipoproteins”

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3
Q

What are type I and II diabetes ? How are they treated ?

A

TYPE 1:

  • Destroy islet cells (autoimmune) which produce insulin
  • Treated with insulin

TYPE 2:

  • Insulin resistance
  • Treated with anti-hyperglycaemic (not insulin usually)
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4
Q

How can we measure long-term sugar consumption in a diabetic patient ?

A

Using non-enzymatic glycolsylation of haemoglobin (since half life of haemoglobin is 60 days)
Poor diabetic control would be shown through elevated glycated haemoglobin

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5
Q

Define glycation.

A

The nonenzymatic covalent bonding of a sugar molecule to another molecule, especially a protein.

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6
Q

Explain how hypertension affects the CVS.

A
  • “The increased workload caused by hypertension leads to compensatory left ventricular hypertrophy. The left ventricular free walls and interventricular septum become thickened
  • Hypertension also is associated with more severe coronary artery atherosclerosis.”
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7
Q

Explain how familial hyperlipideamia affects the CVS.

A

Promotes atherosclerosis (can result in thrombus, emboli) which affects heart and coronary arteries (may well present with MI for a relatively young person).

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8
Q

Explain how COPD (and specifically emphysema) affects the CVS.

A

Through “abnormal cell repair, increased airway inflammation, oxidative stress and extracellular matrix destruction”.

In the case of emphysema, resistance increases due to the joining of separate blood vessels (due to damage to some), decrease the number of parallel circuits we have. As a result, ability to oxygenate blood decrease. This may also result in pulmonary hypertension, which causes an enlargement of the RV.

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9
Q

Explain how pulmonary hypertension arises, and how it affects the CVS.

A

As a result of chronic lung disease (e.g. acute emphysema, recurrent pulmonary emboli, chronic bronchitis) or mitral stenosis or L ventricular failure
Causes an enlargement of the RV and possibly cor pulmonale (i.e. R sided heart failure)

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10
Q

Define Amyloidosis. What are its causes ?

A

Progressive, incurable, metabolic disease characterized by abnormal deposits of protein in one or more organs or body systems (can either by AA amyloid or AL amyloid which accumulates between cells and starves them).

AA amyloid accumulation is caused by conditions with chronic inflammation (osteomyelitis, rheumatoid disease) since it is produced in acute phase response.
AL amyloid accumulation is caused by myeloma

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11
Q

Explain how amyloidosis affects the CVS.

A

-Amyloidosis impairs function of the organ it is deposited in.
-For instance, if this affects the kidney, or in brain, or aorta, it will be more difficulty to get
nourishment to those cells
-Heart failure and nephrotic syndrome are common complications

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12
Q

What are other names for AL and AA amyloid ?

A
AA amyloid (i.e. secondary amyloidosis) 
AL amyloid (i.e. Amyloid light-chain, primary amyloidosis)
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13
Q

Is the structure of the amyloid normal in amyloidosis ?

A

No, in such cases, it forms a beta pleated sheet (abnormal structure)

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14
Q

Which cells are AL and AA amyloid produced by ?

A

AA - production by liver is stimulated by secretion of cytokines by chronic inflammatory cells
AL - produced by neoplastic plasma cells

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15
Q

Explain how R. arthritis affects the CVS.

A

1) It is a cause of AA amyloidosis
2) In addition to this, other reasons

Overall, R. arthritis is associated with increased mortality from CV disease

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16
Q

Define vasculitides.

A

Inflammatory diseases affecting vessels, caused by various immunological processes and possibly triggered by infectious agents.

17
Q

Explain how vasculitides affect the CVS.

A
  • Cause fibrinoid necrosis with accelerated phase hypertension.
  • Also causes infarction of small blood vessels.

These damages can affect vessels in the kidney, heart, brain, so vasculitis can cause presentation of heart disease with lung disease with kidney disease…

18
Q

Explain how thyroid disease affect the CVS.

A

Hypothyroidism patients are at increased risk of heart failure.

19
Q

Define Sarcoidosis. Where does it typically form ?

A

Type IV hypersensitivity disease affecting many organs which involves a strong T cell response and the development of granulomas.
Typically forms in the lung.

20
Q

Explain how sarcoidosis leads to CV disease.

A

Sarcoidosis typically forms in the lung (may lead to pulmonary hypertension) but rarely may also directly form in the heart (e.g. can muck up AV node and block signaling, causing arrhythmias)

21
Q

Explain how nutrition leads to CV disease.

A

Vitamin deficiency damages the heart

22
Q

Identify drugs which can have CVS effects.

A
  • Anticancer
  • Immunosuppressive
  • Diabetogenic
  • Anti-inflammatory
23
Q

Why do anti-inflammatory drugs increase CV-related deaths ?

A

Because of prostaglandin inhibition

24
Q

True or False: You should always think about differential (rather than just the one diagnosis) in CVS disease. i.e. Is there an underlying cause we also need to treat ?

A

True